Fibroid Volume Reduction Research Articles

Place de l’embolisation dans le traitement des fibromes

Uterine artery embolization using non spherical PVA particles or calibrated trisacryl microspheres above 500 μm is effective to treat menorrhagia, bulk-related symptoms and pelvic pain in more than 90% of cases in the short-term. In the long-term, embolization is effective in 75% of cases at 5-7 years. At 6 months, uterine volume reduction and dominant fibroid volume reduction varies between 30-60% and 50-80% respectively. During hospital stay, the complication rate is 3%. Secondary hysterectomy for complication is less than 2% at 3 months. Definitive amenorrhea is reported in less than 5% of cases in women of less than 45 years of age. No significant impact of embolization on hormonal function has been reported in women less than 45 years with normal baseline function. Secondary hysterectomy for clinical failure or recurrence is reported in 14-28% of cases at 5 years. Non-spherical PVA particles are associated with more microcatheter occlusion than trisacryl microspheres. No difference between PVA particles and trisacryl microspheres was found in terms of post-embolization pain or analgesic doses. PVA microspheres (Contour SE et Bead Block) are associated with lower clinical success and lower fibroid devascularization using MRI than trisacryl microspheres. No difference between PVA particles and trisacryl microspheres was found in terms of clinical efficacy, uterine volume reduction and complication rate. Randomized studies comparing embolization to hysterectomy demonstrate that reinterventions are more frequently performed after embolization. Secondary hysterectomy is performed in 13 to 24% of cases at 2 years and in up to 28% of cases at 5 years. Hospital stay, duration of recovery and time off work are shorter after embolization compared to hysterectomy. Embolization is cheaper than hysterectomy at 12 and 24 months even taking into consideration the additional costs of imaging and reinterventions. Randomized studies comparing embolization to myomectomy demonstrate that in the short- and mid-term there is no difference in terms of control of menorrhagia and bulk-related symptoms. Uterine volume reduction and quality of life were not different at 6 months. Periprocedural and 30-day complication rates are not different. At 6 months, the rate of complications is higher after myomectomy. Reinterventions are more frequent after embolization compared to myomectomy. Hospital stay, duration of recovery and time off work are shorter after embolization compared to myomectomy. Embolization should be considered with caution in pregnancy-seeking women since there is still a lack of good quality data available in the specific group of patients. FSH level is more frequently elevated after embolization compared to myomectomy. Pregnancy rate and term pregnancy rate are higher after myomectomy compared to embolization. Spontaneous abortion is more frequent after embolization than after myomectomy. There is no difference between embolization and myomectomy for the rates of pre-term delivery, cesarean section, post-partum hemorrhage, pre-eclampsia or intra-uterine growth retardation. Embolization performed before myomectomy (preoperative or combined procedures) can be discussed for an individual patient but there is not enough data to support its routine use.

Radiofrequency Ablation for Treatment of Symptomatic Uterine Fibroids

The use of thermal energy-based systems to treat uterine fibroids has resulted in a plethora of devices that are less invasive and potentially as effective in reducing symptoms as traditional options such as myomectomy. Most thermal ablation devices involve hyperthermia (heating of tissue), which entails the conversion of an external electromagnetic or ultrasound waves into intracellular mechanical energy, generating heat. What has emerged from two decades of peer-reviewed research is the concept that hyperthermic fibroid ablation, regardless of the thermal energy source, can create large areas of necrosis within fibroids resulting in reductions in fibroid volume, associated symptoms and the need for reintervention. When a greater percentage of a fibroid's volume is ablated, symptomatic relief is more pronounced, quality of life increases, and it is more likely that such improvements will be durable. We review radiofrequency ablation (RFA), one modality of hyperthermic fibroid ablation.

