Uterine Artery Embolization For Fibroids Research Articles

Short- and long-term evaluation of disease-specific symptoms and quality of life following uterine artery embolization of fibroids

BackgroundThe purpose of this study is to evaluate uterine artery embolization (UAE) for the management of symptomatic uterine leiomyomas regarding changes in quality of life after treatment in a large patient collective. This study retrospectively analyzed prospectively acquired standardized questionnaires of patients treated with UAE. Clinical success was evaluated before and after embolization. Patients were stratified into short- (≤ 7 months) and long-term (> 7 months) follow-up groups depending on the time of completion of the post-interventional questionnaire. Uterine leiomyomas were furthermore divided into small (< 10 cm) and large (≥ 10 cm) tumors based on the diameter of the dominant fibroid.ResultsA total of 245 patients were included into the final data analysis. The Kaplan–Meier analysis showed a cumulative clinical success rate of 75.8% after 70 months until the end of follow-up (9.9 years). All questionnaire subscales showed a highly significant clinical improvement from baseline to short- and long-term follow-up (p < 0.001). Patients with small fibroids showed a significantly better response to UAE in multiple subcategories of the questionnaire than patients with fibroids ≥ 10 cm who had a twofold higher probability of re-intervention in the Cox-regression model.ConclusionsUAE is an effective treatment method for symptomatic fibroids that leads to quick relief of fibroid-related symptoms with marked improvement of quality of life and is associated with a low risk for re-interventions. Patients with small fibroids tend to show a better response to UAE compared to patients with large fibroids.Trial registration Charité institutional review board, EA4/167/20. Registered 27 November 2020—Retrospectively registered. https://ethikkommission.charite.de/

Transradial versus transfemoral arterial access in the uterine artery embolization of fibroids.

Transradial arterial access has become more popular in body interventional procedures but has not been ubiquitously adapted. This retrospective study assesses the efficacy of this approach in uterine artery embolization. Aim of the study was to compare transradial to transfemoral arterial access in patients undergoing uterine artery embolization for the treatment of fibroids. A total of 172 patients underwent uterine artery embolization procedures at our institute from October 2014 to June 2020. Of these, 76 patients had their operations performed via transfemoral access while 96 underwent transradial access. The peak radiation dose, fluoroscopy time, procedure time, total contrast volume, and equipment cost for each procedure were all reviewed to evaluate for statistical differences between the 2 groups. All cases were technically successful without major complications. The average peak skin dose was 2281 mGy,with no statistical difference between the transradial or transfemoral cohorts. Average fluoroscopy time was 25 minutes, also with no statistical difference between the subsets. Mean procedure time was 100 min, and mean contrast volume usage was 138 mL with no statistical differences. Similarly, the average equipment cost was $2204, with no significant differences found between transradial and transfemoral access. With respect to many pertinent radiation parameters, transradial access was evaluated as being an equally efficacious alternative to transfemoral access in uterine artery embolization procedures. The results of this study suggest that transradial access should be considered more often, whenever viable, as an option in the uterine artery embolization treatment of fibroids.

Uterine Artery Embolization for Uterine Fibroids: A Closer Look at Misperceptions and Challenges

Uterine artery embolization (UAE) has been shown to be a safe and effective treatment for symptomatic uterine fibroids, with over 25 years of supporting data. Although UAE is a well-established treatment option, several misperceptions exist that may limit the number of patients who are considered candidates for UAE. There are also challenges that may affect the ability of interventional radiologists to effectively treat some patients and offer the best possible experience. This article will discuss these misperceptions and challenges, which represent opportunities for further growth and innovation that will allow interventional radiologists to better serve this patient population.

Long-term effects of uterine artery embolization caused by the embolic material

Background and objectives. Uterine artery embolization (UAE), or uterine fibroid embolization (EFM), a technique introduced in the conservative treatment of uterine fibroids in the 1990s, has been increasingly used in the last decades. The data accumulated in time revealed also, besides the expected benefits, some undesirable complications, initially unanticipated. The study aims at analyzing the histological changes of myometrium occurred after uterine artery embolization for fibroids. Materials and method. Presentation of a series of three cases that have undergone gynecologic surgery in the Bucur Maternity of the “Sf. Ioan” Emergency Clinical Hospital, Bucharest, after the embolization of the uterine arteries performed (in the past) for fibroids. Results. In two of the three cases presented, it was practiced hysterectomy with bilateral anexectomy and in one case myometrectomy. At the histopathological examination, what was proven to be specific for the long-term effects of UAE was the thickening of vascular structures containing intraluminal amorphous material, with vascular and perivascular infiltration with giant multinucleated histiocytes around the foreign body. This histological aspect corresponds to a nonspecific granulomatous inflammation with giant cells. Conclusions. Embolization of the uterine arteries may cause a giant-cell type inflammation at the level of the myometrium and fibrosis, and this type of changes could be the cause of a poor prognosis for women who want a future pregnancy.

