Article

Uterine artery embolization versus myomectomy: a multicenter comparative study

February 2006
Fertility and Sterility 85(1):14-21

DOI:10.1016/j.fertnstert.2005.05.074

Source
PubMed

Authors:

Scott C Goodwin

University of California, Irvine

Linda D Bradley

Cleveland Clinic

Elizabeth A Stewart

Mayo Foundation for Medical Education and Research

Show all 9 authorsHide

To determine whether there is significant quality of life score improvement after uterine artery embolization (UAE) and to compare UAE and myomectomy outcomes. Prospective cohort controlled study. Sixteen medical centers in the United States. One hundred forty-nine UAE patients and 60 myomectomy patients. Patients were assigned to myomectomy or UAE on the basis of a best treatment decision made by the patient and her physician. All patients were observed for 6 months. The UAE patients also had follow-up examinations at 1 year. Myomectomy or UAE. Quality of life score changes, menstrual bleeding score changes, uterine size differences, time off, and adverse events. Both groups experienced statistically significant improvements in the uterine fibroid quality of life score, menstrual bleeding, uterine volume, and overall postoperative quality of life. The mean hospital stay was 1 day for the UAE patients, compared with 2.5 days for the myomectomy patients. The UAE and myomectomy patients returned to their normal activities in 15 days and 44 days, respectively, and returned to work in 10 days and 37 days, respectively. At least one adverse event occurred in 40.1% of the myomectomy patients, compared with 22.1% in the UAE group. The uterine fibroid quality of life score was significantly improved in both groups. No significant differences were observed in bleeding improvement, uterine volume reduction, uterine fibroid quality of life score improvement, and overall quality of life score improvement between groups. Patients receiving UAE required fewer days off work, fewer hospital days, and experienced fewer adverse events.

Evaluating Treatment Options for Symptomatic Uterine Fibroids: A Systematic Review and Meta-analysis of Effectiveness, Recovery, and Long-Term Outcomes (MARIE WP1)

Preprint

Full-text available

Feb 2025

Background: Uterine fibroids can significantly impair the quality of life of women. While most fibroids remain asymptomatic, 25% of women diagnosed with uterine fibroids require medical intervention. Methods: A systematic review and meta-analysis protocol was developed and published in PROSPERO (CRD42022346251) to explore surgical treatment outcomes linked to uterine fibroids. Data was gathered using PubMed, Web of Science and ScienceDirect. The pooled data was analysed using the meta-package (version 8.0-1 and version 4.6-0) in R software (version 4.4.2). Results: Five studies met the eligibility criteria, and were further analysed to report quality of life, symptom severity and complications linked to surgery. Three studies (n=520) assessed HRQoL via UFS-QoL pre- and post-uterine artery embolisation and myomectomy. The pooled mean difference was -6.99 (95% CI: [-16.49, 2.51]; I²=71.9%; P=0.03), indicating no significant difference in quality of life impact between procedures. However, the pooled mean difference for UFS-QoL symptom severity was 4.85 (95% CI: [0.50, 9.21]; I²=0.0%; P=0.52), suggesting myomectomy significantly reduces symptom severity compared to uterine artery embolisation. Most studies did not report race and ethnicity, and the study sample was not representative of the global female populous. Conclusion: Uterine artery embolisation and myomectomy result in comparable improvements in health-related quality of life although myomectomy appears to offer a greater reduction in symptom severity compared to uterine artery embolisation. These findings can assist clinicians and patients make improved shared decisions when selecting the most appropriate treatment for uterine fibroids. Improved research study designs and representation in sample need to be considered when conducting future research.

Systematic review and meta-analysis of current evidence in uterine artery embolization vs myomectomy for symptomatic uterine fibroids

Article

Full-text available

Aug 2024

This review compares the efficacy of Uterine Artery Embolization (UAE) and Myomectomy (MYO) in managing symptomatic Uterine Fibroids (UFs) in women who do not want hysterectomy. A meta-analysis was performed on all available studies that evaluated the relative benefits and harms of MYO and UEA for the management of patients suffering from UFs. Outcomes evaluated reintervention, UFs scores for quality of life (QOL) and symptom severity, and other complications. To determine mean differences (MDs) or odds ratios (ORs) with 95% confidence intervals (CIs), a random or fixed-effects model was utilized. A meta-analysis of 13 studies (9 observational and 4 randomized controlled trials) was conducted. The results indicated that UAE had a higher reintervention rate (OR 1.84; 95% CI 1.62–2.10; P < 0.01; I² = 39%), hysterectomy rate (OR 4.04; 95% CI 3.45–4.72; P < 0.01; I² = 59%), and symptom-severity score (OR − 4.02; 95% CI 0.82, 7.22; P = 0.01; I² = 0%) compared to MYO at a four-year follow-up. However, UAE was associated with a lower rate of early complications (OR 0.44; 95% CI 0.20–0.95; P = 0.04; I² = 25%), and readmission rate (OR 1.16; 95% CI 1.01–1.33; P = 0.04; I² = 0%) compared to MYO. Furthermore, both procedures had comparable improvement in pregnancy rates and abnormal uterine bleeding. In conclusion, UAE and MYO are effective in treating symptomatic UFs but they have different outcomes. The decision on which procedure to choose should be made based on individual preferences and the physician’s expertise.

Comparison of Recurrence and Quality of Life Between Myoma Embolization and Myomectomy

Research

Full-text available

May 2023

Introduction: Uterine myomas represent the most frequently diagnosed tumors among women of childbearing age. Symptoms often include profuse menstrual bleeding, diminished quality of life, and in some cases, infertility. The size and position of the fibroids typically influence the condition's manifestations. Moreover, symptomatology often varies depending on the fibroids' location. This investigation aimed to discern if there exists a significant correlation between life quality, reoccurrence rate, quality of life, and recurrence levels among patients who have undergone myomectomy and uterine fibroid embolization, respectively. Methodology: A retrospective cross-sectional study was conducted to compare the rates of recurrence and impacts on life quality between uterine fibroid embolization and myomectomy in women diagnosed with uterine myomas. Data were collected from 152 women who sought treatment at the Obstetrics and Gynecology clinic and also the Interventional Radiology clinic between January 2009 and January 2021. Thirteen participants were excluded due to the inability to maintain contact. The trial encompassed 76 patients who underwent myomectomy and 63 who had uterine fibroid embolization. In both groups, the life quality of 50 patients, five years postsurgery, was assessed using the UFS-QOL measure. Eligible participants were females between 20 and 40 years, with symptomatic Type 3-5 fibroids as per the FIGO classification, and with no comorbidities. Individuals under 20 or over 40 years, or those with fibroids classified as FIGO types 1,2,6,7,8, were not included. Other exclusion criteria included pregnancy status, abnormal endometrial biopsy results, abnormal smear tests, polyps, cancer, adenomyosis and coagulation disorders. Results: The recurrence of fibroids was identified through symptomatology and diagnostic radiological methods. The recurrence rate was found to be 31.6% (n=24) for myomectomy patients and 14.3% (n=9) for those who underwent uterine fibroid embolization, with no statistically significant difference between the two groups (p > 0.05). The group subjected to myomectomy exhibited fewer symptoms, lower anxiety, and better physical mood scores. The myomectomy group displayed higher average anxiety scores (p<0.01). There were no significant disparities in control, consciousness, sexual function, or overall scores between the two groups. Symptoms and anxiety saw a marked reduction in the first postoperative year compared to the preoperative period (p<0.01). Compared to presurgery, energy, mood, awareness, and sexual function exhibited significant improvements in the first and fifth postoperative years (p<0.01). Conclusions: Our findings suggest a nonsignificant recurrence rate in the myomectomy group compared to the uterine artery embolization group. Notably, the decrease in symptom occurrence and anxiety following myomectomy was significantly favorable in terms of quality of life. While embolization was offered as a therapeutic option, myomectomy yielded more favorable results concerning quality of life.

Uterine artery embolization (UAE) compared with myomectomy for the management of uterine fibroids: a systematic review and meta-analysis

Preprint

Jun 2022

Background Uterine artery embolization (UAE) and myomectomy are uterus-sparing treatments for uterine fibroids. Each carries a different risk and efficacy profile. Despite this there is a lack of direct comparison between the two techniques making treatment choice decisions difficult. Objectives To compare the therapeutic efficacy and complications of UAE versus myomectomy. Search strategy A systematic search of The Cochrane Library, Medline, and EMBASE databases was conducted using a pre-defined search strategy. The review was prospectively registered on PROSPERO (CRD42021259347). Selection Criteria All randomised controlled trials and cohort studies published between January 1995 and August 2021 directly comparing UAE and myomectomy were included. Data Collection and Analysis Meta-synthesis of raw data was performed using Review Manager 5.4.1 from the Cochrane Collaboration. A pooled estimate of efficacy was established using a fixed-effect model. Main results 8 studies were identified. UAE was associated with lower complication rates (OR 0.56; 95% CI 0.40-0.79), increased improvement in bleeding (OR 1.61 95% CI 1.07-2.43) and a shorter total recovery time (7.72 days versus 36.63 days). Whilst myomectomy was associated with a higher post-procedure quality of life (mean difference -10.56; 95% CI -15.34 - -5.79) and lower re-intervention rate (OR 5.16; 95% CI 2.41-11.04). No significant difference in procedural failure rate was seen (OR 0.67; 95% CI 0.30-1.50). Given concerns with UAE and future fertility limited post-procedure fertility outcomes were identified. Conclusions: Given differences in efficacy profiles a personalised approach to treatment discussions should be maintained. Funding: None Keywords: Uterine artery embolization, myomectomy, uterine fibroid

Innovative and conventional “conservative” technologies for the treatment of uterine fibroids in Italy: a multidimensional assessment

Article

Full-text available

Mar 2022

Background To evaluate the potential benefits of the Magnetic Resonance-guided high intensity Focused Ultrasound (MRgFUS) introduction in the clinical practice, for the treatment of uterine fibroids, in comparison with the standard “conservative” procedures, devoted to women who wish to preserve their uterus or enhance fertility: myomectomy and uterine artery embolization (UAE). Methods A Health Technology Assessment was conducted, assuming the payer’s perspective (Italian National Healthcare Service). The nine EUnetHTA Core Model dimensions were deeply investigated, by means of i) a literature review; ii) the implementation of health economics tools (useful for uterine fibroids patients’ clinical pathway economic evaluation, and budget impact analysis), to define MRgFUS economic and organizational sustainability, and iii) administration of specific questionnaires filled by uterine fibroids’ experts, to gather their perceptions on the three possible conservative approaches (MRgFUS, UAE and myomectomy). Results Literature revealed that MRgFUS would generate several benefits, from a safety and an efficacy profile, with significant improvement in symptoms relief. Advantages emerged concerning the patients’ perspective, thus leading to a decrease both in the length of hospital stay (p-value< 0.001), and in patients’ productivity loss (p-value = 0.024). From an economic point of view, the Italian NHS would present an economic saving of − 6.42%. A positive organizational and equity impact emerged regarding the capability to treat a larger number of women, thus performing, on average, 131.852 additional DRGs. Conclusions Results suggest that MRgFUS could be considered an advantageous technological alternative to adopt within the target population affected by uterine fibroids, demonstrating its economic and organisational feasibility and sustainability, with consequent social benefits.

Intermediate and long-term outcomes following uterine artery fibroid embolization

Article

May 2015

Duration of Sick Leave, Patient's Postoperative Satisfaction and Impairment of Daily Living after Open Abdominal Myoma Enucleation in Dependence on Myoma Size

Article

May 2015

Purpose: What is the average duration of sick leave and the postoperative impairment to daily living in dependence on the size of the removed myoma? Does patient satisfaction depend on the size of the removed myoma? Is there a difference in the rate of improvement of symptoms depending on the size of the myoma? Patient Collective: This is a retrospective survey of the data of 377 consecutive female patients treated for symptomatic uterus myomatosus by open abdominal myoma enucleation between 2/2002 and 12/2009; the number of removed myomas, myoma size and localisation, myoma-associated complaints, length of sick leave, postoperative impairments of daily living and scar length were assessed. Results: The response rate amounted to 61 % (230/377 patients). The average sick leave of patients with a myoma diameter ≥ 10 cm was 1.5 days shorter than that for patients with myomas < 10 cm. Depending on the symptoms between 7 and 75 % of the patients reported an improvement of their complaints. For those patients with myomas > 10 cm the proportion with an improvement in symptoms was smaller than that for the patients with smaller myomas - exception "feeling of pressure in the bladder". Conclusions: Even for relatively large myomas, the quality of life is not impaired more strongly or for longer periods than that after removal of smaller myomas. Activities of daily life are impaired for about 4 weeks.

Quality Improvement Guidelines for Uterine Artery Embolization for Symptomatic Leiomyomata

Article

Nov 2014

The membership of the Society of Interventional Radiology (SIR) Standards of Practice Committee represents experts in a broad spectrum of interventional procedures from both the private and academic sectors of medicine. Generally, Standards of Practice Committee members dedicate the vast majority of their professional time to performing interventional procedures; as such, they represent a valid broad expert constituency of the subject matter under consideration for standards production. Technical documents specifying the exact consensus and literature review methodologies as well as the institutional affiliations and professional credentials of the authors of this document are available upon request from SIR, 3975 Fair Ridge Dr., Suite 400 N., Fairfax, VA 22033.

