Midterm Outcome of Ultrasound-Guided Alcohol Gel Sclerotherapy for Symptomatic Leiomyoma

Abstract

AbbreviationsGnRH, gonadotropin-releasing hormone; UAE, uterine artery embolization eiomyoma, also known as a fibromyoma or fibroid, is a frequent gynecologic disorder affecting approximately 25% to 35% of women, especially black women, at some point in their lives. 1Although most patients are asymptomatic, the fact that about 50% have clinical symptoms explains the high number of hysterectomies performed all over the world (538,722 per year for benign disease in the United States in 2003).2 The main symptoms of leiomyoma include heavy menstrual bleeding, pelvic pain, abdominal swelling, intestinal, urinary, or venous pressure, and hemorrhagic vaginal discharge (bleeding between periods).3 In addition, myomas are considered infertility factors, although the mechanisms of this association have not been clarified. 4 Diagnosis has been facilitated in the past few years by dissemination of ultrasound techniques. The sensitivity and specificity of ultrasound for diagnosing leiomyomas are as high as 99% and 91%, respectively. L ArticleObjective. The purpose of this study was to describe the outcome of ultrasound-guided ethanol gel sclerotherapy of myomatous nodules 1 to 18 months after treatment. Methods. A total of 118 consecutive patients with a diagnosis of symptomatic leiomyomas referred for ethanol gel sclerotherapy were studied between November 2005 and July 2007. Clinical (self-administered symptom questionnaire) and ultrasound follow-ups were done 1 to 2, 6 to 8, and 12 to 18 months after the procedure. Results. The mean baseline volumes ± SD were 223.3 ± 158.3 cm 3 for the uterus and 68.4 ± 110.5 cm 3 for the dominant fibroid. The most common adverse reaction in the immediate postoperative period was pelvic pain in 27.1% of the patients, but 58.4% had no reactions. After 12 months, a 29.5% reduction in uterine volume was observed in 64.7% of the patients. A 55.5% reduction in dominant fibroid volume was observed in 82.8% of the patients. Pelvic pain improved in 29.8% of the sample, dysmenorrhea in 51.7%, and menstrual flow in 39%. Most patients (77%) reported being satisfied or very satisfied with the treatment. Conclusions. The results suggest that ethanol gel sclerotherapy is a safe, conservative alternative for treating symptomatic uterine leiomyomas. Further randomized studies are necessary to determine the suitability and indications of this procedure in comparison to other minimally invasive techniques.