P31.01: Vascularization flow index as a predictor of uterine fibroid volume reduction after uterine artery embolization

P31.01: Vascularization flow index as a predictor of uterine fibroid volume reduction after uterine artery embolization

Study on the efficacy and safety of ultrasound ablation in treatment of uterine fibroids

To investigate the safety and efficacy of ultrasound ablation in treatment of uterine fibroids. Ninety-nine patients with 117 leiomyomas in total treated by Haifu JC focused ultrasound tumor therapeutic system were enrolled in prospective and non-randomized clinical trial in First Affiliated Hospital of Chongqing Medical University and Academy of Military Medical Sciences. Ultrasound ablation was performed guided by real-time ultrasonography under conscious sedation for single session. All patients were followed up at 6 months after treatment. On the day of treatment and after 1 month, patients were given by magnetic resonance imaging (MRI) exam to evaluate the effect of fibroids ablation. At 3 and 6 months after treatment, the ratio of ablated area and volume reduction of fibroids more than 50% were evaluated by MRI exam again. The symptoms improvements were evaluated by uterine fibroid symptom (UFS) and complications were analyzed by guideline of society of international radiation (SIR). The average ablated area ratio of the target fibroid was (76 ± 24)%. The average reduction in fibroid volume determined by MRI at 3 and 6 months after treatment was (45 ± 21)% and (59 ± 26)%. Which were significantly decreased than those before treatment (P < 0.05). At 6 months after treatment, 84.6% (99/117) of patients showed more than 50% volume reduction, the rate of improved symptom score was 92% (66/72). All patients could resume normal daily activities at 2 hours after treatment. The adverse reactions of SIR C-D included delayed hospitalization, repeat treatment and increased level of nursing. E-F included permanent sequelae and death. In this study, no adverse reactions of C-F were recorded. Common complications (SIR A-B, only observation or simple management without sequelae) were 35% (35/99). Four cases with adverse reactions B of SIR were found, including 2 cases with skin burning of degree II and 2 cases with febrile, they were administered by symptomatic therapy and changing dressing. The other adverse reaction A of SIR included sorness of buttock, vaginal discharge, dysuria and painful urination, they were only suggested by follow-up. It was efficacy and safe that ultrasound ablation as a single strategy were used in treatment of uterine fibroids.

Midterm Outcome of Ultrasound-Guided Alcohol Gel Sclerotherapy for Symptomatic Leiomyoma

The purpose of this study was to describe the outcome of ultrasound-guided ethanol gel sclerotherapy of myomatous nodules 1 to 18 months after treatment. A total of 118 consecutive patients with a diagnosis of symptomatic leiomyomas referred for ethanol gel sclerotherapy were studied between November 2005 and July 2007. Clinical (self-administered symptom questionnaire) and ultrasound follow-ups were done 1 to 2, 6 to 8, and 12 to 18 months after the procedure. The mean baseline volumes +/- SD were 223.3 +/- 158.3 cm(3) for the uterus and 68.4 +/- 110.5 cm(3) for the dominant fibroid. The most common adverse reaction in the immediate postoperative period was pelvic pain in 27.1% of the patients, but 58.4% had no reactions. After 12 months, a 29.5% reduction in uterine volume was observed in 64.7% of the patients. A 55.5% reduction in dominant fibroid volume was observed in 82.8% of the patients. Pelvic pain improved in 29.8% of the sample, dysmenorrhea in 51.7%, and menstrual flow in 39%. Most patients (77%) reported being satisfied or very satisfied with the treatment. The results suggest that ethanol gel sclerotherapy is a safe, conservative alternative for treating symptomatic uterine leiomyomas. Further randomized studies are necessary to determine the suitability and indications of this procedure in comparison to other minimally invasive techniques.

Magnetic Resonance-guided Focused Ultrasound (MRgFUS) Treatment of Uterine Fibroid

Abstract Magnetic resonance-guided focused ultrasound (MRgFUS) is a new treatment modality in treating uterine fibroid. It is noninvasive and can be done as out-patient procedure. It is the least invasive treatment option other than medical treatment. Early reports have demonstrated feasibility and safety. It is efficacious in symptom improve and fibroid volume reduction. This article reviews the principle, patient selection and treatment. Results from early trial and our center are summarized.

Fibroids Treated With Uterine Artery Embolization: Do Imaging Findings Correlate With Patient Outcomes?

