Dominant Fibroid Volume Research Articles

Use of Non-Contrast-Enhanced MR Angiography to Assess Recanalization after Uterine Artery Embolization

The purpose of this study was to examine the use of non-contrast-enhanced MR angiography (MRA) for assessing recanalization of uterine arteries (UAs) after uterine artery embolization (UAE) for symptomatic fibroids. Pre-procedural and follow-up unenhanced MRA images of 30 patients were reviewed, and the extent to which the UAs could be visualized was classified on a 4-point scale. An increase in the score between consecutive time points indicates that a previously inconspicuous segment of the UA became visible on follow-up images. Patients were divided into two groups according to the presence (or absence) of recanalization. The median UA visualization score at each follow-up was significantly lower than that at baseline (p < 0.01), but there was no significant difference between the scores of the follow-up images. Recanalization was detected in 63% (19/30) of patients. In these patients, the mean decrease in uterine and largest fibroid volume at 12 months after UAE was inferior to the mean decrease in patients for whom recanalization was not detected. Based on MRA assessment, recanalization after UAE occurred in 63% of patients but did not compromise the reduction in uterine and dominant fibroid volumes within 12 months after UAE.

Uterin Fibroid Embolizasyon İşleminde Kullanılan Mikroküre Boyutunun Tedaviye Etkilerinin Retrospektif Analizi

Giriş: Uterin fibroidlerin tedavisinde altın standart yöntem minimal invaziv uterus koruyucu cerrahilerdir. Uterin fibroid embolizasyonu işlemi yaklaşık 20 yıldır uygulanmaktadır. Embolizan ajan olarak kullanılan mikroküre boyutlarının UFE tedavisine etkileri retrospektif olarak araştırılmıştır. &#x0D; Gereç ve Yöntemler: Retrospektif çalışmamızda UFE uygulanan 44 hastadan 500 Mikron ve altı boyutta mikroküreler ile tedaviye başlayan hastalar (Grup 1) ile 700 Mikron ve üstü mikroküre kullanılan hastaların (Grup 2) sonuçları karşılaştırıldı. Ağrı skorlaması, semptomlar ve dominant fibroid volümü işlem öncesi ve UFE sonrası 6. ay sonuçları karşılaştırıldı. &#x0D; &#x0D; Bulgular:Çok ciddi ağrı ve ciddi ağrı skorlayan hastaların sayısı Grup 1’de daha fazladır. Grup 1 ortalama ağrı skoru 4,9 iken Grup 2’de bu skor 3,6 bulundu(P

Randomised Controlled Trial of Particles Used in Uterine fibRoid Embolisation (PURE): Non-Spherical Polyvinyl Alcohol Versus Calibrated Microspheres

PurposeThe PURE study is a randomised controlled trial (RCT) comparing the clinical and MRI outcomes of patients treated with non-spherical polyvinyl alcohol, ns-PVA (Contour PVA–Boston Scientific–355–500 & 500–700 microns) versus calibrated hydrogel microspheres (Embozene–Varian Inc–700 & 900 microns) for symptomatic uterine fibroids.Materials and MethodsProspective, ethically approved non-sponsored RCT in 84 patients in a single UK tertiary IR unit, ISRCTN registry trial number ISRCTN18191539 in 2013 and 2014. All patients with symptomatic fibroid disease were eligible. UAE followed a standardised protocol with UFS-QOL and contrast-enhanced MRI before and 6 months post UAE. Outcome measures included: (1) Uterine Fibroid Symptom and Quality of Life questionnaire (UFS-QOL). (2) Percentage total and dominant fibroid infarction. (3) Uterine and dominant fibroid volume reduction. (4) Volume of embolics.ResultsSixty-three patients completed the QOL follow-up (33 ns-PVA vs 30 Embozenes), the groups were equivalent at baseline. Patients were followed up for 6 months following UAE. There was no significant difference in symptom scores or HR-QOL between ns-PVA and Embozenes, p = 0.67 and 0.21, respectively. 92.7% of patients treated with ns-PVA achieved > 90% dominant fibroid infarction versus 61.8% treated with Embozenes (p = 0.0016). 66% of patients treated with ns = PVA achieved > 90% total fibroid percentage infarction compared with 35% in the Embozene group (p = 0.011). The mean vials/syringes used were 5.2 with Embozenes versus 4.1 using PVA (p = 0.08).ConclusionThe PURE study informs IRs regarding the efficacy of embolic agents in UAE, with superior fibroid infarction on MRI using ns-PVA versus Embozenes however no significant difference in clinical outcomes at 6 months after UAE.

