Uterine Artery Embolization versus Abdominal Myomectomy: A Long-term Clinical Outcome Comparison

Abstract

Purpose: To assess long-term clinical efficacy of uterine artery embolization compared to abdominal myomectomy.Materials and Methods-Consecutive women who received either uterine artery embolization or abdominal myomectomy for symptomatic uterine leiomyomata between 2000 and 2002 at a single institution were enrolled. We include patients whose procedures were performed 5 years prior to the study. Symptom evaluations using symptom severity scores, pregnancy rates and satisfaction of the procedures were obtained by IRB-approved questionnaires. Chart reviews were performed to supplement analyses.Results-The retrospective cohort included 185 patients, including 87 uterine artery embolization patients (47.0%) and 98 abdominal myomectomy patients (53.0%). Eighty nine patients (48.1%) completed the long-term follow-up, of whom 48 had uterine artery embolization and 41 had abdominal myomectomy. Follow up ranged from 50 to 83 months.A higher but not statistically significant number of patients received repeat interventions after abdominal myomectomy (14%) than uterine artery embolization (8%) (p=0.204). Statistically significantly higher symptom severity score improvement in patients with uterine artery embolization than abdominal myomectomy was seen (34 vs 31, p = 0.02). Uterine artery embolization patients were less likely to attempt to get pregnant (p = 0.02), however those who did had a 66.7% success rate compared with 58.8% for abdominal myomectomy patients. Similar numbers of patients with uterine artery embolization were satisfied (p= 0.57), reported effectiveness in relieving symptoms (p=0.43), and would recommend the procedure (p=0.37) compared with abdominal myomectomy patients.Conclusion-Uterine artery embolization results in long-term clinical success with outcomes comparable or superior to abdominal myomectomy.

Is Embolization Equal to Hysterectomy in Treating Uterine Fibroids?

“…Hysteroscopic myomectomy is an method for the management of abnormal uterine bleeding caused by submucous leiomyomas. Submucosal leiomyomas are estimated to be the cause of 5-10% of cases of abnormal uterine bleeding, pain, and subfertility and infertility (Guarnaccia & Rein, 2001;Narayan et al, 2010;Wallach & Vlahos, 2004). Laparoscopic myomectomy minimizes the size of the abdominal incision, resulting in a quicker postoperative recovery, a shorter time to hospital discharge, reduced analgesic requirements and less blood loss.…”

“…There is neither need for the blood transfusion nor the abdominal incision. Recovery is shorter than recovery from hysterectomy or open myomectomy (seven to 10 days versus six weeks), and UAE results in long-term clinical success with outcomes comparable or superior to those of abdominal myomectomy (Narayan et al, 2010;Worthington-Kirsch et al, 1998) and early menopause-like symptoms are rarely induced as a result of UAE, as are often seen with gonadotrophin releasing hormone (GnRh) therapy. All fibroids are treated at once, which is not the case with myomectomy.…”

Uterine fibroids embolization in a tertiary hospital: our initial experience

“…4 Various studies also show comparable results of abdominal myomectomies with UFE and indeed even suggest that UFE is safer with shorter recovery time. 5,6 There are studies that show that patients can conceive and have successful pregnancy outcomes after UFE. 7 UFE has hence gained considerable acceptance as an alternative treatment for uterine fibroids.…”

The Outcomes of Minimally Invasive Uf Treatment Technologies

“…Данные о темпах и итогах сокращения размеров миоматозных узлов и объеме деваскуляризации варьируют, затрудняя оценку клинической эффективности ЭМА и вероятность прогнозирования рецидивов ММ [6]. Однако суммация ближайших и отдаленных исходов ЭМА позволяет утверждать о предикции редукции узлов их локализацией, особенностями кровоснабжения, наличием маточно-яичниковых анастомозов, корректностью показаний к вмешательству и технике его исполнения [5].…”