Embolization of uterine fibroids from the point of view of the gynecologist: pros and cons

Abstract

Uterine artery embolization (UAE) is a minimally invasive procedure with large symptomatic potential in treatment of women with uterine leiomyomas. Due to specificities of this method and possible complications the appropriate indication is crucial. Patient’ symptoms, age, plans for pregnancy, and surgical and reproductive history play a major role in decision-making regarding appropriate subjects for UAE. Close cooperation between the gynecologist and the interventional radiologist is necessary. UAE is usually offered as an alternative to surgical treatment. In patients with no fertility plans, it is a less invasive option than abdominal hysterectomy, with a comparable effect on fibroid-related symptoms and quality of life. The need for reintervention is markedly greater in patients after UAE (up to 35% within 5 years) than after hysterectomy. Women with large symptomatic fibroids wishing to retain the uterus and ineligible for minimally invasive (laparoscopic or vaginal) hysterectomy are good candidates for UAE. However, studies comparing UAE with minimally invasive hysterectomy are lacking. Use of UAE in younger women desiring pregnancy is more controversial, mainly because of the significant risk of miscarriage (as high as 64% in some studies) as well as the increased risk of other complications of pregnancy, such as preterm delivery, abnormal placentation, and post-partum hemorrhage. The risk of infertility or subfertility following UAE is unknown. Even poor candidates for myomectomy should be carefully selected for UAE after counseling about all possible adverse effects on fertility. Good prospective studies focused on fertility comparing UAE with no treatment or with myomectomy are needed but would be ethically questionable. This review summarizes the current knowledge regarding the benefits and potential risks of UAE from the point of view of the gynecologist, who should be responsible for proper indication of this treatment.

A myoma uteri diagnosztikája és kezelése

“…Meddőség, ismételt vetélés kapcsán elvégzett beavatkozásokkal is találkozhatunk az irodalomban, illetve leírnak embolisatio után fogant és kihordott terhességet is [36]. Hosszú távú szövődményként a korai petefé-szek-kimerülés, infekció, amely későbbi petevezetőfunk-ció-vesztéssel meddőséghez vezethet, terhesség alatti méhruptura, illetve a placenta keringésének zavara figyelhető meg [37].…”

Abnormal Uterine Bleeding

“…Although UAE is highly effective in reducing bleeding and the size of the myoma, it may be necessary to repeat the procedure in 15-20% of cases after successful embolization, and in up to 50% of cases of incomplete ischemia. 16,17 (C,D) There are also concerns about the impact of UAE on the ovarian reserve. 18 (C) The desire for future gestation is still recognized as a relative contraindication because there are not enough studies in the literature to guarantee good results.…”

Cost and Distribution of Hysterectomy and Uterine Artery Embolization in the United States: Regional/Rural/Urban Disparities

“…Hysterectomy remains the most frequent surgical procedure to treat uterine fibroids among women who develop severe symptoms during their childbearing years [ 2 , 7 , 8 , 9 , 10 , 11 ]. A study of patient data for the period of 1998 to 2010 indicated that 7,438,452 inpatient hysterectomies were performed in the United States [ 12 , 13 ], 40% of which were to treat patients for uterine fibroids. In 2001 through 2003, women who had abdominal hysterectomy had a longer length of stay [ 14 ].…”

“…However, there is considerable anxiety among women about losing their uteri. Thus, many would prefer alternative procedures to remove the fibroid, saving the uterus, relieving them of the pain, and providing a sense of relief [ 6 , 12 , 16 , 17 , 18 , 19 ]. In addition, better quality of life outcomes have been correlated with these alternative procedures [ 6 , 20 , 21 , 22 , 23 , 24 ].…”