Uterine Embolization Research Articles

Rare Case Report on Placenta Increta with Previous History of Uterine Artery Embolization for Arterio Venous Malformation

Rare Case Report on Placenta Increta with Previous History of Uterine Artery Embolization for Arterio Venous Malformation

Uterine artery embolization versus myomectomy: a systematic review and meta-analysis.

Uterine fibroids are the commonest benign tumors of the reproductive tract in women of childbearing age. They are usually asymptomatic but can cause menorrhagia. Treatments include myomectomy and uterine artery embolization (UAE). The latter is a relatively new procedure, therefore of special interest. We conducted a systematic review and meta-analysis of all published studies to provide a comprehensive outlook on the effectiveness of UAE by comparing its outcomes to those of myomectomy. Electronic databases (PubMed and Cochrane Central) were systematically searched from January 2000 to March 2022 for published randomized control trials, observational studies, and meta-analyses that compared UAE to myomectomy for at least one of the pre-specified outcomes, namely re-intervention rates, length of hospital stay, and complications. We shortlisted nine studies for the final analysis. For continuous outcomes, results from random-effects meta-analysis were presented as mean differences (MDs) and corresponding 95% confidence intervals (CIs). Risk ratios (RRs) for dichotomous outcomes were pooled using a random-effects model. The final analysis consisted of nine studies. Factors like re-intervention, hospitalization, and complications, each with its unique follow-up duration were assessed. Pooled analysis demonstrated significant results for greater re-intervention rates with UAE as compared to myomectomy (RR: 2.16, 95% CI: (1.27-3.66), p-value 0.004, heterogeneity I2 = 85%). UAE holds a greater but statistically insignificant risk for major complications (RR: 0.62, 95% CI: (0.29-1.33), p-value 0.22, heterogeneity I2 = 0%) and myomectomy shows a statistically insignificant greater risk for minor complications (RR: 1.72, 95% CI: (0.92-3.22), p-value 0.09, heterogeneity I2 = 0%). UAE had a shorter but statistically insignificant duration of hospital stay (MD: -1.12, 95% CI: (-2.50 to 0.27), p-value 0.11, heterogeneity I2 = 96%) (p-value for subgroup differences = 0.005). Our meta-analysis of approximately 196,595 patients demonstrates that myomectomy results in a significant reduction in re-intervention rate compared to UAE.

Uterine artery embolization versus hysterectomy for uterine myoma: a meta-analysis of postoperative ovarian function.

Uterine artery embolization (UAE) and hysterectomy are often used to treat uterine myoma. Nevertheless, the impact of these two treatments on postoperative ovarian function remains uncertain. To compare the postoperative ovarian function in individuals with uterine myoma who had UAE against hysterectomy. Searches were conducted in the Wanfang, Web of Science, and PubMed databases to find qualifying studies. The data were combined and analyzed. Seven publications were included in this meta-analysis. Uterus and uterine myoma volume were dramatically decreased by UAE (p < 0.00001 for both). The combined preoperative levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), and estradiol (E2) were similar in both groups. Three months postoperatively, the combined FSH (p = 0.28) and LH (p = 0.64) levels were similar in both groups, while the combined E2 level was notably higher in the UAE group compared to the hysterectomy group (p < 0.00001). Six months postoperatively, the combined postoperative FSH and LH levels were considerably lower in the UAE group compared to the hysterectomy group (p = 0.002 for both). However, the combined E2 levels were similar between the two groups (p = 0.07). Also, 12 months after surgery, the combined postoperative FSH and LH levels were remarkably lower in the UAE group compared to the hysterectomy group (p = 0.02 and p < 0.00001, respectively). However, the combined E2 levels were similar in both groups (p = 0.15). UAE may provide superior preservation of postoperative ovarian function compared to hysterectomy in individuals with uterine myoma.

Fibroid uterus: A case study

Fibroid uterus, also known as Uterine leiomyoma, represents a common gynecological disorder affecting women, particularly those in their reproductive years. This paper presents a case study focusing on the clinical manifestation, diagnosis, management, and nursing care of a 43-year-old woman with fibroid uterus. Fibroids, benign neoplasms of the uterine wall, are classified based on their location within the uterus. Risk factors for fibroid development include early puberty, obesity, genetic predisposition, and oral contraceptive use. Diagnosis often involves ultrasound imaging, revealing characteristic features such as heterogeneous hypoechoic lesions. Management options range from medical to surgical interventions, with considerations for patient age, fertility preservation, and symptom severity. Surgical procedures like myomectomy and hysterectomy may be necessary, while non-surgical alternatives such as uterine artery embolism and myolysis offer alternatives. Nursing care focuses on pain management, nutritional support, infection prevention, and patient education. Early detection and appropriate management are essential to mitigate the risk of complications and preserve fertility in affected women.