Uterine artery embolization with highly compressible calibrated microspheres for the treatment of uterine fibroids.

ObjectiveTo evaluate the safety and efficacy of using highly compressible calibrated microspheres in uterine artery embolization (UAE) for the treatment of uterine fibroids.Materials and MethodsThis was a prospective multicenter study. Thirty-two women with symptomatic uterine fibroids were selected for UAE between January 2019 and March 2020. The participants completed the Uterine Fibroid Symptom and Quality of Life (UFS-QOL) questionnaire, underwent contrast-enhanced pelvic magnetic resonance imaging (MRI), and were submitted to anti-Müllerian hormone measurement, subsequently undergoing UAE with Embosoft microspheres. After six months, the patients again completed the UFS-QOL questionnaire and underwent pelvic MRI.ResultsThe most common symptoms were abnormal uterine bleeding (in 81.3% of the cases), pelvic pain (in 81.3%), and compression (in 46.9%). Of the 32 patients evaluated, 12 (37.5%) had anemia due to abnormal uterine bleeding. Thirty patients completed the study. Among those patients, we observed median reductions of 21.4% in uterine volume and 15.9% in dominant fibroid volume. We identified no adverse events that could be attributed to the material itself, although there were events attributed to the UAE procedure in general.ConclusionFor the treatment of uterine fibroids, UAE using Embosoft microspheres shows satisfactory results, providing reductions in uterine and dominant fibroid volumes, with a low rate of adverse events, and improving patient quality of life, as well as demonstrating safety and efficacy.

The role of uterine artery embolization in management of abnormal uterine bleeding

Background:Abnormal uterine bleeding is a common presenting symptom in the family practice setting. The most common causes are uterine fibroids, dysfunctional uterine bleeding and adenomyosis. All conditions were accompanied by chronic blood loss disabling normal lifestyle with variable degrees of morbidity. Objectives: This study is aiming to evaluate the safety, efficacy, and complications of uterine artery embolization(UAE) in the management of abnormal uterine bleeding (AUB)in different age groups. Patients and Methods: This a prospective randomized clinical trial prospective study included 20 patients referred for UAE. Twelve patients had uterine fibroids, 4 patients had adenomyosis and other 4 patients were diagnosed as dysfunctional uterine bleeding. The embolizing materials were used includingPolyvinyl alcohol, Tris- acryl gelatin microspheresand gelatin sponge. All patients had AUB. Results: Most patients showed good therapeutic responses through the follow up period (6-12 months). Complete control of bleeding was achieved in 90% of patients and recurrence occurred only in 10%. There was complete improvement of the pelvic pain and bulk related symptoms. Reduction of uterine and fibroid size occurred with average uterine and dominant fibroid volumes loss of 39%, and 57% respectively. However, the reduction in the Junctional zone thickness was 5.6 %. Conclusion: UAE is considered minimally invasive, safe, and effective method that plays an important role in treatment of variable types of AUB causes, aiming for uterine preservation and avoiding hysterectomy giving the chance for future fertility. It has high success rate with obvious low morbidity and mortality rates.

The impact on Anti-Mullerian Hormone (AMH), uterine fibroid size and uterine artery patency following Uterine Fibroid Embolization (UFE) with a resorbable embolic agent

The effect of Uterine Fibroid Embolization on fertility and ovarian reserve remains uncertain. We assessed the impact of a new resorbable, spherical particle (Gelbead) on concentration of Anti-Mullerian (AMH) hormone, fibroid volume and uterine artery patency. This prospective cohort study recruited consecutive patients from July 2017 to June 2018. Serum AMH, fibroid and uterine volume, UFS-QOL (uterine fibroid score-quality of life) scores were measured prior to and at 1 month and/or 3 months post embolization. Twenty-four participants were enrolled (median age 44 years, uterine volume 484 cm3, initial dominant fibroid volume 167 cm3). One patient was lost to follow-up. AMH (median ± SD) immediately prior to embolization was 3.2 ± 13.7 pmol/L. At 1-month postembolization, AMH was 4.1 ± 8.6 pmol/L and at 3 months 4.4 ± 8.6 pmol/L. We found no significant difference in AMH levels between baseline and at 1 month (p = 0.58) or baseline and 3 months (p = 0.17). The median dominant uterine fibroid volume decreased (167 to 64 cm3, p < 0.001). At 3 months post-embolization, 17/23 patients had patent uterine arteries bilaterally (73.9%). UFE with Gel-bead did not significantly affect AMH at 3 months post embolization, whilst maintaining a high rate of uterine artery patency.