ObjectiveTo evaluate whether changes on ultrasound in uterine and fibroid volume and fibroid vascularity correlate with changes in symptom severity and health-related quality of life (HRQL) perceived by patients after uterine artery embolization (UAE). Materials and MethodsSixty-four women (mean age 45.3) with symptomatic uterine fibroids underwent UAE at the Hysterectomy Alternatives (HAlt) clinic in Winnipeg, Manitoba. They completed a validated questionnaire assessing symptom severity and HRQL at baseline and at three and six months post-embolization, and ultrasound was also performed at these intervals. Changes in uterine and fibroid volume were compared with changes in symptom severity and HRQL. Data from patients with residual fibroid vascularity, extremes of baseline fibroid volume, and concomitant adenomyosis were analyzed to determine whether the outcomes were different in these patient groups. ResultsChanges in uterine and fibroid volumes did not correlate with changes in symptom severity or HRQL after UAE (P> 0.05). Residual fibroid vascularity was a negative predictor of reduction in uterine and fibroid volume (P< 0.05), but did not affect changes in symptom severity or HRQL. Extremes of baseline volume in the dominant fibroid did not affect symptom severity or HRQL. Patients with concomitant adenomyosis experienced greater improvement in symptoms than those without adenomyosis (P< 0.05). ConclusionWe found poor correlation between imaging findings and patient- perceived outcomes after UAE. Ultrasound cannot be used to predict improvement in symptoms or HRQL after UAE.

A mobile interventional radiology unit: innovation and social responsibility.

To present the preliminary results of a feasibility study performed to determine the value of a mobile interventional radiology unit used to promote a uterine embolization program for low-income patients. Forty patients with symptomatic fibroids were treated with uterine embolization. Procedures were performed in four public hospitals in the metropolitan area of Sao Paulo. This study was approved by the institutional research ethics committee and all patients signed an informed consent form. A mobile interventional radiology unit, named ANGIOMOVEL, was conceived and implemented utilizing a small truck to transport one mobile C arm, one radiological table, protection aprons and a small trolley containing specific supplies for the procedures. The ANGIOMOVEL team consisted of two interventional radiologists, one nurse, one driver and one assistant. The unit visited one hospital per week during a three-month period. Patient inclusion was contingent upon several factors, such as evaluation by a trained gynecologist, completion of a pelvic MRI, routine serological laboratory tests and completion of a quality of life questionnaire (QOL). Outcomes, MRI and QOL were evaluated. Data obtained after 12 weeks were collected and analyzed. Technical success was achieved in 100% of cases, with a mean procedure time of 43 minutes and a mean fluoroscopic time of 24 minutes. The mean hospital stay was 1.07 day and the mean time for recovery and return to normal activities was 10 days. After 12 weeks, 36 (90%) of patients noticed improvement of their symptoms and 4 (10%) did not notice any improvement. Thirty-eight patients (95%) were satisfied or very satisfied and 39 (97.5%) said they would recommend the procedure. Pre- and post-procedure magnetic resonance imaging analysis showed that complete fibroid ischemia was achieved in 92.5% of cases with a mean uterine volume reduction of 38% and a mean fibroid volume reduction of 52%. Health-related quality of life scores showed improvement, increasing from 39.30 before the treatment to 79.62 points after therapy. The initial results indicate that using a Mobile Interventional Radiology Unit is feasible, efficient and safe to develop a successful uterine fibroid embolization program providing care to the underserved patient community.