Experience with trans radial uterine artery embolisation for uterine fibroids in a tertiary center in Saudi Arabia

Trans-radial uterine artery embolization (UAE) is acknowledged as a non- invasive, cost-effective and safe procedure for the treatment of symptomatic fibroids. However, it is associated with the recurrence of symptoms like abnormal uterine bleeding and pressure symptom in some patients. This is a comparative study of our data with other international data, in the context of percentage reduction in fibroid size, accompanying controlling factors, short and long term follow up data analysis of the first two years was done. Careful pre-procedural counseling of future possibility of fibroid recurrence and means of management should be stressed. Materials and methods: A retrospective cohort study at the Security Forces Hospital in Riyadh, Saudi Arabia, was conducted. The study was done from 1st November 2017-31st October 2019, on symptomatic patients diagnosed with fibroids, who refused surgical treatment. The outcomes included: fibroid site, size and anatomical position, patients’ symptoms, general condition, and early and delayed complications. These data were compared with those from other international studies. Results: The study involved 23 patients (mean age: 39 years). The average percentage reduction in fibroid volume was 49%. There were no major complications and no recurrence of symptoms during the covered period. Data analysis revealed a poor correlation between the overall percentage reduction of fibroid size with fibroid number, age of patients’, and body mass indices. Conclusion: Despite poor correlation, we provided preliminary data of the first two years out of the total five-year projected period of the study where it showed effectiveness and relative safety of radial - UAE for fibroid.

Value of Dyna CT in guiding embolization during transarterial uterine artery embolization of fibroids.

The present study aimed to assess the usefulness of Dyna CT during transarterial uterine artery embolization (UAE) of fibroids. A total of 65 patients with symptomatic submucosal and intramural fibroids scheduled for transarterial UAE at the First People's Hospital of Changhou between May 2016 and September 2018 were included. Dyna CT and routine digital subtraction angiography (DSA) were performed in all patients during angiographic embolization of the bilateral internal iliac arteries. The visualization qualities of uterine artery origin and fibroids, as imaged by Dyna CT, were compared with DSA anterior-posterior images. Dyna CT provided excellent 3-dimensional visualization of vascular structures of the bilateral internal iliac arteries and uterine artery origin. Dyna CT was primarily useful in patients with overlapped uterine arteries or complex vascular anatomies on DSA anterior-posterior images (Dyna CT 100% vs. DSA anterior-posterior 69.2%, P=0.03). However, stained fibroids were identified in 57/65 cases (87.7%) by Dyna CT, and in all of the cases (100%) by DSA anterior-posterior imaging (P=0.03). Dyna CT is not suitable for procedural evaluation when used alone for transarterial UAE of fibroids. However, Dyna CT is an excellent supplement to DSA anterior-posterior imaging, as it provides additional information to aid in treatment planning.

4:21 PM Abstract No. 174 Uterine artery embolization for fibroids versus fibroids and adenomyosis

To compare outcomes following uterine artery embolization (UAE) for patients with fibroids versus those with fibroids and adenomyosis A total of 145 patients underwent UAE at a single institution between August 2016 and June 2019. A retrospective review was performed of patient demographics, pre procedure MRI findings, and post procedure clinical and MRI outcomes. Statistical analysis was used to compare patients with fibroids only versus those with a combination of fibroids and adenomyosis. Eight patients were excluded due to lack of complete MRI studies available in PACS. Of the eligible patients, 103 had fibroids only and 34 patients had a combination of fibroids and adenomyosis. 81.4% of patients in the fibroid only group presented with menorrhagia vs. 91.2% in the combination group (P = 0.179). Significantly fewer patients with combination fibroids and adenomyosis presented with bulk symptoms, 67.6% vs. 85.1% in the fibroids only group (P = 0.025). There was no difference in demographics, uterine volume (P = 0.727) or amount of embolic material used during the UAE (P = 0.092) between groups. Clinical follow-up was available for 72 fibroid only patients and 23 combination patients with no difference in outcomes between the two groups. Menorrhagia improved in 91.4% of the fibroid only group vs. 82.6% in the combination group (P = 0.236) and bulk symptoms improved in 81.9% of the fibroid only group vs. 94.4% in the combination group (P = 0.191). Post-procedure MRI was available for 58 fibroid only patients and 15 combination patients and demonstrated no significant difference in the degree of nonenhancement (NE) when graded on a 4 tier scale of 100% NE, >90% NE, >80% NE and <80% NE (P = 0.226). Of the patients with adenomyosis, 86.7% (13/15) had improvement in the appearance of adenomyosis on post procedure MRI. This demonstrates that the presence of adenomyosis does not have an impact on the clinical or imaging success rate of uterine artery embolization when treating patients with a combination of fibroids and adenomyosis.