A retrospective cohort study comparing a novel, spherical, resorbable particle against five established embolic agents for uterine fibroid embolisation

To evaluate the effectiveness of a novel, resorbable, spherical embolic agent compared with other established agents, by studying percentage fibroid infarction (the best indicator of long-term symptom improvement) in patients undergoing uterine fibroid embolisation (UFE). This retrospective cohort study examined six different embolic agents used for fibroid embolisation, including a new gelatin-based, fully resorbable, spherical agent. The primary effectiveness outcomes were magnetic resonance imaging (MRI)-determined dominant fibroid infarct percentage (DF%) and all fibroid percentage infarct (AF%) at 3 months post-embolisation. MRI-determined uterine artery patency rate was the secondary outcome. Chi-squared test (χ2), relative risk (RR) calculation (primary outcomes), and analysis of variance (ANOVA) (secondary outcome) were the statistical tests employed. One hundred and twenty patients were treated with six embolic agents (20 consecutive patients per group, overall mean age 44.8±6.4, initial uterine volume 570±472 ml, dominant fibroid volume 249±324 ml). Fibroid infarctrates were similar between the cohorts with no significant difference between the new gelatin-based resorbable particle and other embolics in either DF% (χ2=3.92, p=0.56) or AF% (χ2=2.83, p=0.73). Complete DF% RR=1.07 (0.90-1.27) and AF% RR=1.09 (0.85-1.41) suggest non-inferiority of the resorbable particle (d=0.67, p<0.05). A favourable uterine artery patency rate was demonstrated for the resorbable particle compared with gelatin slurry (82.5% versus 27.5%, p<0.001 after Bonferroni adjustment). This new gelatin-based, fully resorbable particle is an effective embolic agent for fibroid embolisation and achieves an infarct rate non-inferior to established embolics.

Comparison between the outcome of single versus multiple uterine fibroids after uterine artery embolization

BackgroundUterine fibroids are the most common benign tumor of the reproductive tract in women. Uterine artery embolization has been approved as an alternative treatment option for uterine fibroids to reduce uterine and fibroid volumes as well as to relieve the patient symptoms. The current study included 80 patients with symptomatic uterine fibroids. All patients underwent pre-embolization MRI, uterine artery embolization, and follow-up post-embolization MRI at 6 months post procedure for a reduction in uterine and dominant fibroid volumes. The aim of the study was to assess the role of transcatheter uterine artery embolization in reducing the uterine fibroid volume.ResultsThere was a significant difference in the uterine volume reduction between a group with single fibroids and a group with multiple uterine fibroids The mean uterine volume reduction in the first group was 46.5% compared to 37.4% reduction in the second group. While there was no significant difference in the dominant fibroid volume reduction between both groups (48.8% and 44.9% respectively).ConclusionsUAE has a high efficacy in the reduction of both the uterine volume and the dominant fibroid volume, which results in improvement in patient’s quality of life.

Uterine Fibroid Embolization (UFE) with Optisphere: A Prospective Study of a New, Spherical, Resorbable Embolic Agent

Optisphere(Teleflex, Wayne, PA, USA, currently distributed by Medtronic, Minneapolis, MN, USA) is a new, resorbable, calibrated spherical embolic agent. We aimed to evaluate its clinical safety and effectiveness for fibroid embolization through a prospective case series. This prospective case series studied patients treated with fibroid embolization using Optisphere between July 2017 and June 2018. The primary outcomes were device-related adverse event assessments and MRI-determined percentage infarct of the dominant fibroid (DF%) and infarct of all fibroids (AF%) at 3months post-embolization. Secondary outcomes included symptom improvement with the validated Uterine Fibroid Symptom Score and Quality of Life questionnaire (UFS-SS and UFS-QOL) at 3months and 12months post-embolization. Statistical analysis was through the Wilcoxon signed-rank test for nonparametric paired data. Twenty-three consecutive patients were treated with Optisphere (median age 44.0, uterine volume 484.0ml, dominant fibroid volume 167.0ml). The complete dominant fibroid infarction (DF%) rate was 91.3% (21/23 patients), and the complete all fibroid infarction rate (AF%) was 82.6% (19/23). No adverse device-related safety events were encountered. Significant improvement was demonstrated in 3-month UFS-SS (56 vs 19, p < 0.0001), UFS-QOL (40 vs 88, p = 0.0008), uterine volume (484ml vs 246ml, p < 0.0001) and dominant fibroid volume (167 vs 64ml, p < 0.0001). Symptomatic improvement continued to 12months (UFS-SS 56 vs 11, p = 0.0008, UFS-QOL 40 vs 98.7, p = 0.0008). Optisphere is an effective embolic agent for fibroid embolization with good symptomatic response and percentage fibroid infarct.

