Treatment Of Symptomatic Uterine Fibroids Research Articles

Transarterial embolization of uterine arteries in emerging dysfunctional uterine bleeding: a single-center case series study

BackgroundUterine artery embolization is proven to be an effective treatment for symptomatic uterine fibroids. Yet, its role in the management of dysfunctional uterine bleeding is still debatable. Patients with dysfunctional uterine bleeding have abnormal bleeding from the uterine vascular bed with variable underlying mechanisms. Uterine artery embolization will reduce/prevent bleeding by occlusion of the vascular bed, with subsequent cutoff of the effect of hormones on the endometrium. The aim of this work is to demonstrate the safety, efficacy and possible short-term complications of uterine artery embolization in the treatment of dysfunctional uterine bleeding (DUB) as a first-line treatment modality rather than the current treatment options (hormonal and surgical treatment).MethodsThirty patients included in the study were clinically and laboratory diagnosed based on FIGO classification system (PALM-COEIN) as DUB, and the diagnosis was confirmed by MRI imaging. All patients were subjected to transcatheter uterine artery embolization with subsequent clinical and radiological follow-up to assess the treatment outcome.ResultsUterine artery embolization was able to control bleeding in patients diagnosed as DUB, with subsequent complete cessation of medical treatment; no surgical interference was needed with much less morbidity. We had 93.3% improvement in the frequency, volume of bleeding and 100% improvement of the presenting anemia. No significant change in uterine volume or in endometrial thickness has been noted.ConclusionsUterine artery embolization is safe, effective procedure to control dysfunctional uterine bleeding with the preservation of the uterus especially in critical age groups.

Uterine artery embolization in the treatment of uterine fibroids and the preservation of reproductive health in women 40 years of age and older: A retrospective study

Aim. To evaluate the effect of uterine artery embolization (UAE) on reproductive health in women 40 years and older. Materials and methods. A retrospective study was conducted at the perinatal center of the District Clinical Hospital of Khanty-Mansiysk. Patients were divided into two groups: the main group (group 1; n=57) included women with uterine fibroids after UAE, and the control group (group 2; n=42) included women without a history of uterine fibroids. Results. Women with uterine fibroids were statistically more likely to have grade 1 obesity (χ2=4.39; p=0.04) and less likely to have normal body weight (χ2=8.73; p=0.00) compared to women without fibroids. Smoking increased the risk of uterine fibroids twofold (χ2=4.49; p=0.03; odds ratio 1.97; confidence interval 0.64-6.11). More women with uterine fibroids had a history of abortions (n=42; 73.7%) than those without uterine fibroids (n=19; 45.2%; χ2=8.27; p=0.01). The most common gynecological comorbidities in women with uterine fibroids included inflammatory disease of the uterus (N71), endometrial polyp (N84), and endometriosis (N80); p0.05. The most common extragenital diseases in patients with uterine fibroids included thyroid disease, hypertension, and iron deficiency anemia (p0.05). Contour SE embolization agent with spherical particles was more often associated with pain (χ2=0.18; p=0.67) and less often with fever (χ2=4.47; p=0.03). There was a decrease in the number of short menstrual cycles (less than 24 days) from the moment before surgical treatment and after 24 months (χ2=34.580; p0.001) and an increase in the number of cycles of 24–38 days (χ2=14.887; p=0.005). At 24 months after UAE, there were more women with a menstrual period of less than 3 days (χ2=10.385; p=0.035) and fewer with a menstrual period of more than 8 days (χ2=34.573; p0.001). Ultrasound showed a decreased ovarian reserve at 6, 12 and 24 months after UAE (p0.05). Conclusion. When assessing the reproductive health of women 40 years and older after embolization of the uterine arteries, it was found that this method of treatment of symptomatic uterine fibroids leads to a decrease in the duration and heaviness of menstruation but increases the risk of an ovarian reserve decrease.