The impact of uterine artery embolization on ovarian reserve: A systematic review and meta-analysis.

Uterine artery embolization (UAE) has been gaining increasing popularity as an effective and minimally invasive treatment for uterine fibroids. However, there has been growing concern over the risk of unintended embolization of the utero-ovarian circulation, leading to reduction of ovarian blood supply with subsequent impairment of ovarian reserve. The purpose of this study was to investigate the impact of UAE on circulating anti-Müllerian hormone (AMH) and other markers of ovarian reserve. This meta-analysis included all published cohort, cross-sectional and case-control studies, as well as randomized trials that investigated the impact of UAE on circulating AMH. Data sources included MEDLINE, EMBASE, Dynamed Plus, ScienceDirect, TRIP database, ClinicalTrials.gov and the Cochrane Library from January 2000 to June 2019. All identified articles were screened, and articles were selected based on the inclusion and exclusion criteria. AMH and other data were extracted from the eligible articles and entered into RevMan software to calculate the weighted mean difference between pre- and post-embolization values. PROSPERO registration number: CRD42017082615. This review included 3 cohort and 3 case-control studies (n=353). The duration of follow up after UAE ranged between 3 and 12months. Overall pooled analysis of all studies showed no significant effect of UAE on serum AMH levels (weighted mean difference -0.58ng/mL; 95% CI -1.5 to 0.36, I2 =95%). Subgroup analysis according to age of participants (under and over 40years) and according to follow-up duration (3, 6 and 12months) showed no significant change in post-embolization circulating AMH. Pooled analysis of serum follicle-stimulating hormone (FSH) concentrations (4 studies, n=248) revealed no statistically significant change after UAE (weighted mean difference 4.32; 95% CI -0.53 to 9.17; I2 =95%). Analysis of 2 studies (n=62) measuring antral follicle count showed a significant decline at 3-month follow up (weighted mean difference -3.28; 95% CI -5.62 to -0.93; I2 =94%). Uterine artery embolization for uterine fibroids does not seem to affect ovarian reserve as measured by serum concentrations of AMH and FSH.

Randomised trial of two embolic agents for uterine artery embolisation for fibroids: Gelfoam versus Embospheres (RAGE trial)

BackgroundUterine artery embolisation (UAE) is an established treatment option for women with symptomatic uterine fibroids who wish to avoid surgery. However the most efficacious embolic agent remains uncertain.MethodsWe conducted a pilot double blind randomized controlled trial comparing Gelfoam with Embospheres in women undergoing UAE. Outcomes recorded at baseline, 24-h, 1 and 6 months included complications, inflammatory, haematological markers and ovarian function. Contrast enhanced MRI (CEMRI) was acquired at baseline, 24-h and 6 months. Pain score (visual analogue) was measured at 24-h, quality of life (UFS-Qol) at baseline, 1 and 6 months. All patients were followed to 6 months.ResultsTwenty patients were randomized 1:1 to receive either Gelfoam (G) or Embospheres (E). The UFS-Qol symptom score improved in both groups at 6 months mean of 64 ± 18 to 23 ± 16 and 54 ± 15 to 32 ± 26 in the E and G groups respectively. UFS-Qol HRQL also improved in both groups at 6 months, mean 41 ± 28 to 79 ± 20 and 53 ± 19 to 78 ± 21 in the E and G groups respectively.Uterine volume at 6 months reduced from 1018 ± 666mls to 622 ± 436 (p = 0.001) and from 1026 ± 756 to 908 ± 720 (p = 0.15) in the E and G groups respectively. There was a significant difference between groups for this parameter p = 0.01. All uterine arteries were patent at 24-h and 6 months. Complete (100%) fibroid infarction rates were 5(50%) and 2(20%) in the E and G groups respectively. None of the other outcome measures showed any between group differences. There were no re-interventions in either group.ConclusionThe only significant between group differences was for a greater reduction in uterine volume at 6 months in the E group. A larger trial (estimate 172 subjects) is required to determine whether other apparent differences are clinically and statistically significant.Trial registrationISRCTN67347987

Fertility after uterine artery embolization of fibroids: a systematic review.