The Role of Magnetic Resonance Imaging in Evaluation of Leiomyoma after Uterine Artery Embolization

AbstractBackground: Uterine leiomyomas are the most common benign tumours in women and accounts for the majority of hysterectomies in the world. MR imaging performed before and after uterine artery embolization is the best imaging modality to diagnose, map, and characterize fibroids.Aim of Study: To emphasize the utility of MR imaging in the post-procedural assessment for uterine leiomyomas patients who underwent uterine artery embolization.Patients and Methods: A retrospective study was carried out on 15 patients who underwent MRI scan as a six-month follow-up after uterine artery embolization for treating uterine fibroids during the period from October 2018 to March 2019.Results: The mean uterine volume was significantly reduced by 61% (p-value 0.015), the mean dominant fibroids volume significantly reduced by 79% (p-value 0.004) and the dominant fibroids showed significant lack of enhancement 100% (p-value <0.001) that indicted treatment success and in assessing the outcomes and complications as only 1 (6.7%) patient detected with pyometra (uterine infection). In this study we noted significant improvement of bleeding in 69.2% and of pain in 11.1% with slight improvement of pressure symptoms in 66.7%.Conclusion: 6-month follow-up MRI has an important role in evaluation of UAE success through uterine and dom-inant fibroid volume reduction and lack of enhancement, and evaluation of the outcomes and complications including fibroid regrowth, fibroid change site, pyometra and uterine necrosis.

Assessing Safety and Efficacy of Uterine Artery Embolization in Symptomatic Uterine Fibroids

AbstractBackground: Uterine artery embolization (UAE) is a modality for management of symptomatic uterine leiomyomata. UAE for uterine fibroids in Egypt is a procedure with minimal reported data.Aim of Study: To determine safety and efficacy of UAE in treating uterine leiomyomata in Egyptian population.Patients and Methods: 45 consecutive patients undergoing UAE for uterine leiomyomata management were questioned for fibroid associated manifestation and symptomatic improve-ment at predetermined follow-up clinical visits. Data were obtained via verbal questionnaire.Data collected included early, late procedural related complications and possible gynecological interventions were gathered.Follow-up imaging by MRI at three and six months was carried out in order to measure reduction in uterine, dominant leiomyomata volume post-UAE.Results: Technical success was achieved in 100% of patients. No significant complication took place with no necessary post procedural-related gynecological interventions.Follow-up duration was 6 months. Heavy menstrual bleeding improved in 91.1% of patients at 3 months and in 95.6% at 6 months post treatment. Pressure-related symptoms improved in 84.4% of patients at 3 months and in 95.6% at 6 months after treatment. Convenient control of pain was evident in 55.6% of patients at 3 months and in 73.3% at 6 months post-UAE. MRI showed highly significant reduction in uterine as well as dominant fibroid volumes (24.4, 31.1 % at 3, 6 months), (33.3, 44.4% at 3, 6 months) respectively.Conclusion: Uterine artery embolization is an effective procedure in treatment of symptomatic uterine leiomyomata with reduced post-procedural complications.

03:00 PM Abstract No. 131 Uterine artery patency after embolization: a prospective study and multivariate analysis

Patency of the uterine arteries after embolization may have important implications for women with future fertility wishes. We aimed to investigate if certain embolic agents achieved a greater patency rate whilst not compromising on infarct achieved. A prospective study of 124 patients undergoing uterine fibroid embolization (UFE) at a single centre was conducted. Multivariate analysis was performed to compare the uterine artery patency rates of six different embolic agents; PVA, Embozene, Beadblock, Embosphere, Gelfoam, Optisphere. The ANOVA multivariate analysis adjusted for factors including operator, dominant fibroid volume, uterine volume, patient age. Bonferri statistical adjustment was performed. Ordinal regression analysis was conducted to assess for differences in fibroid infarct percentage (classified as 100% infarct, 90-99% and <90%). Baseline patient characteristics were similar to previous studies (mean age 44.8, Uterine volume 579.8 cm3, dominant fibroid volume 249.0 cm3) with no significant difference between the embolic groups. Optisphere (adjusted marginal mean uterine artery patency 83.9%), Embosphere (68.3%) embozene (94.5%), beadblock (91.8%), and PVA (88.9%) all demonstrated similar levels of artery patency following multivariate analysis with no statistically significant difference between these embolic agents (p=1.0 after Bonferri adjustment). Optisphere demonstrated a greater level of vessel patency compared with Gelfoam 83.9% vs 14.0% (mean difference 69.9, p=0.001). All embolic agents demonstrated similar levels of dominant fibroid (DF) and all fibroid (AF) infarct (Optisphere vs other particles; DF odds ratio 0.28- 1.3 p=0.19-0.81, AF odds ratio 0.18-2.0 p=0.23-0.67). Most embolic agents achieved similar levels of uterine artery patency after embolization, other than Gelfoam which had a higher rate of uterine artery occlusion.