A Case-Based Study on the Effectiveness of Embospheres as Embolizing Agent in the Treatment of Symptomatic Uterine Fibroids

Introduction: Embolization of the uterine arteries (UAE) has been approved as a minimally invasive technique for the treatment of uterine fibroid and maintaining fertility; different agents are used in this technique; embospheres have nowadays become widely used in many centers. Aim: assess the effectiveness and safety of Embospheres as Embolizing agents in treating symptomatic uterine fibroids among Iraqi patients. Methods: This was a mixed retrospective-prospective study conducted at Ibn Sina Hospital; the study included 17 patients who were managed and followed up during the period 2018 - 2020 included 17 Iraqi women with symptomatic uterine fibroids and were managed with embolization of uterine arteries using Embosphere as an embolization agent followed for six months by MRI to monitor changes in size & IV contrast enhancement. Results: The mean age of the patients was 39.5 (range: 266-49) years. Single fibroids were reported in 70.6\% of the cases and multiple fibroids in 29.4%, the median number of fibroids was significantly reduced after UAE, (P\(< \)0.05) and the median size reduced by more than 50%, from 11 cm to 5 cm after UAE, (P\(< \)0.05). More than 70% of fibroids decreased in size, and 17.6% disappeared. After UAE, during the follow-up period, 17.6% of women got pregnant safely. Unfortunately, two patients did not get the benefit. Conclusions: Embospheres were safe and effective as an Embolizing agent in treating symptomatic uterine fibroids with good outcomes and no serious adverse effects or complications.

Long-term Health-Related Quality of Life and Symptom Severity Following Hysterectomy, Myomectomy, or Uterine Artery Embolization for the Treatment of Symptomatic Uterine Fibroids

(Abstracted from Am J Obstet Gynecol 2023;229(3):275.e1–275.e17) Symptomatic uterine fibroids (UFs) are benign tumors diagnosed in approximately 30% of American women by the age of 50 years. Symptomatic UFs can significantly affect quality of life (QoL) and have a wide range of symptoms and severity, including pelvic pressure, dyspareunia, sexual dysfunction, infertility, and abnormal uterine bleeding.

Uterine fibroid cell cytoskeletal organization is affected by altered G protein-coupled estrogen receptor-1 and phosphatidylinositol 3-kinase signaling

To determine if cyclic strain affects fibroid cell cytoskeletal organization, proliferation, and collagen synthesis differently than myometrial cells. Basic science study using primary cultures of patient-matched myometrial and fibroid cells. Academic Laboratory PATIENT(S): Premenopausal women undergoing myomectomy or hysterectomy for the treatment of symptomatic uterine fibroids. Application of uniaxial strain patterns mimicking periovulation, menses, or dysmenorrhea using the Flexcell® tension system or static control. Secondarily, inhibition of G protein-coupled ER1 (GPER1, G36), and phosphatidylinositol 3-kinase (PI3K, Ly294002). Cell alignment, cell number, and collagen content RESULT: (s): Menses-strained cells demonstrated the most variation in cell alignment, cell proliferation, and pro-collagen content between myometrial and fibroid cells. Pro-collagen content decreased in myometrial cells with increasing strain amplitude and decreasing frequency. GPER1 inhibition decreases cellular alignment in the presence of strain. (s): Mechanotransduction affecting cytoskeletal arrangement through the GPER1-PI3K pathway is altered in fibroid cells. These results highlight the importance of incorporating mechanical stimulation into the in vitro study of fibroid pathology.

Considerations on implementation of the newest treatment for symptomatic uterine fibroids: Oral GnRH antagonists.

Novel gonadotrophin releasing hormone (GnRH) antagonist treatments have recently been developed in combination with hormonal add-back therapy, as an oral treatment option for women suffering from uterine fibroids. Registration trials assessing the GnRH antagonist combination preparations with relugolix, elagolix and linzagolix have assessed treatment efficacy for fibroid-related heavy menstrual blood loss in comparison to placebo. Marketing authorization has been granted by several agencies including those in Europe, the United Kingdom and the United States. While the registration trials report a robust effect on the reduction of heavy menstrual blood loss and improvement in quality of life scores, reticence is advised before widespread prescription. In this review, we demonstrate limitations in the trial data, namely a lack of generalizability due to the restricted study population, the lack of transparency in the distribution of disease-level characteristics limiting the predictability of treatment success in the real-world diverse population, and the absence of any comparison to current alternative treatment methods. Importantly, no clinically meaningful volume reductions were found with GnRH antagonist combination preparations, and long-term safety data, particularly concerning modest but stable bone mineral density decline, need further addressing. Symptoms related to uterine fibroids adversely affect many women's quality of life and effective medical treatments are lacking. However, despite the urgent need for conservative treatments, it is vitally important that novel drugs, like combination oral GnRH antagonists, undergo sufficiently rigorous evaluation of safety, effectiveness and cost-effectiveness in a representative population and are compared with alternative treatment methods before introduction into mainstream clinical practice.