Cost-effectiveness of uterine-preserving procedures for the treatment of uterine fibroid symptoms in the USA

Article

May 2014

Objective: To evaluate the cost-effectiveness of the following three treatments of uterine fibroids in a population of premenopausal women who wish to preserve their uteri: myomectomy, magnetic resonance-guided focused ultrasound (MRgFUS) and uterine artery embolization (UAE). Materials & methods: A decision analytic Markov model was constructed. Cost-effectiveness was calculated in terms of US

per quality-adjusted life year (QALY) over 5 years. Two types of costs were calculated: direct costs only, and the sum of direct and indirect (productivity) costs. Women in the hypothetical cohort were assessed for treatment type eligibility, were treated based on eligibility, and experienced adequate or inadequate symptom relief. Additional treatment (myomectomy) occurred for inadequate symptom relief or recurrence. Sensitivity analysis was conducted to evaluate uncertainty in the model parameters. Results: In the base case, myomectomy, MRgFUS and UAE had the following combinations of mean cost and mean QALYs, respectively: US

15,459, 3.957; US

15,274, 3.953; and US

18,653, 3.943. When incorporating productivity costs, MRgFUS incurred a mean cost of US

21,232; myomectomy US

22,599; and UAE US

22,819. Using probabilistic sensitivity analysis (PSA) and excluding productivity costs, myomectomy was cost effective at almost every decision threshold. Using PSA and incorporating productivity costs, myomectomy was cost effective at decision thresholds above US

105,000/QALY; MRgFUS was cost effective between US

30,000 and US

105,000/QALY; and UAE was cost effective below US$30,000/QALY. Conclusion: Myomectomy, MRgFUS, and UAE were similarly effective in terms of QALYs gained. Depending on assumptions about costs and willingness to pay for additional QALYs, all three treatments can be deemed cost effective in a 5-year time frame.

The role of VEGF and TGF-β blood levels for fibroid shrinkage, menorrhagia score, and quality of life improvement after uterine artery embolization for uterine fibroids: a study protocol

Article

Full-text available

Aug 2024

Uterine leiomyoma is a common condition affecting women that occurs in more than 70% of females. Women with leiomyomas overall have lower quality of life and deficiency in many specific spheres of life including work-related productivity, sexuality, relationships, social–emotional health, and physical well-being that might be present even in pre-and extended throughout early postmenopausal life. Choices for symptomatic fibroid management include medical, interventional radiology procedures, surgical, and expectant management. The uterine artery embolization (UAE) procedure has gained justified popularity for myoma management. Growth factors, vascular endothelial growth factor (VEGF) and tumor growth factor β (TGF-β), hold an important role in leiomyoma progression. However, blood levels of VEGF and TGF-β in patients before and after UAE are not fully investigated and the possible relationship with myoma shrinkage has not been evaluated. Therefore, this study aims to assess menorrhagia score and quality of life improvement after UAE for uterine fibroids and compare blood levels of VEGF and TGF-β in patients with uterine leiomyoma before and after UAE. This cross-sectional study will be performed at the University Medical Center, Astana, Kazakhstan. Women undergoing the UAE procedure for uterine leiomyoma will be involved in the study following the precisely defined inclusion/exclusion criteria. Uterine leiomyoma nodules’ structural changes after UAE will be assessed along with the blood levels of growth factors (VEGF and TGF-β), menorrhagia score, and quality of life. An important outcome of this project will be an investigation of the blood levels of growth factors (VEGF and TGF-β) before and after the procedure and their association with leiomyoma shrinkage in correlation with the menorrhagia score and quality of life alterations among patients undergoing UAE.

Uterine artery embolisation versus myomectomy for premenopausal women with uterine fibroids wishing to avoid hysterectomy: The FEMME RCT

Article

Full-text available

Apr 2022

Background Uterine fibroids are the most common tumour in women of reproductive age and are associated with heavy menstrual bleeding, abdominal discomfort, subfertility and reduced quality of life. For women wishing to retain their uterus and who do not respond to medical treatment, myomectomy and uterine artery embolisation are therapeutic options. Objectives We examined the clinical effectiveness and cost-effectiveness of uterine artery embolisation compared with myomectomy in the treatment of symptomatic fibroids. Design A multicentre, open, randomised trial with a parallel economic evaluation. Setting Twenty-nine UK hospitals. Participants Premenopausal women who had symptomatic uterine fibroids amenable to myomectomy or uterine artery embolisation were recruited. Women were excluded if they had significant adenomyosis, any malignancy or pelvic inflammatory disease or if they had already had a previous open myomectomy or uterine artery embolisation. Interventions Participants were randomised to myomectomy or embolisation in a 1 : 1 ratio using a minimisation algorithm. Myomectomy could be open abdominal, laparoscopic or hysteroscopic. Embolisation of the uterine arteries was performed under fluoroscopic guidance. Main outcome measures The primary outcome was the Uterine Fibroid Symptom Quality of Life questionnaire (with scores ranging from 0 to 100 and a higher score indicating better quality of life) at 2 years, adjusted for baseline score. The economic evaluation estimated quality-adjusted life-years (derived from EuroQol-5 Dimensions, three-level version, and costs from the NHS perspective). Results A total of 254 women were randomised – 127 to myomectomy (105 underwent myomectomy) and 127 to uterine artery embolisation (98 underwent embolisation). Information on the primary outcome at 2 years was available for 81% ( n = 206) of women. Primary outcome scores at 2 years were 84.6 (standard deviation 21.5) in the myomectomy group and 80.0 (standard deviation 22.0) in the uterine artery embolisation group (intention-to-treat complete-case analysis mean adjusted difference 8.0, 95% confidence interval 1.8 to 14.1, p = 0.01; mean adjusted difference using multiple imputation for missing responses 6.5, 95% confidence interval 1.1 to 11.9). The mean difference in the primary outcome at the 4-year follow-up time point was 5.0 (95% CI –1.4 to 11.5; p = 0.13) in favour of myomectomy. Perioperative and postoperative complications from all initial procedures occurred in similar percentages of women in both groups (29% in the myomectomy group vs. 24% in the UAE group). Twelve women in the uterine embolisation group and six women in the myomectomy group reported pregnancies over 4 years, resulting in seven and five live births, respectively (hazard ratio 0.48, 95% confidence interval 0.18 to 1.28). Over a 2-year time horizon, uterine artery embolisation was associated with higher costs than myomectomy (mean cost £7958, 95% confidence interval £6304 to £9612, vs. mean cost £7314, 95% confidence interval £5854 to £8773), but with fewer quality-adjusted life-years gained (0.74, 95% confidence interval 0.70 to 0.78, vs. 0.83, 95% confidence interval 0.79 to 0.87). The differences in costs (difference £645, 95% confidence interval –£1381 to £2580) and quality-adjusted life-years (difference –0.09, 95% confidence interval –0.11 to –0.04) were small. Similar results were observed over the 4-year time horizon. At a threshold of willingness to pay for a gain of 1 QALY of £20,000, the probability of myomectomy being cost-effective is 98% at 2 years and 96% at 4 years. Limitations There were a substantial number of women who were not recruited because of their preference for a particular treatment option. Conclusions Among women with symptomatic uterine fibroids, myomectomy resulted in greater improvement in quality of life than did uterine artery embolisation. The differences in costs and quality-adjusted life-years are very small. Future research should involve women who are desiring pregnancy. Trial registration This trial is registered as ISRCTN70772394. Funding This study was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme, and will be published in full in Health Technology Assessment ; Vol. 26, No. 22. See the NIHR Journals Library website for further project information.

Uterine artery embolization or myomectomy for women with uterine fibroids wishing to avoid hysterectomy: a cost‐utility analysis of the FEMME trial

Article

Full-text available

Jul 2021
BJOG-INT J OBSTET GY

Objectives: To assess the cost-effectiveness of uterine artery embolization (UAE) and myomectomy for women with symptomatic uterine fibroids wishing to avoid hysterectomy. Design: Economic evaluation alongside the FEMME randomised controlled trial. Setting: 29 UK hospitals. Population: Premenopausal women who had symptomatic uterine fibroids amenable to UAE or myomectomy wishing to avoid hysterectomy. 254 women were randomised to UAE (127) and myomectomy (127). Methods: A within trial cost-utility analysis was conducted from the perspective of the UK NHS. Main outcome measures: Quality-adjusted life years measured using the EuroQoL 3L, combined with costs to estimate cost-effectiveness over two and four years of follow-up. Results: Over a two-year time horizon, UAE was associated with higher mean costs (difference £645; 95% CI -1,381 to 2,580) and lower QALYs (difference -0.09; 95% CI -0.11 to -0.04) when compared with myomectomy. Similar results were observed over the four-year time horizon. Thus, UAE was dominated by myomectomy. Results of the sensitivity analyses were consistent with the basecase results for both years. Over two years, UAE was associated with higher costs (difference £456; 95% CI -1,823; 3,164) and lower QALYs (difference -0.06; 95% CI (-0.11; -0.02). Conclusions: Myomectomy is a cost-effective option for the treatment of uterine fibroids. The differences in costs and quality-adjusted life years are small. Women should be fully informed and have the option to choose between the two procedures.

Conventional myomectomy

Article

Full-text available

Jan 2008

In addition to the conventional/older treatments of myomectomy and hysterectomy, the options now available to the woman with symptomatic fibroids, especially if she wishes to conserve her uterus, include medical treatments such as mifepristone, minimally invasive therapies such as uterine artery embolization (UAE) or magnetic-resonance-guided focused ultrasound surgery (MRgFUS), and laparoscopic or vaginal myomectomy. It is generally accepted, and with justification , that conventional myomectomy is associated with significant morbidity, especially excessive peri-operative blood loss, recurrence of the fibroids and adhesion formation, which might compromise the very reason, i.e. fertility, which the operation is performed to preserve. However, the newer treatments have significant limitations: medical treatments are promising but, to date, have been found to be of limited efficacy; UAE is still under evaluation and its impact on fertility has yet to be researched; and MRgFUS is an even newer therapy which is limited to centres with high technology and hugely expensive open magnetic resonance imaging facilities. Both UAE and MRgFUS cause shrinkage rather than removal of the fibroids, and have limited efficacy when used with really large, multiple fibroids. Laparoscopic myomectomy is also limited by the size and number of fibroids that can be treated by this approach, and demands laparoscopic skills that are still lacking in most institutions; limitations which also apply to vaginal myomectomy. It is therefore evident that conventional abdominal myomectomy still has a major role to play. There are no limitations on size and number of fibroids, and there are good data showing improvement in outcomes of assisted reproduction treatments following myomectomy. The widespread fallacy is probably the assumption that any gynaecological surgeon can perform a my-omectomy; good conventional myomectomy demands no less skill than the laparoscopic approach. There is a need to continue to refine and innovate, especially with regard to reducing

Miomatosis uterina e infertilidad: ¿qué evidencias tenemos como causa y como tratamiento?

Article

Full-text available

Dec 2008

Objetivos: revisar las evidencias actuales que determinen el impacto de la miomatosis uterina en la infertilidad, así como la seguridad y la eficacia de las diferentes formas de tratamiento quirúrgico conservador. Metodología: revisión sistemática cualitativa, consultando las fuentes de datos de Cochrane (Menstrual Disorders and subfertility), Medline (PubMed -MeSH), y de OVID (EBM); desde 1995 a 2008. Resultados: muchos estudios observacionales han sugerido que los miomas causantes de infertilidad son todos los submucosos, los intramurales mayores de 5 cm que alteren la cavidad uterina y también los subserosos cuya cantidad y tamaño distorsionen la fisiología reproductiva. Pero no hay estudios aleatorizados controlados (RCTs) que soporten estas afirmaciones. En la actualidad, las miomectomías constituyen la mejor forma de tratamiento para pacientes infértiles. Por histeroscopia se deben resecar miomas submucosos menores de 5 cm, tipos 0 y I; por laparoscopia miomas intramurales o subserosos menores de 10 cm y no más de 5 miomas; finalmente, por laparotomía es posible resecar todo tipo de miomas, independientemente de su localización, tamaño y número. No hay RCTs que comparen la histeroscopia con otras técnicas de miomectomías; pero sí los hay mostrando que las indicaciones para laparotomía y laparoscopia son igualmente efectivas en resultados reproductivos. Conclusión: hay evidencias limitadas soportando la miomatosis como causante de infertilidad, y las miomectomías por histeroscopia respecto a otros tratamientos conservadores. Sin embargo, hay RCTs que muestran iguales resultados reproductivos al realizar miomatomías intramurales o subserosas por laparoscopia y por laparotomía en pacientes seleccionadas.

From laparotomy to laparoscopy to in vitro fertilization

Article

Aug 2019
FERTIL STERIL

Victor Gomel

Before the modern era of in vitro fertilization, reproductive surgery to deal with pelvic disease was the key intervention in the management of infertility. A series of clinical observations and animal experiments led to the development of microsurgical principles, which were applicable to all forms of gynecologic surgery. The evolution of endoscopy permitted minimally invasive approaches to most pelvic pathology. Assisted reproductive techniques now have primacy in the management of infertility, but women deserve to have fertility-enhancing or fertility-sparing surgery performed by a surgeon with relevant training. Thus, we have an obligation to maintain formal training programs in reproductive surgery.