Pelvic abscess after total laparoscopic hysterectomy for pyomyoma at 2 years after uterine artery embolization

Pelvic abscess after total laparoscopic hysterectomy for pyomyoma at 2 years after uterine artery embolization

High-intensity focused ultrasound in adenomyosis treatment: Insights on safety, efficacy, and reproductive prospects.

The management of adenomyosis has undergone significant evolution, moving from traditional surgical interventions like hysterectomy to more conservative methods aimed at preserving fertility. Essential roles have been played by uterine-sparing surgeries and uterine artery embolization. Despite these advancements, there is a growing interest in less invasive alternatives. This review delves into the potential of high-intensity focused ultrasound (HIFU). HIFU employs focused ultrasound waves for precise ablation of adenomyotic lesions. The review conducts a thorough analysis of HIFU principles, safety, efficacy, and its possible synergies with other therapies. HIFU seems to be effective for adenomyosis treatment, demonstrating a favorable adverse effect profile and suitability for fertility preservation. Combining HIFU with hormonal treatment appears to enhance long-term symptom control, presenting a promising and comprehensive approach for managing adenomyosis. The goal of this article is to develop a comprehensive understanding of HIFU's role in contemporary adenomyosis management and to explore areas requiring further research.

Ultrasonography of uterine leiomyomas: A prospective cross-sectional study

ABSTRACT Background, Sonographic Features of Uterine Leiomyomas Location: Subserosal: Located on the outer surface of the uterus.Intramural: Located within the muscular wall of the uterus. Submucosal: Protrude into the uterine cavity, often causing more symptoms like heavy menstrual bleeding. Size: Leiomyomas can range from very small (a few millimeters) to very large (over 20 centimeters).Size measurement is important for monitoring growth over time. Echotexture: Typically, fibroids appear as well-circumscribed, hypoechoic (dark) or heterogeneous masses.They may have calcifications, which appear as bright echoes within the fibroid. Shape: Generally round or oval.The borders are usually well-defined. Cystic Degeneration: Some fibroids may show areas of cystic degeneration, which appear as anechoic (clear) regions within the mass. Vascularity: Color Doppler ultrasonography can assess the blood flow within and around the fibroid.This is useful for differentiating fibroids from other masses and for planning treatment options like uterine artery embolization. Aims and Objectives: To complement diagnostic hysteroscopy for the assessment of a submucosal leiomyoma, a three-dimensional (3D) TVS can be combined with saline instillation into the uterine cavity. Diagnostic hysteroscopy and TVS have a good overall agreement in the diagnosis of submucosal leiomyomas and in the assessment of fibroids’ myometrial extension. In this regard, 3D saline contrast Sono hysterography may provide even more information than traditional 3D TVS. Materials and Methods: This study was conducted in the department of radiology and was a cross-sectional study that lasted 3 months (November 10, 2022–March 10, 2023). The sample size for this study was determined using predefined exclusion and inclusion criteria. The study population included 30 females aged 20–50 who visited the Diagnostic Centre with complaints of abnormal menstrual bleeding or changes in menstrual cycles. Results: The majority of fibroids (78%), on USG, appeared hypoechoic, with the remainder (10%) appearing heterogeneous. Conclusion: Ultrasound has a high sensitivity and specificity in the diagnosing uterine leiomyoma.

Spontaneous Paravesical and Broad Ligament Hematoma after Vaginal Delivery Had Uterine Artery Embolization after Evacuating the Hematoma

Spontaneous Paravesical and Broad Ligament Hematoma after Vaginal Delivery Had Uterine Artery Embolization after Evacuating the Hematoma

Uterine artery embolization and local and systemic methotrexate therapy followed by hysteroscopic surgery for management of cervical pregnancy: A case report

Uterine artery embolization and local and systemic methotrexate therapy followed by hysteroscopic surgery for management of cervical pregnancy: A case report

Long-Term Health Related Quality of Life Following Uterine Fibroid Embolization in a Predominantly Black African Population: A Retrospective Cohort Study