An Evaluation of Ultrasound-Guided Percutaneous Microwave Ablation for the Treatment of Symptomatic Uterine Fibroids

PurposeTo evaluate the feasibility and effectiveness of ultrasound-guided percutaneous microwave ablation (MWA) for the treatment of symptomatic uterine fibroids. Materials and MethodsA single-center retrospective study was conducted on 17 patients, mean age 37.5 years (SD ± 7.3; range 19-47 years) with symptomatic uterine fibroid who underwent MWA between September 2018 and December 2022. Outcomes included volume reduction of uterine fibroids, hemoglobin levels, uterine fibroid symptoms, and health-related quality-of-life questionnaire scores before and 12 months after ablation. ResultsPreoperative fibroid diameter was a mean of 6.7 cm (SD ± 1.1; range 5–9 cm), and volume was a mean of 101.9 cm3 (SD ± 63.3; range 16.9–264.1 cm3). The mean ablation time was 12.2 minutes (SD ± 3.1; range, 8–20 minutes). The mean reduction of volume at 12 months after treatment was 70.9% (SD ± 23.8). The hemoglobin level increased significantly from 9.96 g/dL ± 2.33 before treatment to 12.14 g/dL ± 1.34 at 12 months after treatment (P = .002). The symptom severity score and health-related quality-of-life scores were significantly improved at follow-up (P < .001). ConclusionsThe application of MWA as a standalone treatment method might provide an effective, minimally invasive option for Federation of Gynecology and Obstetrics Types 1–6 symptomatic uterine fibroids with the potential to enhance patients’ quality of life.

Our Experience with Hydrogel-Coated Trisacryl Microspheres in Uterine Artery Embolization for the Treatment of Symptomatic Uterine Fibroids and Adenomyosis: A Follow-Up of 11 Years.

Uterine artery embolization (UAE) for the treatment of symptomatic uterine fibroids and non-controllable adenomyosis symptoms is a relatively new procedure for organ-preserving therapy. These benign conditions can become symptomatic in about 30% of women between the ages of 35 and 50. The purpose of the UAE either for fibroids or adenomyosis is the elimination of blood loss, the reduction in pain, and bulky or rectal pressure symptoms. The purpose of this study is to present our experience in UAE with the use of hydrogel-coated tris acryl microspheres for the treatment of symptomatic uterine fibroids and adenomyosis.

ULIPRISTAL ACETATE VERSUS PLACEBO FOR FIBROID TREATMENT

Background: The efficacy and safety of oral ulipristal acetate for the treatment of symptomatic uterine fibroids before surgery are uncertain. Methods: We randomly assigned women with symptomatic fibroids, excessive uterine bleeding (a score of &gt;100 on the pictorial blood-loss assessment chart [PBAC, an objective assessment of blood loss, in which monthly scores range from 0 to &gt;500, with higher numbers indicating more bleeding]) and anemia (hemoglobin level of ≤10.2 g per deciliter) to receive treatment for up to 13 weeks with oral ulipristal acetate at a dose of 5 mg per day (96 women) or 10 mg per day (98 women) or to receive placebo (48 women). All patients received iron supplementation. The coprimary efficacy end points were control of uterine bleeding (PBAC score of &lt;75) and reduction of fibroid volume at week 13, after which patients could undergo surgery. Results: At 13 weeks, uterine bleeding was controlled in 91% of the women receiving 5 mg of ulipristal acetate, and 19% of those receiving placebo (P&lt;0.001 for the comparison of each dose of ulipristal acetate with placebo). The rates of amenorrhea were 73%, and 6%, respectively, with amenorrhea occurring within 10 days in the majority of patients receiving ulipristal acetate. The median changes in total fibroid volume were −21%,, and +3% (P = 0.002 for the comparison of 5 mg of ulipristal acetate with placebo. Serious adverse events occurred in one patient during treatment with 5 mg of ulipristal acetate (uterine hemorrhage) and in one patient during receipt of placebo (fibroid protruding through the cervix). Headache and breast tenderness were the most common adverse events associated with ulipristal acetate but did not occur significantly more frequently than with placebo. Conclusions: Treatment with ulipristal acetate for 13 weeks effectively controlled excessive bleeding due to uterine fibroids and reduced the size of the fibroids.