ACR Appropriateness Criteria ® Radiologic Management of Uterine Leiomyomas

Article

May 2018
J Am Coll Radiol

Uterine fibroids, also known as leiomyomas, are the most common benign tumor in women of reproductive age. When symptomatic, these patients can present with bleeding and/or bulk-related symptoms. Treatment options for symptomatic uterine leiomyomas include medical management, minimally invasive treatment such as uterine artery embolization, and surgical options, such as myomectomy. It is important to understand the role of these treatment options in various clinical scenarios so that appropriate consultation is performed. Furthermore, patients should be presented with the outcomes and complications of each of these treatment options. A summary of the data and clinical trials of the treatment options for symptomatic uterine leiomyomas is outlined in this article. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

Our Clinical Experience on Uterine Artery Embolization for the Treatment of Uterine Fibroids: A Retrospective Case-Series of 32 Patients

Article

Jan 2017

Isil Yildiz

Purpose: To present our experience on uterine artery embolization performed in patients with uterine fibroids. Materials and methods: Thirty-two patients (mean age, 37 years) with symptomatic fibroids who underwent uterine artery embolization in our clinic between July 2014 and May 2015 were retrospectively analyzed. Uterine and fibroid volumes were determined by T1-weighted MR images. The change in symptoms after procedure and the severity of postprocedural pain were assessed by patients. Results: Median follow-up period was 23 months (range 21-30 months). None of patients had menorrhagia, 79% had less menstrual pain, and 82% had less or none abdominal bloating or swelling during follow-up. The mean volumes of uterus and largest fibroid decreased 55% and 66% after embolization, respectively. The rate of patients who satisfied with the procedure was 97%. Majority of women (81.3%) had severe pain which lasted for 4.0 ± 3.0 days. They returned to daily acitivities within 5.0 ± 1.1 days, and to work within 7.0 ± 2.1 days. None of patients had persisting discharge, permanent amenorrhoea, or infective complications. Conclusion: Uterine artery embolization is an effective and safe treatment alternative for ymptomatic uterine fibroids provided that an extensive clinical and radiological evaluation is performed. Early postprocedural period can be painful, but pain resolves fast.

A review of evidence-based management of uterine fibroids

Article

Jan 2016

Key content Fibroids are the most common uterine growth and there is an increasing range of options for their management. Management options are affected by the woman's symptoms, age, desire to conceive and local resources. Pharmacological agents are effective in alleviating symptoms and may improve women’s quality of life. Interventional radiology procedures may prevent the need for hysterectomy. Conventional surgical procedures and minimal access surgery are important in management of fibroids. Learning objectives To understand the options available for the management of uterine fibroids. To create awareness of radiological techniques, such as uterine artery embolisation and magnetic resonance imaging‐guided focused ultrasonography, that preserve the uterus. To understand the use of pharmacological agents in the reduction of menstrual blood loss and fibroid size. Ethical issues Is it ethical to offer new minimally invasive treatment options for fibroids to older women who wish to retain potential fertility?

Genitourinary Applications of MR-Guided High-Intensity Focused Ultrasound

Article

Full-text available

Oct 2014

Magnetic resonance-guided high-intensity focused ultrasound therapy is a novel and non-invasive treatment option for both benign and malignant tumors. In this article, we provide an overview of its basic technical features and biological effects, and describe the main genitourinary applications.

The challenge of preoperative identification of uterine myomas: Is ultrasound trustworthy? A prospective cohort study

Article

Full-text available

Jun 2016
ARCH GYNECOL OBSTET

Purpose: To correlate preoperative ultrasound examination with intraoperative and anatomo-pathological findings, including estimation of number, localization and size of uterine myomas, uterine diameters and volume. Methods: A prospective study on 126 women undergoing surgery for uterine myomatosis at Campus Bio-medico between May 2013 and April 2014. The patients were divided into two groups: one submitted to hysterectomy and the other submitted to open myomectomy. Ultrasound scans were performed 1 day before surgery by the same expert sonographer. The number of myomas at ultrasound was compared to intraoperative visualization and anatomo-pathological findings. Wilcoxon Test was applied to compare data registered with each technique. Results: There was no significant difference between the number of myomas recorded at visualization and at ultrasound, while there was a significant difference between visualization and anatomo-pathology (p = 0.0006). The analysis showed a non-significant difference between myoma number at ultrasound and at anatomo-pathology in the two groups, if the number of myomas was less than or equal to six. Contrarily, we observed a significant difference if the number of myomas was more than six (p = 0.003). Conclusions: Our data show that ultrasound has limits in identifying the exact number of uterine myomas. This mapping is particularly needed in a minority of patients with usually desiring fertility who need a debulking procedure due to the large size and/or number of myomas or myoma location causing symptomatology. In patients with more than six myomas, voluminous uterus, a second-level examination such as Magnetic Resonance may be helpful.

Magnetic Resonance-Guided High-Intensity Focused Ultrasound (MRgHIFU) Treatment of Symptomatic Uterine Fibroids: An Evidence-Based Analysis

Article

Sep 2015

Gaylene Pron

Background: Magnetic resonance-guided high-intensity focused ultrasound (MRgHIFU) is a noninvasive uterine-preserving treatment alternative to hysterectomy for women with symptomatic uterine leiomyomas (fibroids). Uterine fibroids commonly occur, have a broad impact on women's health and lifestyle, continue to be the main indication for hysterectomy, and represent a costly public health burden. Objectives: The objectives of the analysis were to evaluate patients' eligibility for MRgHIFU treatment of symptomatic uterine fibroids and the technical success, safety, effectiveness, and durability of this treatment. The review also compared the safety and effectiveness of MRgHIFU with other minimally invasive uterine-preserving treatments and surgeries for uterine fibroids. Methods: A literature search was performed on March 27, 2014, using Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid EMBASE, EBSCO Cumulative Index to Nursing & Allied Health Literature (CINAHL), and EBM Reviews, for studies published from January 1, 2000, to March 27, 2014. Results: The evidence review identified 2 systematic reviews, 2 RCTs, 45 cohort study reports, and 19 case reports involving HIFU treatment of symptomatic uterine fibroids. Eligibility for MRgHIFU treatment was variable, ranging from 14% to 74%. In clinical cohort studies involving 1,594 patients, 26 major complications (1.6%) were reported. MRgHIFU resulted in statistically and clinically significant reductions in fibroid-related symptoms in studies conducted in 10 countries, although few involved follow-up longer than 1 year. Retreatment rates following MRgHIFU were higher in early clinical studies involving regulated restrictions in the extent of fibroid ablation than in later reports involving near-complete ablation. Emergent interventions, however, were rare. Although a desire for fertility was an exclusion criteria for treatment, spontaneous term pregnancies did occur following HIFU. There were no randomized trials comparing MRgHIFU and other guidance methods, other minimally invasive treatments, or surgeries for symptomatic uterine fibroids. Limitations with MRgHIFU included restricted eligibility, requirement for a dedicated MR device to guide the treatment, lengthy procedure time, and loss of MR opportunity time. Conclusions: For women failing medical therapy and seeking alternatives to hysterectomy for symptomatic uterine fibroids, MRgHIFU provides a safe and effective, noninvasive, uterine-preserving treatment from which they rapidly recover. The treatment advantages of MRgHIFU are potentially offset by restrictive eligibility, lengthy procedure time, and dependence on availability of an MR device. The lack of comparative evidence between MRgHIFU and other, more established uterine-preserving treatments limits informed decision making among treatment options.

Literature review of outcomes and prevalence and case report of leiomyosarcomas and non-typical uterine smooth muscle leiomyoma tumors treated with uterine artery embolization

Article

Jun 2015

To describe the early and late outcomes of uterine smooth muscle tumors that are either malignant or have the potential for recurrence (MRUSMTs) after uterine artery embolization (UAE). Literature review of MRUSMTs in case reports and in studies on patient outcome after UAE and reports of one case of leiomyosarcoma (LMS) and 2 cases of bizarre leiomyoma (BL) after UAE. University hospital. Main outcome measure(s) and clinical outcome of UAE and prevalence of MRUSMT. In the review of clinical trials, six cases of sarcomas were reported after UAE treatment in 8084 procedures. One of the six sarcoma cases and one case of intravenous leiomyomatosis occurred more than two years after the UAE. Thirteen cases of LMS, two cases of BL and no cases of MRUSMTs after UAE were identified in the published case reports. Six of the thirteen patients with sarcomas exhibited a good initial clinical response, but their symptoms relapsed after six months. UAE had a failed outcome in the two BL cases. MRUSMTs are rarely treated using UAE; late malignant transformation is infrequent but may be underreported. UAE treatment of leiomyosarcomas does not seem to spread the disease, but this approach may impair prognosis by delaying diagnosis. Tumors with low malignant potential may initially exhibit volume reduction and a good clinical response, but these tumors may exhibit persistent enhancement with contrast-enhanced magnetic resonance imaging (MRI). Special attention is required in cases with or without a limited response to UAE. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Uterine fibroids and infertility: What evidence do we have regarding cause and treatment?

Article

Full-text available

Dec 2008

Objectives: reviewing the evidence to determine the impact of fibroids on infertility and different types of conservative surgical treatment's efficacy and safety. Methodology: the Cochrane Menstrual Disorders and Sub-fertility Review Group specialized register of controlled trials, MEDLINE (PUBMED-MeSH), and OVID (EBM) were searched from 1995 to 2008 for carrying out a qualitative systematic review. Main results: many observational, retrospective studies have suggested that all infertility-producing myomas are submucosal, intramural myomas bigger than 5 cm thereby altering the endometrial cavity and subserosal myomas whose size distorts reproductive physiology; however, no randomised controlled trials (RCT) were found to support such affirmations. Submucosal myomas must be removed by hysteroscopy (with the exception of myomas bigger than 5 cm or type II); however, no RCTs were found comparing hysteroscopic treatment with other types of treatment. Intramural and subserosal myomas must be removed by laparoscopy or laparotomy (depending on their localisation and size) supported by RCTs showing that there are no outcome differences in terms of reproductive results. Conclusions: there is limited evidence for suggesting the impact of uterine myomas on infertility and the removal of submucosal myomas by hysteroscopy. Some RCTs show no differences in fertility efficacy outcome if intramural or subserosal myomas are removed via laparotomy or laparoscopy. © 2009 Federación Colombiana de Asociaciones de Obstetricia y Ginecología.

Laparoscopic Myomectomy Versus Uterine Artery Embolization: Long-Term Impact on Markers of Ovarian Reserve

Article

Mar 2014

Objective: To compare the relative long-term effects on ovarian reserve of treating fibroids in reproductive-aged women with uterine artery embolization (UAE) versus laparoscopic myomectomy (LM), using sensitive measures including antral follicle count (AFC) and serum anti-Müllerian hormone (AMH). Methods: We undertook a retrospective cohort pilot study to evaluate the utility and feasibility of carrying out a larger prospective trial. Thirteen women were evaluated in this study, including eight in the UAE group and five in the LM group. They were identified from a larger group of 125 women who had undergone LM and 200 women who had undergone UAE at a participating institution at least 12 months previously; of these, 32 who had UAE and 27 who had LM were of reproductive age and eligible to participate. Participants had an assessment of ovarian reserve including measurements of serum AMH, estradiol, and FSH, and ultrasound assessment of AFC and ovarian volume. Results: Median serum AMH levels were significantly lower in women who had undergone UAE at least 12 months previously than in women who had undergone LM (0.78 ng/mL [range 0.67 to 1.28] vs. 2.17 ng/mL [range 1.17 to 2.38], P = 0.01). Median AFC per ovary was also significantly lower in women who had UAE than in those who had LM (3.5 [range 2 to 7] vs. 7 [range 6 to 11], P = 0.03). Median levels of FSH and E2 and of ovarian volume were not significantly different between the two groups. Conclusion: Reproductive-aged women who have undergone treatment of fibroids with UAE may have lower ovarian reserve over the long term (> 12 months) than women with fibroids treated with LM. This could have an adverse impact on future response to fertility treatment and/or fecundity. This finding may inform the choice of minimally invasive treatment for fibroids in reproductive-aged women who have not completed childbearing. It suggests that further study in this area is warranted before the application of UAE is expanded to young reproductive-aged women.

Hyperspectral Imaging of Uterine Fibroids

Article

Feb 2025
J BIOPHOTONICS

Uterine fibroids are non‐cancerous growths of the uterus that affect nearly 70%–80% of women in their lifetimes. Fibroids can cause severe pain, bleeding, and infertility. The main risk of recurrence is smaller fibroids, which are notoriously hard to detect, being missed during a surgical removal procedure, only to enlarge afterwards. In this work, hyperspectral imaging (HSI) datasets were acquired from samples from 10 patients after receiving a hysterectomy. Optical properties including absorption, scattering, and spectral morphology were extracted and fed into machine learning to classify regions as fibroid and myometrium. Top extracted optical features had significant contrast between fibroid and myometrium ( p < 0.0001) and were used to train Random Forest (AUC: 0.9985 ± 0.001, Sensitivity: 0.9534 ± 0.019, Specificity: 0.9936 ± 0.009) and Logistic Regression (AUC: 0.9397 ± 0.013, Sensitivity: 0.8405 ± 0.023, Specificity: 0.8895 ± 0.032) with strong performance across testing splits. With HSI, there is contrast between fibroid and myometrium in the human uterus.