Are fibroid and bony pelvis characteristics associated with urinary and pelvic symptom severity?

Urinary and pelvic floor symptoms often are attributed to size and location of uterine fibroid tumors. However, direct supporting evidence that links increased size to worsening symptoms is scant and limited to ultrasound evaluation of fibroid tumors. Because management of fibroid tumors is targeted towards symptomatic relief, the identification of fibroid and pelvic characteristics that are associated with worse symptoms is vital to the optimization of therapies and prevention needless interventions. We examined the correlation between urinary, pelvic floor and fibroid symptoms, and fibroid size and location using precise uterine fibroid and bony pelvis characteristics that were obtained from magnetic resonance imaging. A retrospective review (2013-2017) of a multidisciplinary fibroid clinic identified 338 women who had been examined via pelvic magnetic resonance imaging, Pelvic Floor Distress Inventory questionnaire (score 0-300), and a Uterine Fibroid Symptoms questionnaire (score 1-100). Multiple linear regression analysis was used to assess the influence of clinical factors and magnetic resonance imaging findings on scaled Pelvic Floor Distress Inventory and Uterine Fibroid Symptoms scores. Data were analyzed with statistical software. Our cohort of 338 women had a median Pelvic Floor Distress Inventory of 72.7 (interquartile range, 41-112.3). Increased Pelvic Floor Distress Inventory score was associated with clinical factors of higher body mass index (P<.001), noncommercial insurance (P<.001), increased parity (P=.001), and a history of incontinence surgery (P=.003). Uterine volume, dominant fibroid volume, dimension and location, and fibroid tumor location relative to the bony pelvis structure did not reach significance when compared with pelvic floor symptom severity. The mean Uterine Fibroid Symptoms score was 52.0 (standard deviation, 23.5). An increased Uterine Fibroid Symptoms score was associated with dominant submucosal fibroid tumors (P=.011), body mass index (P<.0016), and a clinical history of anemia (P<.001) or any hormonal treatment for fibroid tumors (P=.009). Contrary to common belief, in this cohort of women who sought fibroid care, size and position of fibroid tumors or uterus were not associated with pelvic floor symptom severity. Whereas, bleeding symptom severity was associated with dominant submucosal fibroid tumor and previous hormonal treatment. Careful attention to clinical factors such as body mass index and medical history is recommended when pelvic floor symptoms are evaluated in women with uterine fibroid tumors.

Impact of grayscale and Doppler ultrasound characteristics on reducing the size of tumors in the treatment of uterine fibroids by uterine artery embolization.

Aim of the studyUterine fibroids are one of the most prevalent benign tumors. This study aimed to evaluate the effect of uterine artery embolization on treating and reducing the size of symptomatic uterine fibroids.Material and methodsEighty patients with uterine fibroids were selected for this study. Then ultrasound and Doppler were performed by a radiologist to evaluate the size, number, echogenicity, vascularity, and location of fibroids in the uterine wall. Before performing uterine artery embolization, prothrombin time, partial thromboplastin time, international normalized ratio, blood urea nitrogen, and creatinine tests were performed for all the patients to identify background problems. Finally, SPSS 22 was used for data analysis.ResultsThe dominant fibroid volume before the embolization was 244.57 cm3, which decreased to 219.96 cm3, 190.58 cm3, 114.18 cm3, 140.51 cm3, and 78.86 cm3 in the first week, first month, third month, sixth month and first year after embolization, which was statistically significant (p < 0.001 in all cases). Uterine volume in multiple tumor before the embolization was 486.27 cm3, which decreased to 408.36 cm3, 387.60 cm3, 299.67 cm3, 190.00 cm3 and 172.33 cm3 after the first week, first month, third month, sixth month and first year after embolization, which in the first week and third month was statistically significant and not significant in other cases (p = 0.003, p = 0.500, p = 0.028, p = 0.068, p = 0.109). The relationships of the number of fibroid tumors, echogenicity and vascularity with volume reduction were not statistically significant (p = 0.924, p = 0.208, p = 0.455).ConclusionsUterine artery embolization is an effective treatment for fibroid tumors. In this study, the number of tumors, echogenicity, and vascularity of tumors had no effect on tumor volume reduction.