ULIPRISTAL ACETATE VERSUS PLACEBO FOR FIBROID TREATMENT

Background: The efficacy and safety of oral ulipristal acetate for the treatment of symptomatic uterine fibroids before surgery are uncertain. Methods: We randomly assigned women with symptomatic fibroids, excessive uterine bleeding (a score of &gt;100 on the pictorial blood-loss assessment chart [PBAC, an objective assessment of blood loss, in which monthly scores range from 0 to &gt;500, with higher numbers indicating more bleeding]) and anemia (hemoglobin level of ≤10.2 g per deciliter) to receive treatment for up to 13 weeks with oral ulipristal acetate at a dose of 5 mg per day (96 women) or 10 mg per day (98 women) or to receive placebo (48 women). All patients received iron supplementation. The coprimary efficacy end points were control of uterine bleeding (PBAC score of &lt;75) and reduction of fibroid volume at week 13, after which patients could undergo surgery. Results: At 13 weeks, uterine bleeding was controlled in 91% of the women receiving 5 mg of ulipristal acetate, and 19% of those receiving placebo (P&lt;0.001 for the comparison of each dose of ulipristal acetate with placebo). The rates of amenorrhea were 73%, and 6%, respectively, with amenorrhea occurring within 10 days in the majority of patients receiving ulipristal acetate. The median changes in total fibroid volume were −21%,, and +3% (P = 0.002 for the comparison of 5 mg of ulipristal acetate with placebo. Serious adverse events occurred in one patient during treatment with 5 mg of ulipristal acetate (uterine hemorrhage) and in one patient during receipt of placebo (fibroid protruding through the cervix). Headache and breast tenderness were the most common adverse events associated with ulipristal acetate but did not occur significantly more frequently than with placebo. Conclusions: Treatment with ulipristal acetate for 13 weeks effectively controlled excessive bleeding due to uterine fibroids and reduced the size of the fibroids.

Effect of uterine artery embolization on fertility preservation in the treatment of symptomatic uterine fibroids

Introduction: Uterine fibroids are the most common benign tumors of the uterus. Most often they are asymptomatic, but in their course there may be ailments such as: abnormal bleeding, anaemia, pain, constipation, problems with urination. These tumors are also one of the many causes of infertility. They are most often detected during a standard ultrasound examination. Pharmacological, minimally invasive and surgical treatment is currently available.&#x0D; Aim: The aim of our study was to review scientific articles in order to demonstrate whether the treatment of uterine fibroids with uterine artery embolization has an impact on fertility and pregnancy outcomes.&#x0D; Materials and methods: Review of the latest PubMed literature, Google Scholar in the period 2017 - 2023 and evaluation of available randomized controlled trials using uterine artery embolization in terms of fertility preservation by assessing ovarian reserve, number of pregnancies, miscarriages and perinatal complications.&#x0D; Conclusions: Uterine artery embolization is a safe and effective method in reducing symptoms associated with uterine fibroids. This procedure shortens hospitalization and recovery time compared to myomectomy or hysterectomy. Unfortunately, for women who want children, this method is not recommended due to the risk of reduced ovarian reserve and miscarriage, premature birth, placental abnormality, and severe postpartum hemorrhage.&#x0D;

Uterine Artery Embolization for the Treatment of Symptomatic Uterine Fibroids of Different Sizes: A Single Center Experience.