Myomectomie par laparotomie

Article

Oct 2015

Myomectomie cœlioscopique

Article

Apr 2018

Myomectomie par laparotomie

Article

Sep 2022

Fibromes utérins. Embolisation : pratiques actuelles

Article

Apr 2018

H. Trillaud

Use of Uterine Artery Embolization for the Treatment of Uterine Fibroids: A Comparative Review of Major National Guidelines

Article

Nov 2024
J MINIM INVAS GYN

Systematic review and meta-analysis of current evidence in uterine artery embolization vs myomectomy for symptomatic uterine fibroids

Preprint

Full-text available

Feb 2024

Purpose This review compares the efficacy of Uterine Artery Embolization (UAE) and Myomectomy (MYO) in managing symptomatic Uterine Fibroids (UFs) in women who do not want hysterectomy. Materials and Methods A meta-analysis was performed on all relative studies. Outcomes evaluated reintervention, UFs scores for quality of life (QOL) and symptom severity, and so on. To determine mean differences (MDs) or odds ratios (ORs) with 95% confidence intervals (CIs), a random or fixed-effects model was utilized. Results A meta-analysis of 13 studies (9 observational and 4 randomized controlled trials) was conducted. The results indicated that UAE had a higher reintervention rate (OR, 1.84; 95% CI, 1.62 to 2.10; P < 0.01; I² = 39%), hysterectomy rate (OR, 4.04; 95% CI, 3.45 to 4.72; P < 0.01; I² = 59%), and symptom-severity score (OR, -4.02; 95% CI, 0.82, 7.22; P = 0.01; I² = 0%) compared to MYO at a four-year follow-up. However, UAE was associated with a lower rate of early complications (OR, 0.44; 95% CI, 0.20 to 0.95; P = 0.04; I² = 25%), and readmission rate (OR, 1.16; 95% CI, 1.01 to 1.33; P = 0.04; I² = 0%) compared to MYO. Furthermore, both procedures had comparable improvement in pregnancy rates and abnormal uterine bleeding. Conclusion In conclusion, UAE and MYO are effective in treating symptomatic UFs but they have different outcomes. The decision on which procedure to choose should be made based on individual preferences and the physician's expertise.

Miomectomia laparotomica

Article

Sep 2023

Miomectomía por laparotomía

Article

Jun 2023

Asherman Syndrome after Uterine Artery Embolization: A Cohort Study about Surgery Management and Fertility Outcomes

Article

Feb 2023
J MINIM INVAS GYN

Study objective: To study severity of intrauterine adhesions after uterine arterial embolization and to evaluate fertility, pregnancy and obstetrical outcomes after hysteroscopic treatment. Design: Retrospective Cohort SETTING: French University Hospital PATIENTS: Thirty-three patients under the age of 40 years who were treated by uterine artery embolization with non-absorbable microparticles between 2010 and 2020 for symptomatic fibroids or adenomyosis or postpartum hemorrhage. Interventions: All patients had a diagnosis of intrauterine adhesions after embolization. All patients desired future fertility. Intrauterine adhesions was treat with operative hysteroscopy. Measurements: Severity of intrauterine adhesions, number of operative hysteroscopies performed to obtain a normal cavity shape, pregnancy rate, obstetrical outcomes. Main results: On our 33 patients, 81.8% had severe intrauterine adhesions (state IV et V according to the European Society of Gynecological Endoscopy or state III according to the American fertility society classification). To restore fertility potential, an average of 3.4 operative hysteroscopies had to be performed [IC 95% (2.56 - 4.16)]. We reported a very low rate of pregnancy (8/33, 24%). Obstetrical outcomes reported are 50% of premature birth and 62,5% of delivery hemorrhage partly due to 37,5% of placenta accreta. We reported also 2 neonatal deaths. Conclusion: Intrauterine adhesions after uterine embolization are severe, more difficult to treat than others synechiae, probably related to endometrial necrosis. Pregnancy and obstetrical outcomes have shown a low pregnancy rate, an increased risk of preterm delivery, a high risk of placental disorders and very severe post-partum hemorrhage. Those results have to alert gynecologists and radiologists to the use of UAE in women who desired future fertility.

Miomectomia laparoscopica

Article

Sep 2019

Embolisation des artères utérines : pratiques actuelles

Article

Jun 2022

H. Trillaud

Résumé Introduction La pathologie liée au fibrome utérin est un problème de santé publique chez la femme non ménopausée. Le traitement conservateur s’est développé pour éviter l’hystérectomie qui reste malgré tout encore une intervention chirurgicale couramment pratiquée pour fibrome. À côté de la myomectomie dont les indications obéissent à des critères de taille et de situation dans l’utérus, il est possible de réaliser une embolisation des fibromes utérins par voie endovasculaire. Depuis les premières embolisations pour fibrome vers 1995, ce traitement a démontré son efficacité et sa faible morbidité, et permet une alternative à la chirurgie. Données récentes Si dans un premier temps, l’embolisation pour fibrome a été réservée à des femmes qui ne souhaitaient plus procréer, de nombreuses études montrent qu’il est tout à fait possible de concevoir un enfant après embolisation. Les complications et les suites habituelles sont aujourd’hui mieux connues. Conclusions Les indications de l’embolisation s’élargissent et le désir de grossesse ne doit pas être un frein au recours de ce traitement. L’information claire et loyale des patientes constitue la première étape du processus de décision médicale partagée.

A Systematic Review of Minimally Invasive Treatments for Uterine Fibroid-Related Bleeding

Article

Sep 2021

Newer minimally invasive techniques provide treatment options for symptomatic uterine fibroids while allowing uterus preservation. The objective of this review was to analyze the efficacy of uterine-preserving, minimally invasive treatment modalities in reducing fibroid-related bleeding. A comprehensive search was conducted of PubMed, Embase, PsycINFO, ClinicalTrials.gov, Scopus, and Cochrane Library databases from inception to July 2020. English-language publications that evaluated premenopausal women with fibroid-related bleeding symptoms before and after treatment were considered. Randomized controlled trials were assessed for bias with the established Cochrane Risk of Bias Tool 2.0 and observational studies were assessed for quality under the New Castle-Ottawa Scale guidelines. Eighty-four studies were included in the review, including 10 randomized controlled trials and 74 observational studies. Six studies on myomectomy demonstrated overall bleeding symptom improvement in up to 95.9% of patients, though there was no significant difference between mode of myomectomy. Forty-one studies on uterine artery embolization reported significant reduction of fibroid-related bleeding, with symptomatic improvement in 79 to 98.5% of patients. Three studies suggested that embolization may be superior to myomectomy in reducing fibroid-related bleeding. Six studies reported that laparoscopic uterine artery occlusion combined with myomectomy led to greater reduction of bleeding than myomectomy alone. Fifteen studies demonstrated significantly reduced bleeding severity after radiofrequency ablation (RFA). Additional research is needed to establish the superiority of these modalities over one another. Long-term evidence is limited in current literature for magnetic resonance-guided focused ultrasound surgery, cryomyolysis, microwave ablation, and laser ablation.

Miomectomía laparoscópica

Article

Feb 2019

La miomectomía laparoscópica es un acceso mínimamente invasivo para el tratamiento quirúrgico de los fibromas uterinos sintomáticos. Está indicada en los fibromas poco numerosos, de tipo 3 a 7 (clasificación de la International Federation of Gynecology and Obstetrics [FIGO]), menores de 9 cm. La técnica quirúrgica consta de cuatro etapas principales: la histerotomía y el descubrimiento del mioma, la enucleación, la sutura de la celda de miomectomía y la extracción del mioma. Para poder realizar esta técnica, se requiere una evaluación preoperatoria adecuada de las pacientes, así como unos cirujanos con experiencia en cirugía laparoscópica. La miomectomía laparoscópica presenta ventajas respecto a la miomectomía por laparotomía en cuanto a la pérdida de sangre, el dolor postoperatorio, el período de convalecencia y la disminución del riesgo de adherencias. Existe un riesgo de ruptura uterina secundaria, pero es escaso y depende de la calidad de la sutura quirúrgica de la histerotomía.

Fibromas uterinos. Embolización: prácticas actuales

Article

Jun 2018

H. Trillaud

La patología relacionada con los fibromas uterinos es un problema de salud pública en la mujer no menopáusica. El tratamiento conservador se desarrolló para evitar la histerectomía que, a pesar de todo, aún continúa siendo una intervención quirúrgica realizada con frecuencia por fibromas. Al lado de la miomectomía, cuyas indicaciones obedecen a criterios de tamaño y de localización en el útero, es posible realizar una embolización de los fibromas uterinos por vía endovascular, con la consideración de que la miomectomía se recomienda como indicación de entrada en las mujeres que desean un embarazo. Después de más de 20 años, este tratamiento ha demostrado resultados equivalentes a los de la cirugía en términos de eficacia y de morbilidad.

Alternatives to excisional therapy: A clinical review of our current options to conservatively manage symptomatic leiomyomas

Article

Aug 2018
CURR OPIN OBSTET GYN

Purpose of review: This article provides a clinical review of the alternatives to traditional excisional surgical therapies for uterine leiomyomas, such as myomectomy or hysterectomy. Recent findings: In this review, currently available hormonal medications will be briefly discussed. Then, nonhormonal medical therapy will be addressed with respect to mechanism of action, safety, and efficacy. Finally, the risk-benefit profile of nonexcisional procedures for management of leiomyomas will be addressed. Summary: This provides an update on the information available for more conservative options for symptomatic leiomyoma management.

Benign Uterine Diseases

Chapter

Feb 2018

The traditional concept of the uterus is that the endometrium is the dynamic tissue, providing an intricate set of functions throughout the menstrual cycle-a process that rarely culminates in implantation and pregnancy. The myometrium has been viewed as an inert tissue, chiefly important during pregnancy and, when abnormal, providing the surgical livelihood of clinical gynecologists. To understand both the physiology of menstruation and the pathophysiology of abnormal uterine bleeding (AUB), both the myometrial and the endometrial layers of the uterus are important. This chapter covers both myometrial disease (adenomyosis and leiomyomas) and endometrial diseases (polyps, AUB, intrauterine adhesions, and dysmenorrhea). The objective is to provide the reader with an understanding of the various clinical presentations as well as the molecular pathophysiology of the disease process and to enlist various therapeutic options for these benign uterine diseases.

Uterine fibroid embolization efficacy and safety: 15 years experience in an elevated turnout rate center

Article

Jan 2018

Objective: To evaluate effectiveness and safety of UFE as alternative to surgery, in treatment of uterine fibromatosis. Methods/materials: 255 patients (aged 26-55) with symptomatic UF, indication for surgery, followed in our center (2000-2014), single or multiple fibroids, pain and/or functional/compressive disorders, underwent embolization: injection of PVA particles (150-900 μm) from distal portion of uterine arteries (ascending section). Primary end-point: flow-stop distally to injection site, disappearance of lesion design, preservation of flow in main trunk of UA. Secondary end-point: control of pain and functional/compressive disorders during follow-up (2-7 years). Results: Procedure was performed bilaterally in 250 patients (98%). Mean duration: 47 min (average fluoroscopy: 10:50 min). Post-embolization pelvic pain (according with VAS score) was on average 2.2 at discharge (24 h). Follow-up at 2 years: resolution of menstrual disorders in 78% of patients and improvement in 14%; pain disappeared in 66%; significant improvement of menstrual flow and HCT/HB levels, decrease in total uterine (57.7%)/dominant fibroid (76.1%) volume. Recurrence in 18 patients. Conclusions: UFE represents an excellent alternative to surgical treatment: it is safe, tolerable and effective both in short and long term, with evident advantages in economic and social terms.

Fracasos de la embolización en el tratamiento del mioma uterino

Article

Oct 2016

Resumen La embolización de la arteria uterina ha sido descrita como un método efectivo y seguro en el tratamiento de los miomas sintomáticos. Se presentan 3 casos de pacientes con útero miomatoso sintomático, y su tratamiento mediante esta técnica. En estos 3 casos, las complicaciones postembolización de los miomas hizo necesaria la práctica de una histerectomía. Así mismo se describen otras complicaciones derivadas de la técnica señaladas en la revisión bibliográfica realizada.

Comparison of an Additional Transdermal Fentanyl Patch Compared to Intravenous NSAID and Opioid Analgesics within 24 Hours of an Uterine Artery Embolization for Myoma and Adenomyosis

Article

Full-text available

Jan 2011

To evaluate the effectiveness of an additional transdermal fentanyl patch compared to intravenous analgesics in pain control during the 24-hour period following uterine artery embolization (UAE) for myoma and adenomyosis.

Complications of Fibroid Embolisation

Chapter

Jun 2014

Uterine artery embolisation (UAE) is a well-established procedure in the treatment of uterine fibroids. It is a safe procedure in experienced hands, but is not without serious complications. As our experience with the procedure has grown, our understanding of the nature and timing of these complications has also improved. A large number of observational studies and comparative studies of UAE versus surgery have reported a range of complication rates. Two large multicentre registries with the largest patient cohorts have also presented their data on adverse events. These complications are classified according to the Society of Interventional Radiology (SIR) guidelines and the evidence for each category is presented in this chapter. It is important to understand the causes of these adverse events and to maintain awareness during and after UAE, in order to ensure prompt diagnosis and appropriate management should they occur.

Dysmenorrhea

Article

Sep 2015

Dysmenorrhea is a common complaint among women in all stages of premenopausal life. Etiology, diagnosis and treatment differ depending on the age and reproductive wish of the patient. In dysmenorrhea in young women with no desire to become pregnant, it is important to exclude underlying causes, especially in case of early symptoms or therapy resistance. The first line treatment of primary dysmenorrhea consists of non-steroidal anti-inflammatory drugs (NSAIDs) followed by hormonal therapy. For women with a current reproductive desire, the main causes are endometriosis, myomas, adenomyosis, and other acquired causes. A laparoscopic or hysteroscopic procedure often confirms the diagnosis and can be therapeutic at the same time. In women with a fulfilled reproductive desire, the hormone-releasing intrauterine device has acquired an important place. Endometrial ablation enjoys also a fair success ratio, especially in the treatment of menorrhagia. Embolization or myomectomy can be a good solution in cases of myomas. In case a hysterectomy has to be performed, the vaginal approach is preferred above the laparascopic one. An abdominal hysterectomy has to be reserved for more complex interventions. A total hysterectomy has to be preferred to a subtotal hysterectomy.

