Uterine Artery Embolization for Treatment of Leiomyomata

Goodwin, Scott C.; Spies, James B.; Worthington-Kirsch, Robert L.; Peterson, Eric D.; Pron, Gaylene; Li, Shuang; Myers, Evan R.

doi:10.1097/01.aog.0000296526.71749.c9

Cited by 249 publications

(159 citation statements)

References 28 publications

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“…Despite the recent advances of pharmacotherapy, drug treatment of hysteromyoma is temporary in nature, whereby surgical treatment is still the main tactics to treat this disease (8,9). In addition, use of organ-saving techniques such as myomectomy and embolization of uterine arteries is preferable in women interested in childbearing (10).…”

Section: Discussionmentioning

confidence: 99%

The course and outcomes of pregnancy in patients with hysteromyoma in different treatment methods

Gurjeva¹

2017

GIOG

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Hysteromyoma is the most common disease of the female reproductive system. The frequency of this pathology is between 25 and 50% in women of the reproductive age (1). The problem of fertility preservation in patients with uterine myoma is of particular importance, given, on the one hand, "rejuvenation" of the disease, on the other -abilities of the modern reproduction therapy and expansion of reproductive period boundaries. Currently, hysteromyoma is diagnosed in 12.5% of pregnant (2, 3), and in 18-24% of women is the only etiologic factor of infertility (4). These trends cause an increased interest in minimally invasive organ-saving methods of hysteromyoma treatment, such as uterine arteries (EUA) embolization, which allows saving childbirth functions and restoring impaired reproductive function in female patients of childbearing age.Despite the large number of domestic and foreign publications on the effectiveness and safety of EUA as a method of hysteromyoma treatment (5-7), a number of problems associated with its remote results, and primarily the impact on fertility, the course and outcomes of pregnancy are still unsolved. Currently, there are no large randomized studies on the clinical course of pregnancy after EUA. Most articles lack information about hysteromyoma characteristics, methods of previous treatment, initial fertile status of female patients, which probably explains a large variety of results. Until recently, myomectomy was considered to be the "gold standard" of myoma treatment for women who did not realize reproductive function, while EUA was not recommended for women interested in childbirth.Thus, to date there is no clear answer about the method of selection of interstitial hysteromyoma treatment for patients who are interested in maintaining fer-SUMMARY: The course and outcomes of pregnancy in patients with hysteromyoma in different treatment methods. V.A. GURJEVA, O.V. KOLYADO, Y.O. KARACHEVA The need to study the effect of uterine arteries (EUA) embolization on fertility is due to the fact that the reproductive behavior of a modern woman supposes planning to become pregnant after the age of 30 and older, when hysteromyoma is observed in every 4 women. This fact requires a search for the best types of organ-saving myoma treatment, with a guarantee of consecutive pregnancy and childbirth. The aim of the study was to compare the course and outcome of pregnancy in women with hysteromyoma after EUA and myomectomy to determine the choice of the most optimal treatment method in women with

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Section: Discussionmentioning

confidence: 99%

The course and outcomes of pregnancy in patients with hysteromyoma in different treatment methods

Gurjeva¹

2017

GIOG

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“…Furthermore, it is possible that there was a heterogeneous spectrum of disease across groups. Heterogeneity of disease could be evaluated with a uterine fi broid-specifi c quality of life instrument such as the Uterine Fibroid Symptom and Quality of Life questionnaire ( 37 ), although reported baseline fi broid symptom scores in UAE studies ( 38 ) and MR imaging-guided focused ultrasound surgery studies ( 10 ) are similar. If the possibility of heterogeneous disease is considered, trade-off behavior could be variable and comparisons may be most meaningful within groups before and after treatment.…”

Section: Health Policy and Practice: Quality-of-life Assessment Of Fimentioning

confidence: 99%

Quality-of-Life Assessment of Fibroid Treatment Options and Outcomes

Fennessy

Kong²,

Tempany³

et al. 2011

Radiology

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Purpose:To obtain utilities (a unit of measure of a person's relative preferences for different health states compared with death or worst possible outcome) for uterine fi broids before and after treatment and to measure short-term utilities for the following uterine fi broid treatments: abdominal hysterectomy, magnetic resonance (MR) imaging-guided focused ultrasound surgery, and uterine artery embolization (UAE). Materials and Methods:This retrospective study was approved by the institutional review board and was HIPAA compliant. The waiting trade-off (WTO) method, a variation on the time trade-off (TTO) method, is used to obtain utilities for diagnostic procedures on the basis of the fact that people wait longer to avoid noxious tests and/or procedures. The WTO method provides short-term quality of life tolls in terms of quality-adjusted life-weeks by scaling wait times with pre-and posttreatment utilities. Utilities for uterine fi broids before and after treatment were obtained with the TTO method and a visual analog scale (VAS) by using a questionnaire administered by means of a phone interview. WTO wait times were adjusted for quality of life with VAS and TTO utilities and a transformation of VAS. Wait times were compared by using nonparametric tests. The study participants included 62 patients who had undergone abdominal hysterectomy, 74 who had undergone UAE, and 61 who had undergone MR imaging-guided focused ultrasound surgery. Results:Quality of life increased with all treatments. The median WTO wait time was higher for hysterectomy (21.6 weeks) than for UAE or MR imaging-guided focused ultrasound surgery (14.1 weeks for both) ( P , .05). Quality-adjusted life-week tolls were smaller when scaled according to TTO than when scaled according to VAS or transformation of VAS. Conclusion:Quality of life increased after all fi broid treatments. WTO is feasible for assessing the quality-adjusted morbidity of treatment procedures.q RSNA, 2011Supplemental material: http://radiology.rsna.org/lookup /suppl

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“…This interventional radiologic procedure is recommended for large symptomatic myomas in women who do not wish or are poor candidates for major surgery and requires a short hospital stay and. It was already associated with fewer serious adverse effects than hysterectomy and similar rates of satisfaction [6], reduced fibroidrelated menstrual blood loss by 85% and dominant fibroid volume by 30%-46% [7], and improved quality of life [8].…”

Section: Introductionmentioning

confidence: 99%