Comparison of the influence of three fibroid treatment options: supracervical hysterectomy, ulipristal acetate and uterine artery embolization on ovarian reserve \u2013 an observational study

BackgroundTo assess and compare the influence of three fibroid treatment options: supracervical hysterectomy, ulipristal acetate and uterine artery embolization on ovarian reserve.MethodsProspective, observational, open-label study performed at the 3rd Chair and Department of Gynecology of the Medical University of Lublin, Poland. Premenopausal Caucasian women with symptomatic uterine fibroids were recruited into 3 groupspatients qualified for supracervical hysterectomies; patients qualified for preoperative ulipristal acetate (UPA) treatment scheduled for supracervical hysterectomies or myomectomies; patients qualified for uterine artery embolization (UAE). The following markers of ovarian reserve were investigated: antral follicle count (AFC), anti-Mullerian hormone (AMH), inhibin B (INHB), follicle stimulating hormone (FSH) and estradiol (E2). These markers were assessed before and 3 months after supracervical hysterectomies, before and 3 months after UAEs, and before and after 3 months of UPA treatment, before the scheduled surgeries. Baseline characteristics (age, parity, dominant fibroid volume, hemoglobin level, BMI, as well as AFC, AMH, INHB, FSH and E2) were compared between the study groups by Kruskall-Wallis ANOVA. Pre- and post-interventional values of AFC, AMH, INHB, FSH and E2 in the studied groups were compared with the Wilcoxon matched pairs test.ResultsTwenty-six, 27 and 30 patients were included in the final analysis in the supracervical hysterectomy, UPA and UAE groups, respectively. Three months after supracervical hysterectomy INHB and E2 significantly decreased, while AFC, AMH and FSH remained unchanged. After 3 months of UPA treatment the values of all the assessed markers of ovarian reserve were not significantly different in comparison to baseline. Conversely, three months after UAE the values of AFC, AMH, INHB, and E2 were significantly decreased, while FSH was significantly increased.ConclusionsOf the compared fibroid treatment methods UAE seems to have the greatest impact on ovarian function and should not be offered to patients concerned about their ovarian function. Supracervical hysterectomy did not affect the most accurate markers of ovarian reserve, and therefore appears to be safe in terms of ovarian function. UPA did not change any of the studied markers of ovarian reserve and seems a reasonable option when ovarian function is concerned.

Lower Urinary Tract and Pelvic Floor Symptoms and their Correlation with Fibroid Characteristics [39M

INTRODUCTION: Lower urinary tract symptoms (LUTS) are prevalent in women with uterine fibroids. Research suggests that increased fibroid volume and uterine bulk is associated with more severe LUTS and pelvic floor symptoms, however the correlation between fibroid size/location, adenomyosis, and symptoms has been under-studied. We sought to investigate this correlation using MRI which provides detailed information on fibroid characteristics. METHODS: A retrospective chart review was conducted for patients seen at the Stanford Fibroid Clinic. Patient demographics, medical history and pelvic MRI data were collected on 60 patients with completed Uterine Fibroid Symptom (UFS) and Pelvic Floor Distress Inventory (PFDI) validated symptom surveys. Primary outcome was scaled symptom scores and sub-scores including the Urogenital Distress Inventory (UDI-6). RESULTS: Dominant fibroid volume correlated negatively with urinary frequency (r=-0.307, P=.030), urgency (r=−0.287, P=.043), and pelvic pain or discomfort (r=-0.281, P=.049). Longest fibroid dimension also negatively correlated with UDI-6 (r=-0.304, P=.028). Number of fibroids and uterine volume were not significantly associated with LUTS. However, higher PFDI score was significantly associated with presence of adenomyosis on MRI (mean 82.9 vs 159.6, P=.018) and serosal fibroid location (mean 139.3 vs 69.0, P=.011). Patient BMI correlated positively with UDI-6 (r=0.415, P=.002) and PFDI (r=0.371, P=.005). CONCLUSION: Contrary to common belief, dominant fibroid size was inversely associated with LUTS, suggesting that fibroid dimensions may not predict bulk-related symptom severity. Adenomyosis should be considered in the evaluation of LUTS in women with uterine fibroids. In accordance with current literature, BMI is associated with LUTS including incontinence, urgency, and frequency.

