Comparative outcomes of hysteroscopic examinations performed after uterine artery embolization or laparoscopic uterine artery occlusion to treat leiomyomas

Kužel, D; Mára, Michal; Horák, Petr; Kubínová, Kristýna; Mašková, Jana; Dundr, Pavel; Cindr, Josef

doi:10.1016/j.fertnstert.2010.12.014

Cited by 18 publications

(5 citation statements)

References 18 publications

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“…UAE was performed in patients who failed MTX treatment; with the flow of uterine blood blocked, the patients could undergo hysteroscopy after 24 h. Because sponge particles achieve complete vascular embolization, UAE is more effective and reliable than LUAO, but UAE is associated with a greater risk of intrauterine necrosis [24]. The long-term reproductive outcomes of UAE and LUAO are uncertain at present.…”

Section: Discussionmentioning

confidence: 99%

Management of Caesarean Scar Pregnancies Using an Intrauterine or Abdominal Approach Based on the Myometrial Thickness between the Gestational Mass and the Bladder Wall

Shao

et al. 2013

Gynecol Obstet Invest

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Aim: To describe our experience with various interventions for caesarean scar pregnancies (CSPs) based on the myometrial thickness between the gestational mass and the bladder. Methods: All patients were initially administered methotrexate. Then, the appropriate therapies hysteroscopy alone or combined with uterine artery embolization (group A) and direct laparoscopy alone or combined with laparoscopic uterine artery occlusion (group B) was selected based on the myometrial thickness between the gestational mass and the bladder. Results: The uteri of all 53 patients with CSPs were conserved; no conversion to laparotomy or blood transfusion was required. Uterine rupture occurred in one case during surgery in group A. The operative time in group B was longer than group A (42 ± 18 vs. 80 ± 33 min; p = 0.022). The two groups were also similar with respect to other characteristics (p > 0.05). Conclusion: Myometrial thickness should be considered during the management of CSPs. Surgical approaches in the treatment of CSPs using 2-mm boundaries may yield an optimal clinical outcome.

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Section: Discussionmentioning

confidence: 99%

Management of Caesarean Scar Pregnancies Using an Intrauterine or Abdominal Approach Based on the Myometrial Thickness between the Gestational Mass and the Bladder Wall

Shao

et al. 2013

Gynecol Obstet Invest

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“…Organ histology following embolization has been described in uterine leiomyomas. In these cases, the authors describe hyaline necrosis, dense fibrosis and a lack of inflammation (23). Further complications have been reported, the most dangerous including hematoma formation, fistulas, necrosis with secondary infection and septicemia and pseudoaneurysms responsible for significant hemorrhage.…”

Section: Discussionmentioning

confidence: 99%

The histology of prostate tissue following prostatic artery embolization for the treatment of benign prostatic hyperplasia

et al. 2013

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Objective: Prostatic artery embolization (PAE) for the treatment of patients with symptomatic benign prostatic hyperplasia (BPH) is believed to be a safe procedure with a low risk of adverse side effects. Artery embolization is a viable treatment option in patients who are refractory to the classic noninvasive treatments. Knowledge of the histological characteristics of prostate tissue following the procedure is still limited. In this study, we describe the microscopic aspects of the prostate following PAE for BPH. Materials and Methods: Two patients underwent transurethral resections of the prostate (TURP) after PAE. Embolizations were performed under local anesthesia with an initial pelvic angiography to evaluate the iliac vessels and the prostate arteries using a 2.8 French microcatheter. The prostate was embolized with 300-500μm Microspheres (Embosphere®), using complete blood stasis as the end point. The prostate tissues were analyzed histologically to characterize the effects of the embolization. Results: The embolic material within the prostate tissue was easily identified as homogeneous, bright eosin-red spheroids filling the vessel lumens. Ischemic necrosis surrounded or not by chronic inflammatory reactions containing macrophages were considered as a result of the artery embolization. Also, some aspects related to the healing process were observed being fibrotic nodules surrounded by glands with squamous metaplasia of the epithelial lining the most important. In the remaining sections, due to the precocious surgical intervention, the classic findings of BPH were still present with the glandular and stromal hyperplasia associated with nonspecific chronic prostatitis. Conclusions: This is the first description of prostate histology in BPH patients treated by PAE, a new procedure that is being used increasingly as a therapeutic intervention. The recognition of the changes caused by this new modality of treatment has become a very important differential in a chronic granulomatous reaction of the prostate tissue.

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“…A retrospective study showed a 5.6% rate of amenorrhea after uterine arterial embolization and diffuse uterine synechiae during hysteroscopic investigations, 19 although it was much higher in a study by Sentilhes et al, 20 in which a 22% rate of amenorrhea or decreased menstrual flow was reported. Kuzel et al 21 reported comparative outcomes of hysteroscopic examinations performed about 5 months after uterine arterial embolization to treat leiomyomas, and they reported a 43.2% rate of necrotic changes on histologic examinations. The placenta accreta rate seemed to increase after embolization with necrosis and synechia at the time of the previous pregnancy.…”

Section: Discussionmentioning

confidence: 99%

Novel Use of Contrast‐Enhanced Sonography in the Diagnosis of Central Uterine Necrosis Following Embolization for Postpartum Hemorrhage

Desille

Ouldamer

Bleuzen

et al. 2013

J of Ultrasound Medicine

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Since 2007, we have identified 2 cases of central uterine necrosis after uterine arterial embolization for postpartum hemorrhage. Contrast-enhanced sonography showed an absence of enhancement of the internal myometrium. Magnetic resonance imaging with gadolinium confirmed the diagnosis. The images obtained for the first case were corroborated by histologic analysis from a hysterectomy done for sepsis. For the second case, contrast-enhanced sonography performed during a follow-up period of conservative treatment revealed a reduction of necrosis. Our study shows that contrast-enhanced sonography seems to be a useful examination as an adjunct to grayscale and power Doppler imaging in the diagnosis and follow-up of uterine necrosis.

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Comparative outcomes of hysteroscopic examinations performed after uterine artery embolization or laparoscopic uterine artery occlusion to treat leiomyomas

Cited by 18 publications

References 18 publications

Management of Caesarean Scar Pregnancies Using an Intrauterine or Abdominal Approach Based on the Myometrial Thickness between the Gestational Mass and the Bladder Wall

Management of Caesarean Scar Pregnancies Using an Intrauterine or Abdominal Approach Based on the Myometrial Thickness between the Gestational Mass and the Bladder Wall

The histology of prostate tissue following prostatic artery embolization for the treatment of benign prostatic hyperplasia

Novel Use of Contrast‐Enhanced Sonography in the Diagnosis of Central Uterine Necrosis Following Embolization for Postpartum Hemorrhage

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