Long-Term Health Related Quality of Life Following Uterine Fibroid Embolization in a Predominantly Black African Population: A Retrospective Cohort Study

Pyomyoma as a Complication of Uterine Artery Embolization (A Case Report)

Pyomyoma as a Complication of Uterine Artery Embolization (A Case Report)

Efficacy and Safety of Uterine Artery Embolisation for Postpartum Haemorrhage: A Systematic Review and Meta-analysis

Efficacy and Safety of Uterine Artery Embolisation for Postpartum Haemorrhage: A Systematic Review and Meta-analysis

Role of Laparoscopy in Treatment of Uterine Arteriovenous Malformation after Failure of Uterine Arteries Embolization

Role of Laparoscopy in Treatment of Uterine Arteriovenous Malformation after Failure of Uterine Arteries Embolization

Monitored Anesthesia Care Primarily Using Dexmedetomidine Provides Safe Sedation and Analgesic Effect in Uterine Artery Embolization: A Case Report

Monitored anesthesia care (MAC) has been used as a specific anesthesia service for diagnostic or therapeutic procedures performed under local anesthesia along with sedation and analgesia. Procedures such as trans arterial chemoembolization (TACE) or uterine artery embolization (UAE) performed in interventional radiology are typically accompanied by post-embolization syndrome (PES). While in TACE for hepatocellular carcinoma treatment, the severity of PES tends to be milder due to the liver’s dual blood supply, the degree is notably more severe in the case of UAE. Furthermore, the symptoms of PES after UAE procedure tend to follow a typical pattern. Most UAE patients do not develop pain until after the procedure has concluded. It is during the recovery period that patients frequently need significant doses of narcotics and analgesics to alleviate the pain. This report elucidates the application of MAC using dexmedetomidine in UAE, aimed to maintain adequate sedation during procedure and reduce severe pain after procedure.

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 &amp; 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\(&lt; \)0.05) and the median size reduced by more than 50%, from 11 cm to 5 cm after UAE, (P\(&lt; \)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.

Fertility Preservation Approach in a Case of Perforating Gestational Trophoblastic Neoplasia

Background: Gestational trophoblastic neoplasia following spontaneous abortion is rare and in majority cases the approach is hysterectomy followed by chemotherapy. Case: We present case of a 22-year-old woman who presented with complaints of vaginal bleeding for 2 months; pain abdomen for 3-4 days. On reviewing history, patient was one and a half months pregnant and had spontaneous abortion for which she underwent twice dilatation and curettage and once laparotomy in outside hospital. Patient continued to bleed &amp; MRI pelvis was done which revealed arteriovenous malformation and was thereafter referred to our hospital. On presentation her vitals were stable with pallor positive. On per-abdominal examination there was generalized tenderness and mild bleeding on per speculum examination. Her serum beta hCG at the time of admission was 98,156IU/L. Ultrasound pelvis revealed a highly vascular heterogenous hypoechoic mass showing significant internal and peripheral vascularity. We decided for uterine artery embolization owing to highly vascular GTN, young age and no live issues with the aim of uterine preservation. This was followed by chemotherapy with serial beta hcg monitoring. She is in her 14th month of follow up with resolution of her complaints. Conclusion: The aim behind presenting this case is its rarity of presentation as well as management to increase awareness among treating gynecologists. Importance of multi-disciplinary approach should not be undermined in challenging cases.

Uterine Leiomyomas and Infertility: A Comparison of National and International Guidelines.

Uterine leiomyomas are the most common benign tumors of the female genital track, causing various symptoms and problems, including a possible impact on fertility.The relationship between fibroids and infertility has long been a debate among gynecologists. Management of fibroids in women with otherwise unexplained infertility worldwide lacks standardized, evidence-based guidelines. Therefore, a review of guidelines from the Royal Australian and New Zealand College of Obstetricians and Gynecologists, the American College of Obstetricians and Gynecologists, the Society of Obstetricians and Gynecologists of Canada, the Collège National des Gynécologues et Obstétriciens Français, and the American Society of Reproductive Medicine was conducted. There is agreement among all guidelines that the effect of fibroids on fertility is related to their position in the uterus and the alteration of the endometrial cavity. However, whether surgical intervention (laparotomy, laparoscopy, or hysteroscopy) is required varies among committees. More specifically, for submucous myomas, all guidelines agree that surgical intervention is needed. On the other hand, regarding intramural myomas, there is no consensus on what the approach may be. Novel treatments such as uterine artery embolization (UAE) and magnetic resonance-guided focused ultrasound surgery (MRgFUS) should only be used in clinical trial settings. Nevertheless, all guidelines agree that medical management of fibroids further delays efforts to conceive and has no role as a stand-alone treatment of fibroids; though, the use of GnRH analogues preoperatively can be useful to improve anemia and/or reduce fibroid volume. There is a need for updated international protocols to be introduced, in order to help clinicians dealing with fibroids and infertility to better suggest the optimal treatment.