The present study aimed to evaluate the clinical and radiological 1-year outcomes of uterine artery embolization (UAE) performed in a selected population of women with symptomatic myomas and who do not wish to conceive. Between January 2004 and January 2018, a total of 62 patients with pre-menopausal status and with no wish to conceive in the future underwent UAE for the treatment of symptomatic fibroids. All the patients underwent magnetic resonance imaging (MRI) and/or transvaginal ultrasonography (TV-US) before and after the procedure at 1-year follow-up. Clinical and radiological parameters were recorded, stratifying the population into 3 groups according to the size of the dominant myoma (group 1: <50 mm; group 2: ≥50 and ≤80 mm; group 3: >80 mm). Mean fibroid diameter was significantly reduced (42.6% ± 21.6%) at 1-year follow-up, with excellent improvements in terms of both symptoms and quality of life. No significant difference was observed regarding baseline dimension and the number of myomas. No major complications were reported (2.5%). The present study confirms the safety and efficacy of UAE in the treatment of symptomatic fibroids in pre-menopausal women with no desire to conceive.

Long-term health-related quality of life and symptom severity following hysterectomy, myomectomy, or uterine artery embolization for the treatment of symptomatic uterine fibroids

Few studies have directly compared different surgical procedures for uterine fibroids with respect to long-term health-related quality of life outcomes and symptom improvement. We examined differences in change from baseline to 1, 2 or 3-year follow-up in health-related quality of life and symptom severity among patients who underwent abdominal myomectomy, laparoscopic or robotic myomectomy, abdominal hysterectomy, laparoscopic or robotic hysterectomy, or uterine artery embolization. The COMPARE-UF Registry is a multi-institutional prospective observational cohort study of women undergoing treatment for uterine fibroids. A subset of 1,384 women ages 31-45 years who underwent either abdominal myomectomy (n=237), laparoscopic myomectomy (n=272), abdominal hysterectomy (n=177), laparoscopic hysterectomy(n=522), or uterine artery embolization (n=176) were included in this analysis. We obtained demographics, fibroid history, and symptoms by questionnaires at enrollment and at 1-, 2-, and 3-years post-treatment. We used the Uterine Fibroids Symptom and Quality of Life (UFS-QoL) questionnaire to ascertain symptom severity and health-related quality of life scores among participants To account for potential baseline differences across treatment groups, a propensity score model was used to derive overlap weights and compare total HR-QoL and symptom severity (SS) scores post-enrollment with a repeated measures model. For this HRQOL tool, a specific minimal clinically important difference (MCID) has not been determined, but based on previous research, a difference of 10 points was considered a reasonable estimate of MCID. Use of this difference was agreed upon by the Steering Committee at the time the analysis was planned. At baseline, women undergoing hysterectomy and uterine artery embolization reported the lowest health-related quality of life scores and highest symptom severity scores compared to those undergoing abdominal myomectomy or laparoscopic myomectomy (p<0.001). Those undergoing hysterectomy and uterine artery embolization reported the longest duration of fibroid symptoms with a mean of 6.3 years (SD: 6.7, p<0.001). The most common fibroid symptoms were menorrhagia (75.3%), bulk symptoms (74.2%), and bloating (73.2%). More than half (54.9%) of participants reported anemia, and 9.4% women reported a history of blood transfusion. Across all modalities, total health-related quality of life and symptom severity score markedly improved from baseline to 1-year with the largest improvement in the laparoscopic hysterectomy group (UFS-QoL: delta= (+) 49.2; symptom severity: delta= (-)51.3). Those undergoing abdominal myomectomy, laparoscopic myomectomy, and uterine artery embolization also demonstrated significant improvement in health-related quality of life ( delta= (+)43.9, (+)32.9, (+)40.7, respectively) and symptom severity (delta= (-)41.4, (-) 31.5, (-) 38.5, respectively) at 1 year, and the improvement persisted from baseline for uterine sparing procedures during 2nd (UFS-QOL: delta= (+)40.7, (+)37.4, (+)39.3 SS: delta= (-) 38.5, (-) 32.0, (-) 37.7 and 3rd year (UFS-QOL: delta= (+) 40.9, (+)39.9, (+)41.1and SS: delta= (-) 33.9 , (-)36.5, (-) 33.0, respectively), post-treatment intervals, however with a trend towards decline in degree of improvement from years 1 and 2. Differences from baseline were greatest for hysterectomy; however, this may reflect the relative importance of bleeding in the UFS-QoL, rather than clinically meaningful symptom recurrence among women undergoing uterus-sparing treatments. All treatment modalities were associated with significant improvement in health-related quality of life and symptom severity reduction 1-year post-treatment. However, abdominal myomectomy, laparoscopic myomectomy and uterine artery embolization indicated an a gradual decline in symptom improvement and health-related quality of life by 3rd year post-procedure.