PD50-05 DO LUTS CORRELATE WITH UTERINE FIBROID SIZE AND LOCATION?

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Non-neurogenic Voiding Dysfunction I1 Apr 2018PD50-05 DO LUTS CORRELATE WITH UTERINE FIBROID SIZE AND LOCATION? Robyn K Shaffer, Amy D Dobberfuhl, Angela Fast, Kim N Vu, David Hovsepian, Deirdre Lum, Pejman Ghanouni, and Bertha Chen Robyn K ShafferRobyn K Shaffer More articles by this author , Amy D DobberfuhlAmy D Dobberfuhl More articles by this author , Angela FastAngela Fast More articles by this author , Kim N VuKim N Vu More articles by this author , David HovsepianDavid Hovsepian More articles by this author , Deirdre LumDeirdre Lum More articles by this author , Pejman GhanouniPejman Ghanouni More articles by this author , and Bertha ChenBertha Chen More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2333AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Uterine fibroids are prevalent and often co-exist with lower urinary tract symptoms (LUTS) in women. Fibroid bulk is thought to correlate with LUTS and pelvic floor symptom severity. However, these associations are under-studied and data are based mostly on ultrasound measurements. Correlations between LUTS and specific fibroid or pelvic dimensions may impact treatment counseling. We examined the correlation between LUTS and fibroids using MR imaging. METHODS A retrospective review (2013-2016) on Stanford Fibroid Clinic patients identified 238 patients with a complete Pelvic Floor Distress Inventory survey (PFDI; score 0-300, worse symptoms with higher scores) and pelvic MRI. PFDI scores and sub-scores, including urogenital (UDI-6) and colorectal anal (CRAD-8) distress inventory scores, were correlated to MRI data. Data were analyzed in STATA. RESULTS Patients had a mean age of 47.3 years (SD 7.2 years) and a mean PFDI score of 77.5 (SD 52.7). Pearson correlation analysis showed that dominant fibroid volume was inversely correlated with colorectal distress (CRAD-8 r=-0.14, p<0.05). Women with an anteverted uterus tilted towards the bladder reported worse stress incontinence scores [2.2 (n=176) vs 1.5 (n=45); p<0.05]. There was no association between fibroid location on the uterus (anterior, posterior, fundal) or within the uterine wall (intramural, submucosal, subserosal) and LUTS. Analysis of fibroids location relative to bony landmarks demonstrated that 29% of women had fibroids within the true pelvis only while 71% had fibroids extending into the abdomen. Women with anterior displacement of the abdominal wall visible on MRI due to fibroid mass effect reported fewer pelvic floor symptoms [PFDI 68.7 vs 82.0; p<0.05] and fewer colorectal symptoms [CRAD-8 12.5 vs 20.7; p<0.001] than those without abdominal wall distension. Worse pelvic floor and urogenital symptoms correlated to women with a deeper sacral curvature (PFDI r=0.16, p<0.05; UDI-6 r=0.15, p<0.05). Worse colorectal symptoms correlated with higher ratio of dominant fibroid diameter to the pelvic diameter (distance measured from sacral promontory to the superior symphysis) (CRAD-8 r=0.19, p<0.01). CONCLUSIONS Contrary to common belief, LUTS appear to inversely correlate with uterine volume. Women with a smaller pelvis or deeper sacral curvature relative to fibroid size may report worse symptoms unless the fibroid is displaced into the abdomen. Fibroid size relative to bony parameters may help providers counsel patients on whether removal of fibroids will provide symptom relief. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e971-e972 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Robyn K Shaffer More articles by this author Amy D Dobberfuhl More articles by this author Angela Fast More articles by this author Kim N Vu More articles by this author David Hovsepian More articles by this author Deirdre Lum More articles by this author Pejman Ghanouni More articles by this author Bertha Chen More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Measurement of Uterine Leiomyomata Volume Pre and Post Uterine Artery Embolization Aided by MRI