Role of low dose mifepristone in management of uterine leiomyomata

OBJECTIVE: To assess the decrease in uterine and fibroid volume and to evaluate the relief in symptoms of the patients with 10mg/day of mifepristone for 3 months by using monthly transvaginal sonography. DESIGN: Prospective study in a tertiary institute. MATERIALS AND METHODS: Fifty women with symptomatic uterine leiomyoma were given 10mg/day of mifepristone for 3 months. The decrease in menstrual and pressure symptoms and the decrease in uterine and fibroid volume measured by transvaginal sonography were assessed at the end of 3 months of treatment and after 3 months of stopping treatment. RESULTS: There was a significant reduction in the uterine volume and the maximum fibroid volume at the end of 3 months. The mean reduction in uterine and fibroid volume after 1 month was upto 9.6% and 11.1%, after 2nd month was 18.3% and 21.4% and after 3rd month was 27.8% and 32.1%. All the changes were statistically significant (<0.001). Three months after stopping treatment there was increase (p<0.001), but it was still 26.25% and 27.24% less than baseline.TableMean fibroid volume at different periods of treatment(a) 0 month(b) 1st month(c) 2nd month(d) 3rd month(e) 6th monthMean (cc)75.3667.0659.2951.2154.83SD30.4427.9225.6323.7723.98P (a vs. b, c, d, e); (b vs. c); (c vs. d); (d vs. e) <0.001. Open table in a new tab P (a vs. b, c, d, e); (b vs. c); (c vs. d); (d vs. e) <0.001. There was significant reduction of menorrhagia, metorrhagia, polymenorrhoea and dysmenorrhoea and pressure symptoms of bladder pressure, frequency and pelvic pain at the end of three months (<0.001), but they increased slightly (p<0.05) after 6months (three months after completing therapy). CONCLUSIONS: Low dose mifepristone had a shrinking effect on the fibroids, which was maintained for as long as the medication was used, it did not have a permanent effect. Hence it may be used to reduce symptoms and allow time to correct anemia and plan surgery. However some women who are approaching menopause, the “bought time” may lead them right into menopause, when the nature shrinks the fibroids.

Laparoscopically assisted uterine fibroid cryoablation

The objective of the study was to develop a safe and effective cryoablation technique for the treatment of uterine fibroids. This was a multicenter pilot case series to evaluate cryoablation of uterine fibroids using laparoscopically assisted placement of 17-gauge cryoablation needles. Patient satisfaction was documented with a validated Uterine Fibroid Symptom and Quality of Life (UFS-QOL) questionnaire. Procedural efficacy was evaluated by assessing fibroid shrinkage. Treatment was followed by assessments at 3, 6, and 12 months. Median fibroid volume reduction was 43.3% (19 patients) and 66.4% (15 patients) at 6 and 12 months, respectively. Median UFS-QOL score improvement was 61.9% and 66.7% at 6 and 12 months, respectively. Additionally, patients experienced marked improvement of bleeding and fibroid bulk symptoms. The median Symptom Severity Score at baseline was 50, 25.0 (-59%) at 6 months, and 12.5 (-66.7%) at 12 months. These pilot data indicate that uterine fibroid cryoablation is a safe and effective minimally invasive alternative to treat symptomatic uterine fibroids.

Abstract No. 86: Can Functional MRI Predict Volume Reduction Following Uterine Fibroid Embolization?

To evaluate whether functional MR can assist in characterizing fibroids at greater likelihood of significant volume reduction, we examined whether there is a correlation between fibroid apparent diffusion coefficient (ADC) prior to embolization and fibroid volume reduction following UFE.

A randomized prospective trial of the postoperative quality of life between laparoscopic uterine artery ligation and laparoscopy-assisted vaginal hysterectomy for the treatment of symptomatic uterine fibroids: clinical trial design

BackgroundLaparoscopy-assisted vaginal hysterectomy is one of the definite methods for the treatment of symptomatic uterine fibroids with lesser intraoperative bleeding and shorter hospitalization compared with abdominal hysterectomy. However, laparoscopy-assisted vaginal hysterectomy cannot preserve uterus and can show postoperative complications by the change of pelvic structure. Thus, laparoscopic uterine artery ligation has been introduced for relieving the symptoms caused by uterine fibroids in place of hysterectomy. The current study was designed to compare postoperative quality of life between laparoscopic uterine artery ligation and laparoscopy-assisted vaginal hysterectomy, and to evaluate the efficacy of laparoscopic uterine artery ligation which can treat symptomatic uterine fibroids with the preservation of uterus.Methods and designPatients enrolled the current study are randomized to laparoscopic uterine artery ligation or laparoscopy-assisted vaginal hysterectomy. The primary outcome is to compare postoperative quality of life between laparoscopic uterine artery ligation and laparoscopy-assisted vaginal hysterectomy using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire for Cancer patients version 3.0. Secondary outcomes are to evaluate the volume reduction of uterus, uterine fibroids and ovaries by the 2 treatments, to compare the improvement of subjective symptoms using 11-point symptom score and postoperative clinical outcomes between laparoscopic uterine artery ligation and laparoscopy-assisted vaginal hysterectomy, and to investigate the improvement of postoperative vaginal bleeding by laparoscopic uterine artery ligation.DiscussionAmong treatment methods for symptomatic uterine fibroids with the preservation of uterus, laparoscopic uterine artery ligation is expected to have the efficacy like uterine artery embolization, which appeared to be safe for routine use with symptomatic relief. The current study fully recruited in June 2008 and the results will be available in June 2009. If there is no difference of postoperative QOL between laparoscopic uterine artery ligation and laparoscopy-assisted vaginal hysterectomy for the treatment of symptomatic uterine fibroids, the comparison of quality of life between laparoscopic uterine artery ligation and uterine artery embolization will be also needed as a surgical treatment for preserving uterus.Trial registrationCurrent Controlled Trials ISRCTN76790866