Investigating the Underutilization of Uterine Fibroid Embolization by Surveying Practice Preferences of Obstetricians/Gynecologists

This study aimed to survey the practice preferences of obstetricians/gynecologists (OB/GYNs) that may be contributing to the underutilization of uterine fibroid embolization (UFE) in the treatment of symptomatic uterine fibroids (SUFs). A 22-question survey was created using the Qualtrics XM software and distributed to an obstetrics/gynecology–specific social media group of resident or attending OB/GYNs practicing in the United States. One hundred twelve responses met the inclusion criteria. For patients with SUFs, UFE was offered as a first-choice option <2% of the time. For patients with SUFs seeking to maintain fertility, UFE was recommended only 1% of the time after medical therapy (54%) and myomectomy (42%). Respondents reported lower rates of confidence (selecting “strongly agree” or “agree”) regarding risks and benefits of UFE (77%) in comparison with those of myomectomy (99%) or hysterectomy (100%). Because UFE was seldom recommended by respondents, further, more robust polling of OB/GYNs is warranted.

MP37-01 HYSTERECTOMY FOR UTERINE FIBROIDS AND STRESS URINARY INCONTINENCE SURGERY: A NATIONWIDE COHORT STUDY

You have accessJournal of UrologyCME1 Apr 2023MP37-01 HYSTERECTOMY FOR UTERINE FIBROIDS AND STRESS URINARY INCONTINENCE SURGERY: A NATIONWIDE COHORT STUDY Jun Ho Lee Jun Ho LeeJun Ho Lee More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003275.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Uterine fibroids (myomas or leiomyomas) are the most common benign uterine neoplasm. Hysterectomy is the most effective treatment for symptomatic uterine fibroids and uterine fibroids are currently the most common indication for hysterectomy worldwide. Previous studies investigated the relationship between the previous hysterectomy for benign conditions and subsequent stress urinary incontinence (SUI). However, the results are inconsistent across the studies. Additionally, long-term follow-up data from large data sets are lacking. Moreover, the impact of the previous hysterectomy for benign indication on subsequent surgery for SUI is scarcely investigated. METHODS: A retrospective cohort study was conducted on women aged 40 to 59 from the Korean Health Insurance Data 2010 to 2018. The hysterectomy group consisted of women who underwent hysterectomy for uterine leiomyoma and the control group consisted of women who visited a medical facility for a checkup between January, 2011 and December, 2014. Main outcome measures included the occurrence of stress incontinence surgery (R3564, R3565, R3562, R3563) with a urinary incontinence diagnosis code (N39.3, N39.4). For the selected hysterectomy group and control group, 1:1 propensity score matching was done on age at 5-year intervals, year at inclusion, socioeconomic status, parity, region, Charlson Comorbidity Index, adnexal surgery before inclusion, menopause before inclusion, menopausal hormone therapy, and pelvic organ prolapse before inclusion. RESULTS: After 1:1 propensity score matching, 81,373 cases and 81,373 controls were enrolled. The mean follow-up period was 7.9 years for cases and 7.8 years for control subjects. The rate of anti-incontinence surgery was significantly higher in the hysterectomy group compared to the non-hysterectomy group (1.7 vs. 2.0%; p<.001). As compared to the non-hysterectomy group, abdominal hysterectomy significantly increased anti-incontinence surgery before and after adjusting confounders (HR: 1.215; 95% CI: 1.097-1.347; p<.001). However, laparoscopic hysterectomy, laparoscopic hysterectomy with adnexal surgery, and abdominal hysterectomy with adnexal surgery did not increase anti-incontinence surgery as compared to the non-hysterectomy group before and after adjusting confounders. This significant relationship between abdominal hysterectomy and anti-incontinence surgery was maintained after stratifying patients according to age group. CONCLUSIONS: In conclusion, hysterectomy, especially transabdominal hysterectomy significantly increases the risk of subsequent anti-incontinence surgery. Our data suggest that patients who plan to undergo transabdominal hysterectomy for the treatment of uterine fibroids should know and be counseled about the risk of SUI and especially the risk of anti-incontinence surgery. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e513 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jun Ho Lee More articles by this author Expand All Advertisement PDF downloadLoading ...