Magnetic Resonance-Guided High-Intensity Focused Ultrasound (MRgHIFU) for Treatment of Symptomatic Uterine Fibroids: An Economic Analysis

Article

Sep 2015

Background: Uterine fibroids, or leiomyomas, are the most common benign tumours in women of childbearing age. Some women experience symptoms (e.g., heavy bleeding) that require aggressive forms of treatment such as uterine artery embolization (UAE), myomectomy, magnetic resonance-guided high-intensity focused ultrasound (MRgHIFU), and even hysterectomy. It is important to note that hysterectomy is not appropriate for women who desire future childbearing. Objectives: The objective of this analysis was to evaluate the cost-effectiveness and budgetary impact of implementing MRgHIFU as a treatment option for symptomatic uterine fibroids in premenopausal women for whom drugs have been ineffective. Review methods: We performed an original cost-effectiveness analysis to assess the long-term costs and effects of MRgHIFU compared with hysterectomy, myomectomy, and UAE as a strategy for treating symptomatic uterine fibroids in premenopausal women aged 40 to 51 years. We explored a number of scenarios, e.g., comparing MRgHIFU with uterine-preserving procedures only, considering MRgHIFU-eligible patients only, and eliminating UAE as a treatment option. In addition, we performed a one-year budget impact analysis, using data from Ontario administrative sources. Four scenarios were explored in the budgetary impact analysis: MRgHIFU funded at 2 centresMRgHIFU funded at 2 centres and replacing only uterine-preserving proceduresMRgHIFU funded at 6 centresMRgHIFU funded at 6 centres and replacing only uterine-preserving proceduresAnalyses were conducted from the Ontario public payer perspective. Results: The base case determined that the uterine artery embolization (UAE) treatment strategy was the cost-effective option at commonly accepted willingness-to-pay values. Compared with hysterectomy, UAE was calculated as having an incremental cost-effectiveness ratio (ICER) of

46,480 per quality-adjusted life-year (QALY) gained. The MRgHIFU strategy was extendedly dominated by a combination of UAE and hysterectomy, and myomectomy was strictly dominated by MRgHIFU and UAE. In the scenario where only MRgHIFU-eligible patients were considered, MRgHIFU was the cost-effective option for a willingness-to-pay threshold of

50,000. In the scenario where only MRgHIFU-eligible patients were considered and where UAE was eliminated as a treatment option (due to its low historic utilization in Ontario), MRgHIFU was cost-effective with an incremental cost of

39,250 per additional QALY. The budgetary impact of funding MRgHIFU for treatment of symptomatic uterine fibroids was estimated at

1.38 million in savings when funded to replace all types of procedures at 2 centres, and

1.14 million when funded to replace only uterine-preserving procedures at 2 centres. The potential savings increase to

4.15 million when MRgHIFU is funded at 6 centres to treat all women eligible for the procedure. Potential savings at 6 centres decrease slightly, to

3.42 million, when MRgHIFU is funded to replace uterine-preserving procedures only. Conclusions: Our findings suggest that MRgHIFU may be a cost-effective strategy at commonly accepted willingness-to-pay thresholds, after examining the uncertainty in model parameters and several likely scenarios. In terms of budget impact, the implementation of MRgHIFU could potentially result in one-year savings of

1.38 million and $4.15 million in the scenarios where MRgHIFU is implemented in 2 or 6 centres, respectively. From a patient perspective, it is important to consider that MRgHIFU is the least invasive of all fibroid treatment options for women who have not responded to pharmaceuticals; it is the only one that is completely noninvasive. Also important, from a societal point of view, is the potential benefit from faster recovery times. Despite these benefits, implementation of MRgHIFU beyond the 2 centres which currently offer the treatment faces logistical challenges (for example, competing demands for use of existing equipment), as well as financial challenges, with hospitals needing to fundraise to purchase new equipment.

MRI-Guided Focused Ultrasound Surgery for Uterine Fibroid Treatment: A Cost-Effectiveness Analysis

Article

Full-text available

Aug 2014

OBJECTIVE. The purpose of this article is to evaluate the cost effectiveness of a treatment strategy for symptomatic uterine fibroids that uses MRI-guided focused ultrasound as a first-line therapy relative to uterine artery embolization (UAE) or hysterectomy. MATERIALS AND METHODS. We developed a decision-analytic model to compare the cost effectiveness of three first-line treatment strategies: MRI-guided focused ultrasound, UAE, and hysterectomy. Treatment-specific short- and long-term utilities, lifetime costs, and quality-adjusted life years (QALYs) were incorporated, allowing us to conduct an incremental cost-effectiveness analysis, using a societal willingness-to-pay (WTP) threshold of

50,000/QALY to designate a strategy as cost effective. Sensitivity analyses were subsequently performed on all key parameters. RESULTS. In the base-case analysis, UAE as a first-line treatment of symptomatic fibroids was the most effective and expensive strategy (22.75 QALYs;

22,968), followed by MRI-guided focused ultrasound (22.73 QALYs;

20,252) and hysterectomy (22.54 QALYs;

11,253). MRI-guided focused ultrasound was cost effective relative to hysterectomy, with an associated incremental cost-effectiveness ratio (ICER) of

47,891/QALY. The ICER of UAE relative to MRI-guided focused ultrasound was

234,565/QALY, exceeding the WTP threshold of $50,000/QALY, therefore rendering MRI-guided focused ultrasound also cost effective relative to UAE. In sensitivity analyses, results were robust to changes in most parameters but were sensitive to changes in probabilities of recurrence, symptom relief, and quality-of-life measures. CONCLUSION. First-line treatment of eligible women with MRI-guided focused ultra-sound is a cost-effective noninvasive strategy. For those not eligible for MRI-guided focused ultra-sound, UAE remains a cost-effective option. These recommendations integrate both the short- and long-term decrements in quality of life associated with the specific treatment modalities.

A Matched Cohort Study Comparing the Outcome of Intrauterine Adhesiolysis for Asherman's Syndrome After Uterine Artery Embolization or Surgical Trauma

Article

May 2014

Study objective: To compare the outcome of hysteroscopic adhesiolysis in women who had Asherman's syndrome after uterine artery embolization (UAE) with those who had Asherman's syndrome caused by surgical trauma. Design: A retrospective cohort study matched for age and intrauterine adhesion score (Canadian Task Force classification II-2). Setting: A tertiary hysteroscopic center in a teaching hospital. Patients: Nineteen women with Asherman's syndrome after UAE and 57 women with Asherman's syndrome caused by surgical trauma. Interventions: Hysteroscopic adhesiolysis was followed by a second-look hysteroscopy 1 month later. The scoring system proposed by the American Fertility Society was used to evaluate intrauterine adhesion during hysteroscopy. Measurements and main results: In the UAE group, only 42.1% of women experienced improvement in menstruation defined as a subjective increase in menstrual flow after surgery, which was significantly lower than that of 86.0% observed in the non-UAE group. In the UAE group, the reduction of the American Fertility Society (AFS) score after intrauterine adhesiolysis was 30%, which was significantly lower than that of 80% in the non-UAE group. The pregnancy rate and live birth rate in the UAE group (5% and 0%, respectively) were significantly lower than the corresponding rates in the non-UAE group (33% and 25%, respectively). Conclusion: The outcome of hysteroscopic adhesiolysis in women with Asherman's syndrome after UAE was worse than in women with Asherman's syndrome caused by surgical trauma.

Myomectomy: Technique and current indications

Article

Feb 2014
Minerva Ginecol

Uterine fibroids are the commonest benign tumor of the female genital tract. They affect a significant proportion of reproductive aged women and while some women are asymptomatic, fibroids can cause excessive menstrual bleeding, pelvic pressure, and adversely affect reproductive outcomes. Myomectomy is the most suitable surgical option for women who desire preservation of their fertility potential. However, only a selected group of women of childbearing age will benefit from a myomectomy. Furthermore, the consequences of myomectomy on reproductive function have remained controversial. The purpose of this paper is to review the main surgical approaches for myomectomy - hysteroscopic resection, laparoscopic myomectomy and open myomectomy (by laparotomy) - and discuss evidence-based indications for myomectomy in women with fibroids, especially with regards to its impact on reproductive outcomes. A critical review of the literature pertaining to the surgical approaches of myomectomy and the indications for myomectomy was performed, focusing on their impact on fertility and reproductive outcomes. Myomectomy is useful for the treatment of symptomatic fibroids and in selected women with infertility. Symptomatic submucosal fibroids are classically treated by hysteroscopic resection. Symptomatic intramural and subserosal fibroids may be treated by myomectomy, either by laparotomy or laparoscopy depending on their number and size. Prophylactic myomectomy is not recommended for preventing obstetrical complications or the risk of leiomyosarcoma. Although fibroids can have a negative effect on fertility, only the removal of submucosal fibroids has been consistently shown to improve spontaneous fertility or outcomes of assisted reproduction technology.

Uterine Fibroid Embolization: Measurement of Health-Related Quality of Life before and after Therapy

Article

Full-text available

Nov 1999
J VASC INTERV RADIOL

To determine the change in health-related quality of life associated with uterine fibroid embolization (UFE). A health-related quality-of-life questionnaire was administered before and after therapy. The questionnaire contained validated scales from the Medical Outcomes Study, with additional domains and symptom items specific to fibroids. Patients treated with UFE for symptomatic uterine leiomyomata completed a health-related quality of life questionnaire before therapy. A follow-up quality of life questionnaire and an additional brief questionnaire to assess symptom improvement were completed 3 and 6 months postprocedure. Confirmatory reliability and validity testing was also conducted. Mean scores for each scale on the quality of life questionnaire were calculated and change scores were computed. Fifty women were enrolled in the study and completed the baseline assessment. Health-related quality of life scores improved in all instances at follow-up. Mean change scores were statistically significant for all domains between baseline and month 3 (P < .01) and between baseline and month 6 (P < .05) except backache (P = .12). Patients undergoing UFE report significant improvements in health-related quality of life and fibroid-specific symptoms. These findings suggest that the measurement of health-related quality of life may be an effective means of comparing the outcome of UFE with other fibroid therapies.

Uterine Artery Embolization Using Gelatin Sponge Particles Alone for Symptomatic Uterine Fibroids

Article

Full-text available

Feb 2002

The purpose of this study was to assess the safety and effectiveness of uterine artery embolization using gelatin sponge particles alone for women with symptomatic uterine fibroids. During 38 months, 60 patients (age range, 32-52 years; mean age, 42.5 years) with symptomatic uterine fibroids underwent uterine artery embolization. Only gelatin sponge particles, approximately 500-1000 microm in diameter, were used in all patients. The improvement of clinical symptoms was assessed by questionnaire. Reduction of the largest tumor and uterine volume reductions were assessed using MR imaging. The follow-up period ranged from 1 to 38 months (mean, 10.6 months). Menorrhagia improved markedly or moderately in 41 (98%) of 42 of patients 4 months after embolization and in 20 (100%) of 20 patients 1 year after embolization. Bulk-related symptoms improved markedly or moderately in 31 (97%) of 32 of patients 4 months after embolization and in 19 (100%) of 19 of patients 1 year after embolization. MR imaging revealed that the mean largest tumor volume reduction rates were 55% at 4 months and 70% at 1 year after embolization, and the mean uterine volume reduction rates were 40% at 4 months and 56% at 1 year after embolization. Follow-up MR imaging showed no new fibroids and no regrowth of existing fibroids. No major complications were observed in any women. We suggest that uterine artery embolization with gelatin sponge particles alone is a safe and effective treatment for symptomatic fibroids. The outcomes bear comparison with those of uterine artery embolization using polyvinyl alcohol particles, which have been reported in the literature.

Uterine Fibroids: Uterine Artery Embolization versus Abdominal Hysterectomy for Treatment—A Prospective, Randomized, and Controlled Clinical Trial1

Article

Full-text available

Mar 2003

To evaluate the effectiveness of uterine artery embolization (UAE) in the management of bleeding in patients with uterine fibroids and to compare UAE with hysterectomy, particularly with regard to length of hospital stay and associated complications (ie, safety). A prospective clinical trial was performed with patients who were randomly assigned to one of two groups: patients who were offered the option of undergoing either UAE or hysterectomy (group 1) and patients who were not informed of the alternative treatment-that is, UAE (group 2). The primary variables that were considered for evaluation of the effectiveness, efficiency, and safety of the two procedures were, respectively, bleeding cessation, total length of hospital stay, and resulting complications. The lengths of hospital stay in the two study arms were compared on an intent-to-treat basis. Owing to crossover between the treatment arms, however, effectiveness and safety were evaluated on the basis of the actual treatment received. The clinical success rate for the patients who underwent UAE, which was based on the cessation of bleeding, was 86% (31 of 36 patients). The mean hospital stay for group 1 was 4.14 days shorter than that for group 2 (P <.001). Ten (25%) of the 40 patients who underwent UAE experienced minor complications, in contrast to four (20%) of the 20 who underwent hysterectomy and experienced major complications. Compared with hysterectomy, UAE is safe and effective for treatment of bleeding fibroids, necessitates a shorter hospital stay, and results in fewer major complications.

Uterine artery embolization

Article

Aug 2002
Appl Radiol

Recently, uterine artery embolization (UAE) has received much attention in both the scientific literature and the lay press as a minimally invasive procedure for treating symptomatic fibroid disease. Increasing numbers of women report satisfaction with the effectiveness and efficiency of the procedure over the conventional options. The purpose of this article is to review the literature regarding UAE and its development, techniques, indications, results, and complications. The results to date indicate that UAE is a highly successful, uterine-sparing alternative to hysterectomy for women with symptomatic fibroid disease.