Background: uterine fibroid embolization (UFE) is now evolving to be the first-line treatment for symptomatic uterine leiomyomata alongside the conventional surgical treatment of hysterectomy and myomectomy. Cochrane review comprises six RCTs comparing UAE versus hysterectomy or myomectomy for management of symptomatic leiomyomata where UFE had similar short and midterm outcomes, inclusive of symptomatic relief, quality of life and patient satisfaction, while benefiting from uterine preservation, shorter hospital stay and a faster recovery before resuming ordinary life activities. These benefits are in line with the minimally invasive nature of the embolization procedures. Aim of the Work: t this study aimed to review and illustrate the role of MR imaging in the pre- and post-procedural assessment for uterine fibroid patients undergoing uterine artery embolization. Patients and Methods: the current study was carried out in Radiodiagnosis Department, Faculty of Medicine, Ain shams University and specialized private radiology centers during the period between April 2017 and December 2017. It included 30 patients that were referred from gynecology clinic with their ultrasonographic reports to Radiodiagnosis Department, body imaging unit with a view to carry-out pelvic MRI with contrast. Results: imaging follow-up via pelvic MRI with contrast was obtained in 30 patients at 3, 6 months after treatment. The mean uterine volume was reduced by 25% (standard deviation was SD 0.03763) 3 months after treatment and was further reduced by a mean of 30% (SD 0.02638) by six months after treatment. Post-procedural subtraction MRI revealed mean myoma enhancement to be 5.6 + 0.5 SI in contrast to 133.4 + 18.3 SI prior to UFE. The mean dominant fibroid volume reduced by 34 % (SD 0.09247) after 3 months, 44 % (SD 0.05994) after 6 months. A cumulative reduction in both uterine and dominant leiomyoma mean volume from baseline to 6 months post – UAE was evident with significant interval changes between 3, 6 months follow up (p 0.000) Conclusion: the MRI findings following UAE vary with the interval from embolization and success of the procedure. MRI with its multiplanar capabilities was typically employed to evaluate the uterus following UAE for fibroid infarction, size reduction, location change, persistent enhancement, fibroid recurrence, changes in adenomyosis, and unexpected complications that may require surgical intervention or identify women who would benefit from repeated UAE. Recommendations: further studies on a larger scale of patients are needed to confirm the results obtained by this work.

Uterine fibroid embolization efficacy and safety: 15years experience in an elevated turnout rate center.

To evaluate effectiveness and safety of UFE as alternative to surgery, in treatment of uterine fibromatosis. 255 patients (aged 26-55) with symptomatic UF, indication for surgery, followed in our center (2000-2014), single or multiple fibroids, pain and/or functional/compressive disorders, underwent embolization: injection of PVA particles (150-900μm) from distal portion of uterine arteries (ascending section). Primary end-point: flow-stop distally to injection site, disappearance of lesion design, preservation of flow in main trunk of UA. Secondary end-point: control of pain and functional/compressive disorders during follow-up (2-7years). Procedure was performed bilaterally in 250 patients (98%). Mean duration: 47min (average fluoroscopy: 10:50min). Post-embolization pelvic pain (according with VAS score) was on average 2.2 at discharge (24h). Follow-up at 2years: resolution of menstrual disorders in 78% of patients and improvement in 14%; pain disappeared in 66%; significant improvement of menstrual flow and HCT/HB levels, decrease in total uterine (57.7%)/dominant fibroid (76.1%) volume. Recurrence in 18 patients. UFE represents an excellent alternative to surgical treatment: it is safe, tolerable and effective both in short and long term, with evident advantages in economic and social terms.

The impact of uterine artery embolisation on fibroid volume at 43.6 months in women with symptomatic fibroids at a tertiary-level hospital

Background. Symptomatic uterine fibroids have a significant impact on women’s health. Surgical intervention (myomectomy and hysterectomy) has been the mainstay of treatment. Women living with symptomatic uterine fibroids contribute significantly to a growing waiting list for surgery in South African public hospitals. Uterine artery embolisation (UAE) is a newer treatment option and has shown to be a minimally invasive, safe and effective alternative to surgery for such women. Objective. To evaluate the efficacy of UAE in women with symptomatic fibroid uterus. Methods. A prospective, observational, single-centre study of 51 women with symptomatic fibroid uterus who underwent UAE at Steve Biko Academic Hospital from February 2007 to November 2012. Results. A total of 51 women underwent UAE, 3 of whom were lost to follow-up. The remaining 48 women were followed for a mean duration of 43.6 months. There was a statistically significant reduction in the mean uterine and dominant myoma volumes, as well as improvement in the haemoglobin levels ( p =0.001). The mean uterine and dominant fibroid volume reductions were 38% and 58%, respectively. Minor complications were reported in 19% of the women (fever, post-embolisation syndrome and vaginal fibroid passage were frequently reported complications). Reintervention (hysterectomy and gonadotropin-releasing hormone analogue use) was required in 35% of women. Conclusion. UAE has a good clinical effect on fibroid volume reduction. It is a treatment option that can be considered prior to major surgery in a select group of women with symptomatic fibroid uterus.