Clinical Failure after Uterine Artery Embolization: Evaluation of Patient and MR Imaging Characteristics

To investigate the patient and magnetic resonance (MR) imaging characteristics associated with clinical failure after uterine artery embolization (UAE). Seventy-eight consecutive patients who underwent UAE were examined. Contrast-enhanced MR imaging was performed before and 4 months after the procedure, and clinical follow-up was performed at 15 months. Patients were divided into success and failure groups strictly on the basis of their clinical outcomes. Clinical follow-up included evaluation of fibroid symptoms and the need for further treatment after UAE. Findings at pre- and postprocedural MR imaging were compared, and data collected included changes in uterine and fibroid volumes, fibroid location, and fibroid perfusion. Fifty-eight patients were placed into the success group and 20 into the failure group. There were no differences between the baseline characteristics of the two groups. The reduction in uterine and dominant fibroid volumes was greater in the success group compared with the failure group; however, the difference was not statistically significant (success group: [295/845] 34.9% vs [80/282.5] 28.3%, respectively, P=.18; failure group: [317/733] 43.2% vs [114/337.6] 33.9%, P=.32). The reduction in total fibroid volume was greater in the success group than the failure group ([189.6/393.5] 48.2% vs [148.7/439.9] 33.8%, respectively; P=.02) despite the fact that the percentage of fibroids completely infarcted was similar between the two groups ([136/172] 79% vs [41/50] 82%, P=.77). Pedunculated subserosal fibroids were more common in the failure group than in the success group (P<.03) and did not reduce in volume as significantly (53.8% vs 14.7%, respectively; P=.02). In general, the reduction in total fibroid volume after embolization is smaller in patients with poor clinical improvement. In addition, these patients have a higher number of pedunculated subserosal fibroids, and these fibroids tend to reduce in volume to a lesser extent.

Non-surgical management of uterine fibroids

Efforts to develop alternatives to surgery for management of symptomatic uterine fibroids have provided new techniques and new medications. This review summarizes the existing literature on uterine artery embolization (UAE) and investigational studies on four newer approaches. PubMed, Cochrane and Embase were searched up to December 2007. Studies reporting side-effects and complications and presenting numerical data on at least one outcome measure were included. Case studies report 50-60% reduction in fibroid size and 85-95% relief of symptoms following UAE. The largest of these studies reported an in-hospital complication rate of 2.7% (90 of 3041 patients) and a post-discharge complication rate of 26% (710 of 2729 patients). Eight studies compared UAE with conventional surgery. Best evidence suggested that UAE offered shorter hospital stays (1-2 days UAE versus 5-5.8 days surgery, 3 randomized controlled trials (RCTs)) and recovery times (9.5-28 days UAE versus 36.2-63 days surgery, 3 RCTs) and similar major complication rates (2-15% UAE versus 2.7-20% surgery, 3 RCTs). Four studies analysing cost-effectiveness found UAE more cost-effective than surgery. There is insufficient evidence regarding fertility and pregnancy outcome after UAE. Five feasibility studies after transvaginal temporary uterine artery occlusion in 75 women showed a 40-50% reduction in fibroid volume and two early studies using magnetic resonance guided-focused ultrasound showed symptom relief at 6 months in 71% of 109 women. Two small RCTs assessing mifepristone and asoprisnil showed promising results. Good quality evidence supports the safety and effectiveness of UAE for women with symptomatic fibroids. The current available data are insufficient to routinely offer UAE to women who wish to preserve or enhance their fertility. Newer treatments are still investigational.