Treatment of symptomatic uterine fibroids with orally active gonadotropin-releasing hormone antagonists and add-back therapy

Treatment of symptomatic uterine fibroids with orally active gonadotropin-releasing hormone antagonists and add-back therapy

Abstract No. 601 Long-Term Outcomes of MR-Guided Focused Ultrasound for Treatment of Symptomatic Uterine Fibroids

Abstract No. 601 Long-Term Outcomes of MR-Guided Focused Ultrasound for Treatment of Symptomatic Uterine Fibroids

New Surgical Approach to Treat Fibroids and Solid Tumors - Thermal and Nonthermal Ablation.

There is a trend toward more minimally invasive treatment for symptomatic uterine fibroids. They are image-guided ablation surgery with focused ultrasound, microwave, and radiofrequency ablations that are becoming tested and used in some medical centers or hospitals. Nevertheless, these image-guided ablation surgeries involve thermal ablation to the fibroids, which might lead to thermal injury to the surrounding tissues, for example, nerve injury, vessel injury, and skin burn due to heat diffusion. A new technology - irreversible electroporation (IRE) - is a new paradigm for treating solid tumors. This nonthermal ablation process does not induce high temperatures when treating cancers or solid tumors. The IRE treatment may soon be used for treating fibroids or other solid tumors. In a few clinical trials, IRE is currently used in experimental studies for treating gynecological cancers. This paper will present the minimally invasive thermal ablation treatments for fibroids, introduce this new nonthermal IRE ablation in treating gynecological cancer, and propose its future uses in uterine fibroids.

Comparison of hysterectomy and uterine artery embolization in the treatment of symptomatic uterine fibroids: A protocol for systematic review and meta-analysis

Uterine fibroids are common benign tumors in premenopausal women. Surgery is the preferred treatment for symptomatic uterine fibroids. An alternative of hysterectomy to manage symptomatic uterine fibroids is selective uterine artery embolization. We performed a protocol for systematic review and meta-analysis to assess the effectiveness of uterine artery embolization for treating symptomatic uterine fibroids compared with hysterectomy. The current systematic review and meta-analysis will be reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol. This review protocol has been registered in the International Prospective Register of systematic reviews. Its registration number is CRD42022371866. Only randomized controlled trials (RCTs) are included in our study.Two independent reviewers will search for databases including PubMed, Embase, Cochrane Library website, ClinicalTrials.gov databases, Chinese National Knowledge Infrastructure Database, Wanfang database, and VIP database. The risk of bias in each included study will be assessed utilizing the Cochrane Collaboration's risk of bias tool. The RevMan 5.3 software (Cochrane Collaboration, Oxford, UK) will be used to conduct the meta-analyses. The results of this systematic review will be published in a peer-reviewed journal. This systematic review will provide high quality evidence to judge whether uterine artery embolization is an effective surgical method for patients with symptomatic uterine fibroids.

Abdominal Myomectomy For The Treatment Of Symptomatic Uterine Fibroids

Background: Fibroids are common problem for women in elderly reproductive age. Aim: The present study aimed at assessing abdominal myomectomy for the treatment of symptomatic uterine fibroids. Methodology: The present retrospective study was conducted from 22 June 2020 to 23 July 2021 at Mayo Hospital, Lahore. Females undergone abdominal myomectomy with age 30 to 50 years were included. The primary and secondary outcomes were defined and assessed to evaluate the procedure. Results: The findings indicate that 32 (62.74%) of the patients showed successful outcome for menorrhagia. On the other hand, 27 (50.94%) patients showed successful outcome for pain and 30 (60%) showed for mass effect.&#x0D; Conclusion: Abdominal myomectomy is an ideally applicable procedure for the removal of fibroids.