Uterine fibroid embolization

Article

Jul 2000
AM FAM PHYSICIAN

Steven Janney Smith

Interventional radiologists have performed uterine artery embolization to treat women with emergency uterine bleeding since the 1970s. In this procedure, the physician guides a small angiographic catheter into the uterine arteries and injects a stream of tiny particles that decreases blood flow to the uterus. It is now considered a safe and highly effective nonsurgical treatment of women with symptomatic uterine fibroid tumors. Uterine fibroid embolization has several advantages over conventional hormonal suppression and surgical procedures, including avoidance of the side effects of drug therapy and the physical and psychologic trauma of surgery. In addition, after uterine fibroid embolization, patients can normally resume their usual activities several weeks earlier than they can after hysterectomy. Along with hysteroscopic resection, myolysis and laparoscopic myomectomy, uterine fibroid embolization widens treatment options for patients who desire to avoid hysterectomy.

Society of Interventional Radiology clinical practice guidelines. J Vasc Intervent Radiol 14:S199-S202

Article

Sep 2003
J VASC INTERV RADIOL

Uterine artery embolisation for the treatment of symptomatic fibroids in 114 women: Reduction in size of the fibroids and women's views of the success of the treatment

Article

Feb 2002
BJOG-INT J OBSTET GY

Objective To assess the reduction in size of fibroids following uterine artery embolisation and to analyse women's views of the success of treatment.DesignAn uncontrolled case series of 114 consecutive women who underwent uterine artery embolisation for the treatment of fibroids over two years.SettingThe Diagnostic and Interventional Radiology Department at The Royal Surrey County Hospital, Guildford, UK.Methods Bilateral uterine artery embolisation was performed for the treatment of symptomatic fibroids. Magnetic resonance imaging was carried out before and six months following embolisation. Women completed outcome questionnaires following their treatment.Main outcome measuresThe sites, imaging signal characteristics and percentage reduction in the volume of three dominant fibroids were determined from the magnetic resonance scans. Outcome was measured by questionnaire. Women were asked whether their symptoms resolved completely, improved, remained unchanged or deteriorated.ResultsOne hundred and sixty-five fibroids of 114 women (mean age 42) were analysed. Forty-five percent of women had complex fibroid masses and 50% had fibroids ≥8.5cm in diameter. The median reduction in the fibroid volume was 58%. The median reduction of the volume of complex fibroid masses, submucous fibroids, fibroids ≥8.5cm and fibroids with high and low signal on T2 weighted sequences were 58%, 63%, 50%, 62% and 51%, respectively. Ninety-one percent of the women's symptoms had resolved or improved following embolisation.DiscussionThe majority of women were satisfied with their outcome. We have shown that uterine artery embolisation is a successful treatment for symptomatic fibroids of all types, sizes and signal characteristics.

The technique and results of myomectomy

Article

Jan 1931
LANCET

Victor Bonney

Uterine artery embolization of symptomatic uterine fibroids - Initial success and short-term results

Article

Dec 2001
ACTA RADIOL

Purpose: To evaluate reduction in fibroid volume, the effect on clinical symptoms, adverse events and complications after percutaneous uterine artery embolization (UAE) as primary invasive treatment for symptomatic uterine fibroids. Material and methods: Sixty-two patients entered the study. Indications for treatment were fibroid-induced menorrhagia, bulk symptoms, pain, and/or large fibroid size. The first 50 patients were evaluated by clinical examination and ultrasonography with measurement of fibroid volume before treament and 1, 6 and 12 months after UAE. The remaining 12 patients were followed 3 and 12 months after treatment. Embolization with microparticles was performed percutaneously in local analgesia by selective catheterization of both uterine arteries. Results: A primary technical success with bilateral UAE was achieved in 60/62 (97%) of the patients. They were treated for postprocedural pain lasting up to 24 h. In 30 of the 62 patients with 6 months follow-up, the mean fibroid volume was reduced 68% 6 months after treatment. Twenty-nine (96%) of the patients experienced reduced bleeding, 21 (70%) reduced pain, and 18 (61%) reduced bulk symptoms at follow-up. Conclusion: UAE is a method with a high technical success rate. The treatment has good effect on fibroid volume reduction and clinical symptoms. Severe post-procedural pain occurs generally in successful bilateral embolizations, but complications and adverse events are otherwise few and minor. UAE represents a promising new method for treating uterine fibroid-related symptoms.

Uterine artery embolization for the treatment of symptomatic leiomyomata

Article

Apr 2000
OBSTET GYNECOL

Objective: To evaluate uterine artery embolization as an emerging minimally invasive technique in the treatment of patients symptomatic from uterine leiomyomata. Methods: Twenty patients (ages 31–52 years) underwent uterine artery embolization with permanent polyvinyl alcohol particles. Patients were assessed by the same examiner for uterine size and symptomatology. A questionnaire was answered as well as interval ultrasonography to assess uterine volume, as well as total fibroid volume. Volume was calculated using the formula for the prolate epsiloid.Results: At 1 year, 100% of patients with menorrhagia related to fibroids demonstrated complete resolution. One hundred percent of patients with mass symptomatology (pressure on adjacent structures, dyspareunia, or pelvic pain) reported improvement. All women stated that they would undergo the procedure again. Bilateral embolization was successful in all cases except one in which unilateral embolization was achieved. Decrease in uterine and fibroid volume ranged between 39% and 69% over 1 year. Commonly occurring postprocedural effects were low-grade fever and pain. One patient experienced a urinary tract infection; and, in another, an episode of pseudomembranous colitis related to prophylactic antibiotic use was documented by stool culture requiring rehospitalization. Nineteen of 20 patients returned to work within 3 weeks.Conclusions: Uterine artery embolization is a safe and effective alternative for women who desire less invasive management of leiomyomata.

Transcatheter uterine artery embolisation to treat large uterine fibroids

Article

Feb 1998
BJOG-INT J OBSTET GY

Bilateral uterine artery embolisation was performed to treat eight women with symptomatic large fibroids requiring treatment. Uterine volume was quantitatively assessed by magnetic resonance imaging. Both uterine arteries were occluded effectively in all women, and the procedure was well tolerated, with a 24–36 hour admission for pain relief. The level of pain experienced was variable, but well controlled. Some women experienced intermittent vaginal discharge and pain following the procedure. Improvement of symptoms occurred in six of the seven women and the eighth woman conceived. There were no significant complications. At three months four women had a uterine volume of < 350 cm3. Embolisation appears to be a good alternative to surgery, but longer follow up is required to evaluate the long term effects and to determine those patients for whom the procedure is suitable.

Initial Results from Uterine Fibroid Embolization for Symptomatic Leiomyomata

Article

Nov 1999
J VASC INTERV RADIOL

Purpose: To evaluate the safety and short-term efficacy of uterine fibroid embolization (UFE) in patients with symptomatic uterine fibroids. Materials and methods: Bilateral UFE was performed in 61 patients with symptomatic uterine leiomyomata during a 16-month period. Imaging was performed before the procedure and at 3 months and 1 year after the procedure. Questionnaires were obtained at regular intervals after the procedure to assess patient outcome. Results: All procedures but one were technically successful. Mean clinical follow-up was 8.7 months. Minor complications occurred in five patients during the follow-up period. All were treated without permanent sequelae. Menstrual bleeding was improved in 89%, with 81% of patients moderately to markedly improved. Pelvic pain and pressure was improved in 96% of patients, with moderate to marked improvement in 79%. At initial imaging follow-up (mean, 4.4 months postprocedure), median uterine volume decreased 34% (P = .0001) and the median dominant fibroid volume decreased 50% (P = .0001). Imaging at 1 year (mean, 12.3 months) after the procedure showed continued reduction with a median uterine volume reduction of 48% (P = .0002) and median dominant fibroid volume decrease of 78% (P = .0002). Conclusion: In the authors' initial clinical experience, UFE appears effective in controlling symptoms and substantially reducing fibroid volume with few complications.

Uterine Artery Embolization for the Treatment of Uterine Leiomyomata Midterm Results

Article

Nov 1999
J VASC INTERV RADIOL

Introduction: The authors review their midterm experience with uterine artery embolization for the treatment of uterine fibroids. Materials and methods: Sixty patients were referred for permanent polyvinyl alcohol (PVA) foam particle uterine artery embolization during an 18-month period. Detailed clinical follow-up and ultrasound follow-up were obtained. Results: Bleeding was a presenting symptom in 56 patients and pain was a presenting symptom in 47 patients. All patients underwent a technically successful embolization. One of the patients underwent unilateral embolization. Fifty-nine patients underwent bilateral embolization. Of all patients undergoing bilateral embolization, at last follow-up (mean, 16.3 months), 81% had their uterus and had moderate or better improvement in their symptoms. Ninety-two percent of these patients also had reductions in uterine and dominant fibroid volumes. Overall, the mean uterine and dominant fibroid volume reduction were 42.8% and 48.8%, respectively (mean follow-up, 10.2 months). One infectious complication that necessitated hysterectomy occurred. Conclusion: Uterine artery embolization for the treatment of uterine fibroids is a minimally invasive technique with low complication rates and very good clinical efficacy.

Preliminary Experience with Uterine Artery Embolization for Uterine Fibroids

Article

Jul 1997
J VASC INTERV RADIOL

Purpose: To evaluate the potential usefulness of transcatheter uterine artery embolization as a treatment for fibroid-related vaginal bleeding and pelvic pain refractory to hormonal therapy and myomectomy. Materials and methods: Eleven patients (aged 27-55 years; mean, 44.2 years; none desiring future pregnancy) with refractory vaginal bleeding and/or chronic pelvic pain related to uterine leiomyomata underwent uterine artery embolization with use of polyvinyl alcohol (PVA) particles. Clinical improvement was assessed by detailed questionnaire at 2-9 months (mean, 5.8 months) after the procedure. Sonographic measurements of the uterus and dominant masses were obtained before and at 2 months after the procedure. Results: All 11 patients underwent technically successful embolization. Eight of nine women who completed the follow-up questionnaire reported noticeable symptomatic improvement, including three women with complete resolution of symptoms. One woman (the only patient undergoing unilateral embolization) exhibited no clinical response. Another patient developed endometritis and pyometra 3 weeks after the procedure, necessitating hysterectomy. Large reductions in uterine volume (average, 40%) and dominant fibroid size (average, 60%-65%) were sonographically demonstrated. Conclusion: Uterine artery embolization represents a promising new method of treating fibroid-related menorrhagia and pelvic pain. Further investigation will be required to assess clinical response and durability, identify appropriate candidates, and define the optimal angiographic technique and PVA particle size.

Transcatheter uterine artery embolisation to treat large uterine fibroids

Article

Feb 1998
Br J Obstet Gynaecol

Bilateral uterine artery embolisation was performed to treat eight women with symptomatic large fibroids requiring treatment. Uterine volume was quantitatively assessed by magnetic resonance imaging. Both uterine arteries were occluded effectively in all women, and the procedure was well tolerated, with a 24-36 hour admission for pain relief. The level of pain experienced was variable, but well controlled. Some women experienced intermittent vaginal discharge and pain following the procedure. Improvement of symptoms occurred in six of the seven women and the eighth woman conceived. There were no significant complications. At three months four women had a uterine volume of < 350 cm3. Embolisation appears to be a good alternative to surgery, but longer follow up is required to evaluate the long term effects and to determine those patients for whom the procedure is suitable.

Uterine remodelling following conservative myomectomy: Ultrasonographic evaluation

Article

Jan 1993

Uterine leiomyomata develop during the reproductive years and may interfere with fertility through mechanisms as yet not fully understood. A developing intramural or large submucosal leiomyoma causes hypertrophy of the myometrium. Conservative myomectomy, as opposed to hysterectomy, is the preferred surgical procedure for patients who wish to preserve their fertility. Ten patients were ultrasonographically evaluated at monthly intervals following myomectomy and the changes in uterine (myometrial) volume were assessed. There was a gradual decrease in uterine volume in all patients during the six months following removal of intramural and submucosal leiomyomata. The most remarkable decrease in size occurred during the initial two to three months for the majority of the patients. The impact of this process on fertility should be further evaluated. One of the intriguing questions is whether the period of uterine shrinkage represents the time of the healing process during which conception should be prevented.

Myomectomy: recurrence after removal of solitary and multiple myomas

Article

Sep 1969
OBSTET GYNECOL

L J Malone

Arterial Embolization to treat uterine myomata

Article

Oct 1995

Haemorrhage, probably related to hypervascularisation, is the commonest complication of uterine myomata and is difficult to treat. 16 patients, aged 34-48 years, with symptomatic uterine myomata, for which a major surgical procedure was planned after failure of medical treatment, were treated by selective free-flow arterial embolisation of the myomata with Ivalon particles. With a mean follow-up of 20 months (range 11-48) in the responders, symptoms resolved in 11 patients; menstrual cycles returned to normal in ten of these. Three patients had partial improvement. Two failures required surgery. In 14 cases embolisation caused pelvic pain, which required analgesia in all.

Assessment of patients with menorrhagia: How valid is a structured clinical history as a measure of health status?

Article

Mar 1995

A patient-administered questionnaire for menorrhagia based on the type of questions asked when taking a gynaecological history was developed and tested using the following steps: literature reviews, devising the questions, testing responses for internal consistency and test-retest reliability and validating the questionnaire by comparing patient's scores with their responses to the SF-36 general health measure, and with family practitioner perceptions of severity. The main sample consisted of 351 women with menorrhagia, 246 referred to gynaecology ambulatory clinics and 105 from four large training practices in North-east Scotland. Following testing, two questions were discarded from the questionnaire. The final questionnaire demonstrated a good level of reliability and the resulting patient scores correlated significantly with their scores on the scales making up the general health measure. The questions asked in taking a clinical history from a woman with menorrhagia can be used to construct a valid and reliable measure of health status. This clinical measure may be a useful guide in selection for treatment and in the assessment of patient outcome following treatment.

