Uterine Artery Embolization for Symptomatic Adenomyosis: 7-Year Clinical Follow-up Using UFS-Qol Questionnaire

Bruijn, Annefleur M. de; Smink, Marieke; Hehenkamp, Wouter J.K.; Nijenhuis, Robbert J.; Smeets, Albert J.; Boekkooi, Focco P.; Reuwer, Paul; Rooij, W.J. van; Lohle, Paul N.M.

doi:10.1007/s00270-017-1686-1

Cited by 42 publications

(35 citation statements)

References 18 publications

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“…A total score was calculated and transformed into a symptom severity score (SSS) from 0 to 100 (higher score = more symptoms) and an HR-QoL score ranging from 0 to 100 (higher score = better HR-QoL). The UFS-QoL has been used for patients with adenomyosis before [[19], [20], [21], [22]]. Pelvic pain was assessed using the visual analogue scale for pain (VAS pain) [23], which consists of a 100-mm line with the endpoints "no pain" and "worst pain".…”

Section: Methodsmentioning

confidence: 99%

The effect of transcervical endometrial resection on clinical symptoms related to intrinsic adenomyosis and junctional zone changes

Rasmussen

Hansen

Dahl

et al. 2019

European Journal of Obstetrics & Gynecology and Reproductiv

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Objectives To assess the effect of transcervical endometrial resection on clinical symptoms related to histopathological findings of the junctional zone. Study design This prospective study took place at a university hospital. Premenopausal women suffering from abnormal uterine bleeding and/or pelvic pain and scheduled for transcervical endometrial resection were enrolled (n = 112). Histopathological findings of the endomyometrial biopsies were categorized as follows: Adenomyosis of the inner myometrium (intrinsic adenomyosis): ≥ 2 mm myometrial invasion without contact to the basal endometrium, serrated junctional zone: > 3 mm myometrial invasion with contact to the basal endometrium and linear junctional zone: No or marginal myometrial invasion (≤ 3 mm) with contact to the basal endometrium. All study participants received a baseline and two follow-up questionnaires (6 and 18 months after surgery) regarding symptom severity, health-related quality of life and pelvic pain. Data regarding reintervention surgery was obtained from the National Database Patoweb . The rate of reintervention surgery and the improvement in symptom severity, health-related quality of life and pelvic pain were correlated to histopathological findings. Results Twenty-four patients had intrinsic adenomyosis, 31 had serrated junctional zone and 57 had linear junctional zone. Fifteen patients (13%) underwent reintervention surgery; three (20%) within 6 months, nine (60%) between 6–18 months and three (20%) > 18 months after transcervical endometrial resection. Reintervention surgery was more common in women with intrinsic adenomyosis compared to women without (33% (95% CI: 16–55) vs 8% (95% CI: 3–16)) (p-value: < .05). Nine patients (38%) with intrinsic adenomyosis were asymptomatic based on low symptom severity score, high health-related quality of life and no pelvic pain at 18 months follow-up. Patients with linear junctional zone had a higher improvement in symptom severity and health-related quality of life than patients with intrinsic adenomyosis or serrated junctional zone at 6 months follow-up after surgery (p-value < .05). However, there was no significant difference in pelvic pain reduction. Conclusion The effect of transcervical endometrial resection may depend upon the degree of junctional zone changes, and patients with intrinsic adenomyosis are more likely to undergo reintervention surgery than patients with either linear or serrated junctional zone. However, intrinsic adenomyosis may also be successfully treated with endometrial resection.

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Section: Methodsmentioning

confidence: 99%

The effect of transcervical endometrial resection on clinical symptoms related to intrinsic adenomyosis and junctional zone changes

Rasmussen

Hansen

Dahl

et al. 2019

European Journal of Obstetrics & Gynecology and Reproductiv

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“…Recently, innovations in ultrasound skill and reporting systems have proven to be of essential value in diagnosing adenomyosis without the need for prior hysterectomy (Van den Bosch et al ., 2018; Stoelinga et al ., 2018). Therapy options are still scarce and limited to hormonal suppression, hysterectomy, embolization or MRI-guided high-intensity focused ultrasound in experimental settings (de Bruijn et al ., 2017; de Bruijn et al ., 2017; de Bruijn et al ., 2018; Pontis et al ., 2016; Dueholm, 2017; Vannuccini et al ., 2018; Fan et al ., 2012). The pathology of adenomyosis explaining the symptoms of AUB and implantation failure remains inconclusive (Abbott, 2017; Vannuccini et al ., 2017).…”

Section: Introductionmentioning

confidence: 99%

Role of angiogenesis in adenomyosis-associated abnormal uterine bleeding and subfertility: a systematic review

