Abstract No. 417 Uterine fibroid embolization followed by planned hysteroscopic resection: a proposed treatment paradigm

Abstract

To evaluate the effectiveness of uterine fibroid embolization (UFE) followed by planned hysteroscopic resection in the treatment of large, symptomatic submucosal fibroids. This retrospective study was approved by the Institutional Review Board at the authors’ institution. Thirty patients with submucosal fibroids underwent UFE performed by two different interventional radiologists followed by hysteroscopic resection performed by three different gynecologists. Each patient received a pre-embolization pelvic MRI and 19 patients received a post-embolization, pre-resection pelvic MRI. Pre-embolization fibroid size, percentage of target fibroid size at time of resection, estimated blood loss during resection, and pathologic description of the surgically resected fibroid, pre- and postoperative uterine size were evaluated, and patient symptoms were assessed by the gynecologist in follow-up appointments. From August 2011 to August 2016, thirty patients with symptomatic leiomyomas were treated with bilateral UFE followed by hysteroscopic resection (median days from embolization to resection 35 days, range 21-91 days). The average uterine volume on pre-embolization MRI was 526.7 cm3, and all patients had a dominant submucosal fibroid with a maximum diameter of 4.4-6.0 cm. Post-embolization MRI demonstrated partial to complete necrosis of the target fibroid. In all cases, the fibroids were completely surgically resected in a single session with average blood loss less than 20 mL, and without complications. Following resection, all patients reported complete resolution of their pretreatment menorrhagia and pain at a median follow-up 118 days, mean 140 days. In patients with large symptomatic submucosal fibroids, UFE followed by planned hysteroscopic resection represents a potential treatment paradigm combining minimally invasive techniques with surgery to mitigate the most serious complications of either procedure performed in isolation.