Abdominal myomectomy: Results of a simple operative technique

Article

Feb 1996
FERTIL STERIL

To report a simple and safe procedure of abdominal myomectomy and our results performing this technique. The operative technique comprises the incision on the most prominent part of the myoma, the use of a hooked clamp to hold the tumor, and a surgical knife to peel it, without removing the apparent excess of myometrium or serosa. University Medical Centers and private practice. Eighty patients, 9 of whom were operated between 10 and 26 weeks of pregnancy, 3 during cesarean section, and 22 others who had infertility. Myomectomy was performed successfully in all patients for whom it was scheduled. Eight of nine pregnant patients had successful deliveries at term. The cumulative 10-year reoccurrence and reoperation rates of life-table analysis were 38% and 18%, respectively. The cumulative conception rates were 100% for otherwise unexplained infertility at 2 years, and 63% and 79% at 5 years for all infertile and all patients attempting conception after myomectomy, respectively. An age > 30 years, infertility > 3 years, and multiple fibroids negatively affected these rates, whereas the use of an absorbable adhesion barrier (Interceed; Johnson & Johnson AB, Somerville, NJ) had a positive effect. This procedure is an appropriate alternative for most women who want to preserve or enhance fertility potential, and if necessary, for pregnant women.

Abdominal myomectomy as a treatment for symptomatic uterine fibroids

Article

Jan 1996
OBSTET GYN CLIN N AM

Francis L. Hutchins

Using the previously described approach, I find abdominal myomectomy in general to be a procedure quite comparable with other major pelvic procedures, such as hysterectomy. My postoperative course is associated with a 12% complication rate, the majority of which represents transient febrile morbidity, which resolves quite promptly. In addition, my transfusion rate is 3% or less and my postoperative length of stay is 2 to 3 days. This is consistent with other currently reported series and in my estimation justifies the continued philosophy of offering abdominal myomectomy as a primary treatment for symptomatic uterine fibroids regardless of future childbearing options.

Resectoscopic Myomectomy for Treatment of Menorrhagia

Article

Sep 1994

DR Phillips

Since March 1986, 150 women with submucous leiomyomata underwent hysteroscopic resection. The women presented with menorrhagia and/or dysmenorrhea. Patients undergoing concomitant endometrial ablation or who had submucous leiomyomata occupying greater than 50% of the endometrial cavity were medically suppressed for 1 month prior to surgery. The intraoperative complication rate was 1.9%. Resolution of menorrhagia was obtained after 6 months in approximately 91% of the patients who underwent one or two myomectomies and in 98% of the women who underwent one or two concomitant endometrial ablations. After six years, 82.1% continued to have amenorrhea, hypomenorrhea, or normal menses. Of women desirous of pregnancy, 62.5% conceived and carried to term.

Endometrial Ablation in Menopausal Women on Estrogen Replacement Therapy Complaining of Abnormal Uterine Bleeding

Article

Sep 1994

DR Phillips

Since March 1986, 26 menopausal patients complaining of persistent, annoying uterine bleeding with estrogen replacement therapy underwent either a Nd:YAG laser or an electrosurgical endometrial ablation. All patients discontinued estrogen replacement therapy one month prior to the ablation and resumed one month after the surgical procedure. There were no intraoperative complications. All women became amenorrheic within 1 month of the procedure. Endometrial ablation is an effective alternative to discontinuing estrogen replacement therapy in postmenopausal women complaining of unwanted uterine bleeding.

Interest of particulate arterial embolization in the treatment of some uterin myoma

Article

Mar 1997
B ACAD NAT MED PARIS

Unlabelled: In 88 women between the ages of 34 and 51 years with one or several symptomatic uterine leiomyomata (menometrorrhagia, mass syndrome) after failure of medical treatment, particulate arterial embolization was proposed as an alternative to the scheduled surgical operation. Free-flow embolization with Ivalon particles (150 to 600 microns) was performed under local anaesthesia after femoral artery puncture and catheterization of the hypogastric then uterine arteries (5 F catheter) including occlusion Pelvic pain was frequently observed immediately after embolization, lasting 12 to 18 hours, and required analgesia. Necrobiosis syndromes can be observed in the case of very large leiomyomata. No immediate complications directly related to vascular catheterization were observed in this series, but complete necrosis of a very large leiomyomatous uterus required hysterectomy. Five embolization failures were observed. The following results were observed in the 80 interpretable cases with a follow-up of 6 to 60 months: the menstrual periods returned to normal in 60 (89%) of the 67 menorrhagic patients, after six months a volume reduction of myomata equal to 69% of initial volume was observed. Conclusion: in of 80 interpretable cases, embolization constituted an alternative to surgical treatment, which was avoided in 71 cases, 9 failures were observed. The results of this preliminary series must be valited by further studies.

Selective uterine artery embolization as primary treatment for symptomatic leiomyomata uteri

Article

Sep 1999

To analyze initial experience with uterine artery embolization for treatment of symptomatic leiomyomata. Prospective, longitudinal study (Canadian Task Force classification II-2). Private practice, university-affiliated hospital. Three hundred five women (age 26-52 yrs). Uterine artery embolization, performed over 2 years by a single radiologist working in collaboration with a single gynecology practice. Embolization was technically successful in 96% of patients. No major complications occurred. Average reduction in uterine volume was 48%. Control of menorrhagia was reported by 86% of patients at 3 months, 85% at 6 months, and 92% at 12 months after the procedure. Bulk symptoms were satisfactorily controlled in 64% of patients at 3 months, 77% at 6 months, and 92% at 12 months. Six women subsequently underwent hysterectomy and five had myomectomy. Uterine artery embolization appears to be a highly effective treatment for symptomatic uterine leiomyomata. Its impact on fertility and pregnancy remain to be investigated fully. (J Am Assoc Gynecol Laparosc 6(3):279-284, 1999)

Article

Jun 2000

To prospectively evaluate the effectiveness and safety of selective embolization of the uterine arteries in the management of symptomatic uterine leiomyoma. Eighty consecutive women (mean age, 44.7 years) with symptomatic uterine leiomyoma, none of whom desired future pregnancy, underwent superselective embolization of the uterine arteries with polyvinyl alcohol particles. In all women, arterial embolization was performed because of persistent, fibroid-related menorrhagia after failure of hormonal therapy. Follow-up consisted of office visits at 2, 6, 12, and 24 months and of ultrasonography at 2 and 6 months after the procedure. Bilateral embolization of the uterine arteries was performed in 76 women; unilateral embolization, in four women. Menorrhagia disappeared in 72 (90%) women. In five (6%) women (including three women with unilateral embolization), clinical improvement was not observed, and myomectomy was needed. In one woman with a large submucosal uterine leiomyoma, hysterectomy was needed because of septic uterine necrosis. Normal menstruation resumed in all but six women. Full-term pregnancy occurred in three women after the procedure. Superselective arterial embolization of the uterine arteries is an effective means of controlling symptomatic uterine leiomyoma. However, the ideal embolic regimen remains to be determined.

Arterial embolization of uterine myomata: Results in 286 cases

Article

Jun 2000
J Gynecol Obstet Biol Reprod

Report outcome in non-surgical treatment of symptomatic uterine myomata by particulate arterial embolization. and method: Two hundred eighty-six women aged 21 to 53 years with symptomatic uterine fibroids initially programmed for surgery were studied. The size and number of myomata were determined by pelvic ultrasound. After retrograde transfemoral introduction of a 4 French catheter, the left and right uterine arteries were successively catheterized. PVA particles were injected by free flow until devascularization. Two hundred sixty-two patients were evaluable. Complete resolution of symptoms was obtained in 245 cases. There were 17 failures. A marked reduction in the size of the myomata was observed (60% at six months). Hemorrhage disappeared in 80% of the cases immediately. Thirteen pregnancies were observed. No recurrence were observed. Complications were rare. Particulate embolization is a new minimally invasive treatment for uterine myomata which provides a alternative to hysterectomy and can replace myomectomy in young women.

Uterine artery embolization of symptomatic uterine fibroids: Initial success and short-term results

Article

Apr 2001

To evaluate reduction in fibroid volume, the effect on clinical symptoms, adverse events and complications after percutaneous uterine artery embolization (UAE) as primary invasive treatment for symptomatic uterine fibroids. Sixty-two patients entered the study. Indications for treatment were fibroid-induced menorrhagia, bulk symptoms, pain, and/or large fibroid size. The first 50 patients were evaluated by clinical examination and ultrasonography with measurement of fibroid volume before treament and 1, 6 and 12 months after UAE. The remaining 12 patients were followed 3 and 12 months after treatment. Embolization with microparticles was performed percutaneously in local analgesia by selective catheterization of both uterine arteries. A primary technical success with bilateral UAE was achieved in 60/62 (97%) of the patients. They were treated for postprocedural pain lasting up to 24 h. In 30 of the 62 patients with 6 months follow-up, the mean fibroid volume was reduced 68% 6 months after treatment. Twenty-nine (96%) of the patients experienced reduced bleeding, 21 (70%) reduced pain, and 18 (61%) reduced bulk symptoms at follow-up. UAE is a method with a high technical success rate. The treatment has good effect on fibroid volume reduction and clinical symptoms. Severe post-procedural pain occurs generally in successful bilateral embolizations, but complications and adverse events are otherwise few and minor. UAE represents a promising new method for treating uterine fibroid-related symptoms.

Uterine Artery Embolization for Leiomyomata

Article

Aug 2001
OBSTET GYNECOL

To determine whether uterine artery embolization is safe and effective for treating uterine leiomyomata. We analyzed 200 consecutive patients (61 reported previously) undergoing uterine artery embolization for the treatment of uterine leiomyomata at a single institution. After treatment, follow-up data were obtained by written questionnaire mailed to the patients at intervals of 2 weeks, 3 months, 6 months, and 12 months after treatment. Follow-up imaging was obtained at 3 months and 12 months after therapy. All complications and subsequent gynecologic interventions were recorded prospectively, obtained using the patient questionnaires and physician contact. The percentages and their 95% confidence intervals (CI) were calculated to compare the symptoms at follow-up. Proportional odds models for repeated ordinal responses were used to assess the stability of symptom improvement over time. The mean follow-up was 21 months (minimum 12). Heavy menstrual bleeding improved in 87% (95% CI 82%, 92%) of patients at 3 months and in 90% (95% CI 86%, 95%) at 1 year after therapy. Bulk symptoms improved in 93% of patients (95% CI 88%, 96%) at 3 months and in 91% (95% CI 86%, 95%) at 1 year after treatment. Only one major periprocedural complication occurred (pulmonary embolus), which resolved with anticoagulant therapy. Subsequent gynecologic interventions occurred in 10.5% of the patients (95% CI 7.0%, 15.0%) during the follow-up period. Uterine artery embolization is safe and controls the symptoms caused by leiomyomata in most patients.

The Vascular Impact of Uterine Artery Embolization: Prospective Sonographic Assessment of Ovarian Arterial Circulation

Article

Sep 2001
J VASC INTERV RADIOL

The etiology of premature ovarian failure after uterine artery embolization (UAE) is unknown. The authors prospectively assessed ovarian arterial circulation before and after UAE with use of ultrasonography (US). The authors hypothesize that nontarget embolization of the ovary occurs during routine UAE. Twenty-three women (mean age of 42.6 years; range, 35-51 y) participated in the study. Grayscale, color, and pulsed-wave Doppler US studies were performed immediately before and after UAE. Resistive index (RI) and pulsatility index (PI) were calculated. The proportion of women who developed increased vascular impedance after UAE was statistically assessed with use of the Yates-corrected chi(2) test. Seventeen of 23 patients (74%) completed the study. Nine of 17 (54%) showed complete loss of ovarian arterial perfusion after UAE. Six of 17 (35%) had increases in RI and PI, whereas two of 17 (11%) had decreases in RI and PI. The increase in vascular impedance after UAE in 15 of 17 patients was significant (P <.0001). Loss of detectable ovarian arterial perfusion occurs in the majority of patients undergoing UAE. Ovarian vascular impedance increases in nearly all patients as a result of UAE. The authors conclude that inadvertent nontarget embolization of the ovarian arterial bed occurs during routine UAE.

Reporting standards for uterine artery embolization for the treatment of uterine leiomyomata

Article

Oct 2001
J VASC INTERV RADIOL

Uterine fibroid embolization compared with myomectomy

Article

Oct 2001

Leiomyomata Treated with Uterine Artery Embolization: Factors Associated with Successful Symptom and Imaging Outcome1

Article

Feb 2002

To determine whether baseline variables are associated with treatment success after uterine artery embolization for treatment of uterine leiomyoma. Two hundred consecutive patients who underwent uterine artery embolization at one institution were prospectively examined. Baseline clinical variables measured included age, race, prior oral contraceptive use or progesterone treatment, prior gonadotropin-releasing hormone agonist treatment, and prior births. Imaging parameters were baseline uterine volume, baseline leiomyoma volume and location, and number of leiomyomas. After treatment, follow-up imaging and questionnaire data were obtained at 3 and 12 months. Associations between baseline characteristics and outcome variables of interest were assessed by using linear regression, logistic regression, Pearson product moment correlation coefficients, and Kendal tau correlation coefficients, with adjustment for confounding variables when indicated. Regression models indicated that larger dominant leiomyoma volume was associated with a smaller percentage reduction in volume at 3 months (P =.03). A submucosal leiomyoma location was associated with a greater volume reduction at 3 months (P =.04), but this difference did not persist at 12 months (P =.09). The odds of reported menstrual bleeding improvement at 3 months were higher with a submucosal leiomyoma location (P =.04); however, this association was not statistically significant after adjustment (P =.07). The odds of improved bulk-related symptoms were not associated with leiomyoma volume change or location. Smaller baseline leiomyoma size and submucosal location are more likely to result in a positive imaging outcome. There are limited associations between other baseline parameters and either symptom change or imaging outcome.