Evaluation of Uterine Fibroid Vascularity Using Contrast-Enhanced Ultrasound in Comparison with Contrast-Enhanced Magnetic Resonance Imaging

ObjectiveTo assess uterine fibroid vascularity using contrast-enhanced ultrasound (CEUS) comparing these findings with magnetic resonance imaging (MRI). MethodsForty women diagnosed with symptomatic uterine fibroids scheduled for uterine artery embolization (UAE) were enrolled in this IRB-approved study. Subjects underwent CEUS examination prior to UAE using an Aplio i800 scanner (Canon Medical Systems, Tustin, CA, USA) with curvilinear array (8C1). CEUS was performed using 2.0ml of the ultrasound contrast agent, Lumason (Bracco, Milan, Italy) administered intravenously. Digital CEUS clips were acquired, randomized off-line and fibroids were characterized hyper- or hypovascular. MRI was used as reference standard for fibroid vascularity and compared to CEUS. Results were analyzed using McNemar's test. ResultsForty subjects were enrolled in the trial. One patient did not proceed with the UAE procedure and one patient refused pre-procedure MRI due to claustrophobia. Therefore, 38 subjects underwent CEUS and MRI examinations prior to UAE. Hypervascular fibroids were seen on MRI and CEUS in 24 and 26 subjects, respectively. Hypovascular fibroids were seen with MRI and CEUS in 14 and 12 subjects, respectively. Fibroids characterized as hypovascular in two subjects by MRI were characterized as hypervascular by CEUS. CEUS and MRI findings were similar in 36/38 subjects corresponding to an accuracy of 95% (p = 0.62). ConclusionCEUS can accurately assess uterine fibroid vascularity serving as a potential alternative to MRI to determine vascularity of uterine fibroids.

Recurrence of Uterine Fibroids After Conservative Surgery or Radiological Procedures: a Narrative Review.

The present narrative review aims to discuss the available data on the incidence and the risk factors of uterine fibroids (UFs) recurrence after different types of conservative surgical or radiologic procedures in women wishing to preserve their uterus. UFs are the most common benign tumors in women all over the world. Clinical presentation, including abnormal uterine bleeding (AUB), pelvic pain, bulky symptoms, and infertility affect patients' quality of life, and a large variety of conservative treatments are available especially for those with desire of pregnancy. Fertility sparing surgery, by either laparoscopy, hysteroscopy or laparotomy, or radiological interventions (uterine artery embolization, high-intensity focused ultrasound or magnetic resonance-guided focused ultrasound), are the most common therapeutic approaches. However, the genetic or acquired predisposition to UFs remain despite the treatments, and the recurrences are frequently described in a large percentage of patients. The most relevant risk factors for recurrence of UFs are young age at the first surgery, incomplete fibroid resection, the presence of multiple lesions, an enlarged uterus, and the coexistence with other pelvic diseases. The discussion on the possible medical strategy to reduce the recurrence is an open field of clinical investigation, in particular by using hormonal drugs.

Anatomic variation of a duplicated uterine artery.

During the anatomical dissection of the pelvis, a duplication of the uterine artery was identified unilaterally on the left side in a 59-year-old Korean female cadaver. The first uterine artery was found to arise directly from the anterior division of the internal iliac artery and supply the upper uterine body and tube. The second uterine artery shared a common stem with the superior and inferior vesical arteries, supplying the lower uterine body. The external diameter of each uterine artery at its origin on the left side was smaller than that of the right uterine artery. One vaginal artery was identified to arise from the left internal pudendal artery. Embryologically, a duplicated uterine artery could imply the presence of two primordial arteries separately supplying the cranial and caudal parts of the Müllerian duct during the early fetal period. This case of variational anatomy is noteworthy: clinicians could elucidate it and successfully perform uterine artery embolization or hysterectomy with minimal complications.