Uterine Artery Embolization in 101 Cases of Uterine Fibroids: Do Size, Location, and Number of Fibroids Affect Therapeutic Success and Complications?

The purpose of this study was to evaluate whether the size, location, or number of fibroids affects therapeutic efficacy or complications of uterine artery embolization (UAE). Patients with symptomatic uterine fibroids (n = 101) were treated by selective bilateral UAE using 500- to 710-mum polyvinyl alcohol (PVA) particles. Baseline measures of clinical symptoms, sonography, and MRI taken before the procedure were compared to those taken 1, 3, 6, and 12 months later. Complications and outcomes were analyzed for associations with fibroid size, location, and number. Reductions in mean fibroid volume were similar in patients with single (66.6 +/- 21.5%) and multiple (67.4 +/- 25.0%) fibroids (p-value = 0.83). Menstrual improvement occurred in patients with single (93.3%) and multiple (72.2%) fibroids (p = 0.18). Changes in submucosal and other fibroids were not significantly different between the two groups (p's > 0.56). Linear regression analysis between primary fibroid volume as independent variable and percentage reduction of fibroid volume after 1 year yielded an R(2) of 0.083 and the model coefficient was not statistically significant (p = 0.072). Multivariate regression models revealed no statistically or clinically significant coefficients or odds ratios for three independent variables (primary fibroid size, total number, and fibroid location) and all outcome variables (percent reduction of uterus and fibroid volumes in 1 year, improvement of clinical symptoms [menstrual, bulk related, and urinary] in 1 year, and complications after UAE). In conclusion, neither the success rate nor the probability of complications was affected by the primary fibroid size, location, or total number of fibroids.

Hounsfield Number Measurement after a Uterine Fibroid Embolization: Significance as a Predictive Factor of Embolization Success

Purpose: To assess the usefulness of the Hounsfield number, measured by a non-contrast enhanced pelvic CT, after a uterine artery embolization as an index of the successful outcome of a uterine fibroid embolization (UFE). Materials and Methods: The study subjects included 15 women (age range: 28-49 years, mean age: 36.4 years) diagnosed with symptomatic uterine myomas and seen from March 2003 to August 2005. A non-contrast enhanced pelvic CT scan was performed six hours after a uterine artery embolization. The global and maximal CT numbers were measured for each myoma. In addition, a pelvic MRI was performed to measure the volume of each myoma prior to and 6 months after the UFE. The relationship between fibroid volume reduction and the global CT number were prospectively analysed. Results: The mean global CT number was 91.25 HU in Group I and 40.8 HU in Group II. Further, the mean fibroid volume reduction rate was 73% in Group I and 10% in Group II (p

Non-invasive magnetic resonance imaging-guided focused ultrasound treatment for uterine fibroids – early experience

Objective To describe early results regarding efficacy and safety of magnetic resonance imaging-guided focused ultrasound surgery (MRgFUS) for the treatment of uterine leiomyomas among a population of Japanese women. Study design In this single site study, 48 Japanese women, over 18 years of age, who were candidates for surgical intervention due to symptomatic fibroids, were recruited. Fifty-five uterine fibroids were treated by MRgFUS and followed up for 12 months. Results During the 12-month follow-up period, two patients (4%) required surgical interventions, and two patients required additional drug treatment for fibroids. The average reduction in fibroid volume determined by MR imaging at 6 months after treatment was 33%. This volume reduction is correlated with the fibroid's treated volume. No serious complications were recorded during the treatments or follow-up period. Conclusion MRgFUS can safely be used to non-invasively treat symptomatic uterine fibroids and avoid the need for surgical intervention in the short term. With large treatment volumes, MRgFUS also results in significant fibroid shrinkage in a relatively short time. Additional follow-up is needed to determine the long-term durability of this promising non-invasive approach.