Embolization versus myomectomy versus hysterectomy - Which is best, when?

Article

Mar 2002

Ma Lumsden

Uterine fibroids are the commonest tumour affecting the female reproductive tract. In many instances they are asymptomatic, but in some women there does appear to be an association with heavy menstrual blood loss and, possibly, subfertility. Classically, treatment has been surgical with hysterectomy the most common approach for women who have completed their fertility and myomectomy for those who wish to conceive. The surgery can be carried out laparoscopically, vaginally and abdominally, although all routes are associated with an appreciable rate of morbidity. Myomectomy can also be achieved hysteroscopically. Hysterectomy is associated with a high rate of satisfaction and is likely to relieve menstrual problems in virtually all women. The success of myomectomy is less certain since no randomized trials against expectant management have ever been carried out. In addition, myomectomy may lead to adhesion formation within the abdominal cavity, which may impair fertility further. Since myomectomy is not the ideal answer, other treatments for fibroids are being sought. Medical treatment may be useful in specific instances and for the short-term, but does not lead to a cure. Consequently, other modalities are being developed, one of which is uterine artery embolization. This procedure involves occluding the vessels using either foam or coils. The normal myometrium rapidly develops a new blood supply from collateral circulations, whereas the fibroids do not. The procedure leads to fibroid shrinkage of approximately 30-50% and appears to lead to relief of fibroid-associated symptoms, although it is too early to determine the effect on fertility. However, it is associated with significant complications and requires further evaluation before being accepted as a useful alternative to surgical therapy in the management of women with uterine fibroids.

Uterine artery embolisation for the treatment of symptomatic fibroids in 114 women: reduction in size of the fibroids and women's views of the success of the treatment

Article

Feb 2002

To assess the reduction in size of fibroids following uterine artery embolisation and to analyse women's views of the success of treatment. An uncontrolled case series of 114 consecutive women who underwent uterine artery embolisation for the treatment of fibroids over two years. The Diagnostic and Interventional Radiology Department at The Royal Surrey County Hospital, Guildford, UK. Bilateral uterine artery embolisation was performed for the treatment of symptomatic fibroids. Magnetic resonance imaging was carried out before and six months following embolisation. Women completed outcome questionnaires following their treatment. The sites. imaging signal characteristics and percentage reduction in the volume of three dominant fibroids were determined from the magnetic resonance scans. Outcome was measured by questionnaire. Women were asked whether their symptoms resolved completely, improved, remained unchanged or deteriorated. One hundred and sixty-five fibroids of 114 women (mean age 42) were analysed. Forty-five percent of women had complex fibroid masses and 50% had fibroids > or =8.5cm in diameter. The median reduction in the fibroid volume was 58%. The median reduction of the volume of complex fibroid masses, submucous fibroids, fibroids > or =8.5cm and fibroids with high and low signal on T2 weighted sequences were 58%, 63%, 50%, 62% and 51%, respectively. Ninety-one percent of the women's symptoms had resolved or improved following embolisation. The majority of women were satisfied with their outcome. We have shown that uterine artery embolisation is a successful treatment for symptomatic fibroids of all types, sizes and signal characteristics.

II. Uterine fibroid embolization: Technical aspects

Article

Apr 2002
Tech Vasc Intervent Radiol

Successful superselective catheterization of the uterine artery requires familiarity with female pelvic arterial anatomy, knowledge of effective catheter and guidewire combinations, and a few tricks. A learning curve can be expected for each of these elements, although it is assumed that the operator will already have experience in basic catheter techniques. Safe transcatheter delivery, understanding of embolization end points, and avoidance of nontarget embolization are essential. Equally important are knowledge of the properties of the embolic agents currently available and their indications for use. Uterine fibroid embolization unavoidably results in radiation exposure to the uterus and ovaries, and adherence to meticulous fluoroscopic technique is crucial to keep the absorbed dose as low as possible.

Comparison of Long-Term Outcomes of Myomectomy and Uterine Artery Embolization

Article

Dec 2002
OBSTET GYNECOL

To compare long-term outcomes of uterine artery embolization and abdominal myomectomy in patients with symptomatic uterine myomas. At a single institution in an 18-month time, 59 patients had bilateral uterine artery embolization and 38 patients had abdominal myomectomy to treat symptomatic uterine myomas. We reviewed medical records and surveyed patients 3 or more years after their procedures to assess how many needed further surgical procedures in the intervening years, to what extent symptoms remained improved, and how satisfied the patients were with the long term results of the index procedure. Follow-up was available on 51 embolization and 30 myomectomy patients and ranged from 37 to 59 months. Patients who had embolization were older (44 versus 38 years, P <.001) and more likely to have had previous surgical procedures (P <.001) than those who had myomectomy. Taking into account the variable follow-up period, embolization patients were more likely to have had further invasive treatment for myomas (29% versus 3%) (P =.004). Among women not needing further surgery, overall symptoms improved in 92% (33/36) of embolization and 90% (26/29) of myomectomy patients (P =.78). Ninety-four percent (34/36) of embolization patients and 79% (23/29) of myomectomy patients were at least somewhat satisfied with their choice of procedure (P =.06). Women who had embolization were more likely than those who had myomectomy to need further invasive treatment (surgery or repeat embolization) in the 3-5 years after the index procedure. Among women who did not need such treatment, satisfaction and relief of symptoms were similar. Large, randomized trials are needed to more accurately compare these two procedures.

The Ontario Uterine Fibroid Embolization Trial. Part 2. Uterine fibroid reduction and symptom relief after uterine artery embolization for fibroids

Article

Feb 2003
FERTIL STERIL

To evaluate fibroid uterine volume reduction, symptom relief, and patient satisfaction with uterine artery embolization (UAE) for symptomatic fibroids. Multicenter, prospective, single-arm clinical treatment trial. Eight Ontario university and community hospitals. Five hundred thirty-eight patients undergoing bilateral UAE. Bilateral UAE performed with polyvinyl alcohol particles sized 355-500 microm. Three-month follow-up evaluations including fibroid uterine volume reductions, patient reported symptom improvement (7-point scale), symptom life-impact (10-point scale) reduction, and treatment satisfaction (6-point scale). Median uterine and dominant fibroid volume reductions were 35% and 42%, respectively. Significant improvements were reported for menorrhagia (83%), dysmenorrhea (77%), and urinary frequency/urgency (86%). Mean menstrual duration was significantly reduced after UAE (7.6 to 5.4 days). Improvements in menorrhagia were unrelated to pre-UAE uterine size or post-UAE uterine volume reduction. Amenorrhea occurring after the procedure was highly age dependent, ranging from 3% (1%-7%) in women under age 40 to 41% (26%-58%) in women age 50 or older. Median fibroid life-impact scores were significantly reduced after UAE (8.0 to 3.0). The majority (91%) expressed satisfaction with UAE treatment. UAE reduced fibroid uterine volume and provided significant relief of menorrhagia that was unrelated to initial fibroid uterine size or volume reduction. Patient satisfaction with short-term UAE treatment outcomes was high.

Abdominal Myomectomy Versus Uterine Fibroid Embolization in the Treatment of Symptomatic Uterine Leiomyomas

Article

Jul 2003

The purpose of this study was to compare treatment efficacy and complications of abdominal myomectomy with those of uterine fibroid embolization in women with symptomatic uterine fibroids. We analyzed the outcomes of 111 consecutive patients who underwent abdominal myomectomy (n = 44) or fibroid embolization (n = 67) over a 30-month period. The mean ages of the two groups were 37.7 years (range, 28-48 years) and 44.2 years (range, 31-56 years), respectively. A questionnaire and review of medical records assessed all procedure-related complications and changes in symptoms. Length of hospital stay, time until resumption of daily activities, and pain medication requirements after the procedure were also analyzed. Follow-up times for the myomectomy and embolization groups were 14.6 and 14.3 months, respectively. The respective observed success rates in abdominal myomectomy and uterine fibroid embolization patients were 64% versus 92% for menorrhagia (p < 0.05), 54% versus 74% for pain (not significant), and 91% versus 76% for mass effect (p < 0.05). The complication rates were 25% (abdominal myomectomy) and 11% (uterine fibroid embolization) (p < 0.05). The respective secondary end points for the two procedures were 2.9 versus 0 days mean hospital stay, 8.7 versus 5.1 days of narcotics use, and 36 versus 8 days until resumption of normal activities. These differences were all statistically significant. Uterine fibroid embolization is a less invasive and safer treatment option in women with symptomatic leiomyomas than myomectomy. Menorrhagia may be better controlled with embolization, and myomectomy may be a better option in patients with mass effect. Both procedures were equally effective in controlling pain.

Reporting Standards for Uterine Artery Embolization for the Treatment of Uterine Leiomyomata

Article

Oct 2003
J VASC INTERV RADIOL

Scott C. Goodwin, MD, Sheila C. Bonilla, MD, David Sacks, MD, Richard A. Reed, MD, James B. Spies, MD,Wendy J. Landow, MPH, Robert L. Worthington-Kirsch, MD, the Members of the Reporting Standards forUterine Artery Embolization (UAE) Subcommittee, the Members of the UAE Task Force StandardsSubcommittee, and the Members of the Society of Interventional Radiology Technology Assessment Committee

Tolerance, Hospital Stay, and Recovery after Uterine Artery Embolization for Fibroids: The Ontario Uterine Fibroid Embolization Trial

Article

Nov 2003
J VASC INTERV RADIOL

Uterine artery embolization (UAE) is gaining popularity as an alternative to hysterectomy for the treatment of fibroids. Although minimally invasive treatments such as UAE offer the potential of fewer complications, shorter hospital stay, and quicker recovery than surgery, there have been few published data on tolerance and recovery in patients undergoing UAE. This was a multicenter prospective single-arm clinical treatment trial involving the practices of 11 interventional radiologists in eight Ontario university-affiliated and community hospitals. Between November 1998 and November 2000, 555 women underwent UAE for symptomatic uterine fibroids. Follow-up included ultrasound examinations and telephone interviews. UAE was performed under conscious sedation. Polyvinyl alcohol particles (355-500 micro m) were the primary embolic agent, and the procedural endpoint involved stasis in the uterine arteries. Pain protocols included antiinflammatory medications and narcotics and a planned overnight hospital admission. Tolerance and recovery were measured by patient-reported pain intensity (10-point numeric rating and five-point descriptor scale), hospital length of stay (LOS), and time until return to work. Intraprocedural pain was reported by 30% of patients and postprocedural pain was reported by 92% of patients (mean pain rating +/- SD, 7.0 +/- 2.47). The mean hospital LOS was 1.3 nights. Postprocedural pain was the most common indication for an LOS greater than 1 night (18%) or 2 nights (5%). Return visits to the hospital (10%) and readmissions (3%) were primarily for pain. The overall postprocedural complication rate was 8.0% (95% CI: 5.9%-10.6%). Of the 44 complications, 32 (73%) were pain-related. The mean recovery time after UAE was 13.1 days (median, 10.0 d). The majority of patients had a 1-night LOS after UAE and recovered within 2 weeks. Postprocedural pain varied considerably and was the major indication for extended hospital stay and recovery.

Uterine remodeling following conser-vative myomectomy

Jan 1992
632-5

Y Beyth
R Jaffe
Goldberger

Beyth Y, Jaffe R, Goldberger S. Uterine remodeling following conser-vative myomectomy. Acta Obstet Gynecol Scand 1992;71:632–5.

ASA physical status classifi-cation system Available at

Feb 2005

American Society

American Society of Anesthesiologists. ASA physical status classifi-cation system. Available at: http://www.asahq.org/clinical/physicalsta-tus.htm. Last accessed January 13, 2005.

Uterine artery embolization for the treatment of symptomatic leiomyomata. Presented at the 48th Annual Meeting of the American College of Obstetricians and Gynecologists

Apr 2000

Young A Barth
Mh

Young A, Barth MH. Uterine artery embolization for the treatment of symptomatic leiomyomata. Presented at the 48th Annual Meeting of the American College of Obstetricians and Gynecologists, San Francisco, CA; May 22, 2000.

FDA talk paper: FDA clears device to treat fibroids

Feb 2002

Drug Food
Administration

Food and Drug Administration. FDA talk paper: FDA clears device to treat fibroids. Available at: http://www.fda.gov/bbs/topics/answers/ 2002/ans01175.html. Last accessed January 13, 2005.

Abdominal myomectomy

Jan 1996
41

Acien

[Recourse to particular arterial embolization in the treatment of some uterine leiomyoma]

Jan 1997
233

Ravina

Abdominal myomectomy vs. uterine fibroid embolization in the treatment of symptomatic uterine leiomyomas

Jan 2003
1571

Razavi

Fibroid-related menorrhagia

Jan 2000
428

Pelage

Uterine fibroid embolization

Jan 2002
17

Worthington-Kirsch

Uterine artery embolization versus myomectomy: a multicenter comparative study

Abstract

No full-text available

Recommended publications

Uterine Artery Embolization versus Abdominal Myomectomy: A Long-term Clinical Outcome Comparison

Long-term Outcome of Uterine Artery Embolization for Symptomatic Uterine Leiomyomas

A transient blocking uterine perfusion procedure to decrease operative blood loss in laparoscopic my...

Pierce and push: A simplified method to facilitate laparoscopic myomectomy