Harmsen

Wong

Mijatovic

et al. 2019

Human Reproduction Update

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BackgroundAdenomyosis commonly occurs with abnormal uterine bleeding (AUB) and is associated with subfertility and a higher miscarriage rate. Recent evidence showed abnormal vascularization in the endometrium in patients with adenomyosis, suggesting a role of angiogenesis in the pathophysiology of AUB and subfertility in adenomyosis and providing a possible treatment target.Objective and rationaleWe hypothesized that the level of abnormal vascularization and expression of angiogenic markers is increased in the ectopic and eutopic endometrium of adenomyosis patients in comparison with the endometrium of control patients. This was investigated through a search of the literature.Search methodsA systematic search was performed in PubMed and Embase until February 2019. Combinations of terms for angiogenesis and adenomyosis were applied as well as AUB, subfertility or anti-angiogenic therapy. The main search was limited to clinical studies carried out on premenopausal women. Original research articles focusing on markers of angiogenesis in the endometrium of patients with adenomyosis were included. Studies in which no comparison was made to control patients or which were not published in a peer-reviewed journal were excluded. A second search was performed to explore the therapeutic potential of targeting angiogenesis in adenomyosis. This search also included preclinical studies.OutcomesA total of 20 articles out of 1669 hits met our selection criteria. The mean vascular density (MVD) was studied by quantification of CD31, CD34, von Willebrand Factor (vWF) or factor-VIII-antibody-stained microvessels in seven studies. All these studies reported a significantly increased MVD in ectopic endometrium, and out of the six articles that took it into account, four studies reported a significantly increased MVD in eutopic endometrium compared with control endometrium. Five articles showed a significantly higher vascular endothelial growth factor expression in ectopic endometrium and three articles in eutopic endometrium compared with control endometrium. The vascular and pro-angiogenic markers α-smooth muscle actin, endoglin, S100A13, vimentin, matrix metalloproteinases (MMPs), nuclear factor (NF)-kB, tissue factor (TF), DJ-1, phosphorylated mammalian target of rapamycin, activin A, folli- and myostatin, CD41, SLIT, roundabout 1 (ROBO1), cyclooxygenase-2, lysophosphatidic acid (LPA) 1,4-5, phospho signal transducer and activator of transcription 3 (pSTAT3), interleukin (IL)-6, IL-22 and transforming growth factor-β1 were increased in ectopic endometrium, and the markers S100A13, MMP-2 and -9, TF, follistatin, myostatin, ROBO1, LPA1 and 4-5, pSTAT3, IL-6 and IL-22 were increased in eutopic endometrium, compared with control endometrium. The anti-angiogenic markers E-cadherin, eukaryotic translation initiation factor 3 subunit and gene associated with retinoic-interferon-induced mortality 19 were decreased in ectopic endometrium and IL-10 in eutopic endometrium, compared with control endometrium. The staining level of vWF and two pro-angiogenic markers (NF-κB nuclear p65 and TF) correlated with AUB in patients with adenomyosis. We found no studies that investigated the possible relationship between markers of angiogenesis and subfertility in adenomyosis patients. Nine articles reported on direct or indirect targeting of angiogenesis in adenomyosis—either by testing hormonal therapy or herbal compounds in clinical studies or by testing angiogenesis inhibitors in preclinical studies. However, there are no clinical studies on the effectiveness of such therapy for adenomyosis-related AUB or subfertility.Wider implicationsThe results are in agreement with our hypothesis that increased angiogenesis is present in the endometrium of patients with adenomyosis compared with the endometrium of control patients. It is likely that increased angiogenesis leads to fragile and more permeable vessels resulting in adenomyosis-related AUB and possibly subfertility. While this association has not sufficiently been studied yet, our results encourage future studies to investigate the exact role of angiogenesis in the etiology of adenomyosis and related AUB or subfertility in women with adenomyosis in order to design curative or preventive therapeutic strategies.

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“…Uterine artery embolization (UAE) was first described in 1995 by Ravina et al [20] then later established as an effective treatment option for patients with symptomatic uterine fibroids [21, 22]. Since then, UAE has been investigated as a noninvasive treatment option for adenomyosis with initial promising results [23, 24]. What remains to be known is whether UAE can be validated as a safer, noninvasive, uterine-sparing alternative to hysterectomy.…”

Section: Introductionmentioning

confidence: 99%

“…Earlier studies by Popovic, Keung, and Zhou et al demonstrate long-term improvement in patient symptoms (in over 60% of patients) and a short-term decrease in uterine volumes (in over 20% of patients), especially in vascular lesions [23, 107, 108]. Current literature by Dueholm and Bruijn et al show up to 67% long-term (40 month) treatment success and up to and 72% patient satisfaction rates respectively [24, 100]. In the latest systematic review and meta-analysis by de Bruijn et al, patients were divided into four groups to report short- and long-term outcomes.…”

Section: Introductionmentioning

confidence: 99%

Management of uterine adenomyosis: current trends and uterine artery embolization as a potential alternative to hysterectomy

Dessouky

Gamil²,

Nada

et al. 2019

Insights Imaging

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Adenomyosis is a challenging clinical condition that is commonly being diagnosed in women of reproductive age. To date, many aspects of the disease have not been fully understood, making management increasingly difficult. Over time, minimally invasive diagnostic and treatment methods have developed as more women desire uterine preservation for future fertility or to avoid major surgery. Several uterine-sparing treatment options are now available, including medication, hysteroscopic resection or ablation, conservative surgical methods, and high-intensity focused ultrasound each with its own risks and benefits. Uterine artery embolization is an established treatment option for uterine fibroids and has recently gained ground as a safe and cost-effective method for treatment of uterine adenomyosis with promising results. In this review, we discuss current trends in the management of uterine adenomyosis with a special focus on uterine artery embolization as an alternative to hysterectomy.

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Uterine Artery Embolization for Symptomatic Adenomyosis: 7-Year Clinical Follow-up Using UFS-Qol Questionnaire

Cited by 42 publications

References 18 publications

The effect of transcervical endometrial resection on clinical symptoms related to intrinsic adenomyosis and junctional zone changes

The effect of transcervical endometrial resection on clinical symptoms related to intrinsic adenomyosis and junctional zone changes

Role of angiogenesis in adenomyosis-associated abnormal uterine bleeding and subfertility: a systematic review

Management of uterine adenomyosis: current trends and uterine artery embolization as a potential alternative to hysterectomy

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