Uterine Artery Embolization Versus Hysterectomy in the Treatment of Symptomatic Uterine Fibroids: 2 Years’ Outcome From the Randomized EMMY Trial

Available reports suggest that uterine artery embolization (UAE) has advantages over surgery when treating heavy menstrual bleeding caused by uterine fibroids, but some of these studies lack a control group of women treated in other ways—as by hysterectomy. The EMMY trial (comparing EMbolization with hysterectoMY), conducted at 28 Dutch hospitals, compared the efficacy of UAE with that of hysterectomy for treating menorrhagia resulting from uterine fibroids. Women describing increased or prolonged menstrual blood loss that interfered with daily life were included in the trial. A total of 88 patients were randomized to UAE and 89 to hysterectomy, which usually was performed transabdominally. The primary end point was whether, after a prospective 24-month follow-up interval, UAE avoided subsequent hysterectomy in at least 75% of cases. UAE failed bilaterally in 4 patients who later underwent hysterectomy. The rate of unilateral failure was 12%. In all, 23.5% of patients assigned to UAE had undergone hysterectomy 2 years after treatment. The hysterectomies were evenly distributed over time. All but one of them were done for persistent or recurrent menorrhagia. There were no significant group differences in the rate of improvement in either lower abdominal pain or bulk-related symptoms. Pain was less than at baseline in more than three-fourths of both patient groups, and bulk-related symptoms in at least two-thirds of women in each group. Reductions in uterine volume and fibroid volume following UAE were highly significant. Blood hemoglobin levels rose significantly in both groups compared to baseline values. The investigators conclude that UAE is a sound alternative to hysterectomy in women with symptomatic uterine fibroids. Nevertheless, hysterectomy remains the preferred treatment for patients who wish to be certain that bleeding will cease.

Uterine artery embolization versus hysterectomy in the treatment of symptomatic uterine fibroids: 2 years’ outcome from the randomized EMMY trial

The purpose of this study was to compare the 2 years' efficiency of uterine artery embolization (UAE) with hysterectomy in the treatment of menorrhagia caused by uterine fibroids in a randomized controlled trial. Twenty-eight Dutch hospitals recruited patients with uterine fibroids and menorrhagia, who were eligible for hysterectomy. Patients were randomized to UAE or hysterectomy. The primary endpoint was if UAE could avoid a subsequent hysterectomy in at least 75% of cases. Secondary endpoints were changes in pain, bulk-related complaints, and uterine and dominant fibroid volume reduction. One hundred seventy-seven patients were randomized to UAE (n = 88) or hysterectomy (n = 89). Two years after treatment 23.5% of UAE patients had undergone a hysterectomy. There were no significant differences in improvement compared to baseline in pain and bulk-related complaints. Uterine and dominant fibroid volume reduction in UAE patients was 48.2% and 60.5%, respectively. UAE is a valuable alternative treatment for symptomatic uterine fibroids. Nevertheless, when patients seek for certainty on the cessation of bleeding problems, a hysterectomy remains the treatment of choice.

Uterine artery embolization for symptomatic fibroids with imaging follow up

The aim of this study was to determine the effectiveness of uterine artery embolization (UAE) as a primary treatment method in treatment of symptomatic fibroids, whether there are any preembolization MRI characteristics of fibroid predictive of reduction in volume and assess reduction in uterine and dominant fibroid volumes using ultrasound (US) and MRI. Study was carried out in total of 32 patients aged 25-49 years (mean 40.9 years). Uterine and dominant fibroid volume were determined using US and MRI before UAE, MRI and US at 3 months and US alone at 6 and 12 months post-UAE, supplemented by clinical evaluation at interval of 3, 6 and 12 months. Procedure was carried out through unilateral femoral puncture using poly vinyl alcohol (PVA) particles 355-500 microm in size. All 32 patients had successful procedures. Overall, 25 patients responded, giving a clinical success rate of 78.12%. Mean reduction in volume of uterus and fibroid was 33 and 59.7% and 48.9 and 75.5% on US at 3 and 12 months respectively, and 33.3 and 58.6% on MRI at 3 months. Volume reduction on US and MRI at 3 months was highly correlative. There was no statistical difference in size reduction in volume of fibroids, which were hypointense or hyperintense on T2-weighted image (T2WI) on pre-UAE MRI. Uterine artery embolization leads to good technical success and fibroid volume reduction. Ultrasound alone may be used for follow up of patients post-UAE. Preprocedure signal characteristics on T2WI are not predictors of volume reduction after UAE.