The impact of uterine artery embolization (UAE) for the purpose of diminishing the effect of uterine fibroids on fertility is unclear. We have investigated the reported rates of pregnancy and miscarriage after treatment of uterine fibroids with UAE. We searched for relevant information in PubMed and Embase for randomized controlled trials (RCT), controlled clinical trials, comparative before-after trials, cohort studies, case-control studies and case series where UAE treatment of premenopausal women was performed for uterine fibroids with and where a control intervention was included. The PRISMA guideline was used to do a systematic review using the main outcomes pregnancy rate and miscarriage rate. Risk of bias was assessed by the Cochrane risk of bias tool or by ROBINS-I. The quality of evidence was assessed by the GRADE approach. We included 17 studies (989 patients): 1 RCT, 2 cohort studies, and 14 case series. Pregnancy rates after UAE were 50% in the RCT and 51 and 69% in the cohort studies. Among the case series median pregnancy rate was 29%. Miscarriage rates were 64% in the RCT. Miscarriage rates at 56 and 34% were found in the cohort studies after UAE. The median miscarriage rate was 25% in the case series. Pregnancy rate was found to be lower and miscarriage rate higher after UAE than after myomectomy. However, we found very low quality of evidence regarding the assessed outcomes and the reported proportions are uncertain. There is a need for improved prospective randomized studies to improve the evidence base. Systematic review registration number: CRD42016036661.

EP15.06: A case of abnormally invasive placentation in a nulliparous woman following uterine artery embolisation for uterine fibroids

Abnormal placentation is typically associated with prior Caesarean delivery but other etiologies have been reported. Uterine artery embolisation is increasingly being performed for non-invasive treatment of uterine artery fibroids. The impact of this therapy on subsequent pregnancy outcome is unclear. We present a case of a 32 year old woman with a large multifibroid uterus and resultant heavy menstrual bleeding. The largest leiomyoma was posterofundal, extending through the entire myometrial thickness, and measuring 86 x 84 x 97 mm, with very little surrounding myometrium. She desired fertility preservation due to nulliparity and underwent uterine artery embolisation via interventional radiology. The procedure failed to cure her symptoms and she subsequently underwent laparotomy and myomectomy with successful removal of the leiomyoma. She conceived spontaneously a year later. Routine fetal anatomy survey at 18.6 weeks gestation demonstrated an extensive placental implantation with multiple large placental lacunae. As the pregnancy advanced, the lacunae increased in complexity and size, with high velocity blood flow seen swirling around the lacunae on Cine-loops and in B-Flow mode. The largest lacunae were 80 mm in diameter. It was noted that the myometrium was very thin at the site of the myomectomy. The woman's pregnancy course was complicated by gestational diabetes mellitus and pre-eclampsia. A Caesarean delivery was performed at 35.2 weeks gestation due to worsening pre-eclampsia. A live female infant weighing 2300g was delivered. The placenta was morbidly adherent. An emergent peripartum hysterectomy was performed with a 6000 mL blood loss. Histopathological studies of the placenta and uterus confirmed the diagnosis of placenta accreta with focal placenta increta. This case demonstrates the ultrasound signs of abnormally invasive placentation, and that pregnancy after arterial embolisation for leiomyomas may be associated with adverse pregnancy outcomes.

Epidural Anesthesia vs General Anesthesia in Uterine Artery Embolization

Background: Uterine Artery Embolization (UAE) has been used worldwide for the treatment of uterine fibroids. The aim of the current study is to evaluate the effects of epidural analgesia (EDA) given only intraoperatively to those of general anesthesia (does it still affect in recovery) in women undergoing uterine artery embolization (UAE) for the treatment of systematic uterine fibroids. Patients and methods: A total of 40 ASA1-III patients (ages 35-55) selected for uterine artery embolization were divided into 2 groups i.e. an epidural anesthesia group (A) and a general anesthesia group (B). Each group comprised of 20 individuals. The parameters i.e. pain scoring, incidence of nausea and vomiting, need for opioids, overall patient satisfaction score and discharge from hospital were measured. Pain intensity was measured using VAS (1–10) at 0, 1, 2, 4, 8, 12 and 24 h. Nausea lasting more than 10 min or vomiting was treated with ondansetron 4 mg. Patient satisfaction for postoperative analgesia was recorded according to a satisfaction score (poor=0, fair=1, good=2, excellent=3). All data were recorded with residents of anesthesia. Primary outcome was morphine and or pethidine, consumption in the first 24 h. Secondary outcome measures were; pain intensity, postoperative analgesic consumption, postoperative nausea and vomiting (PONV) and patient satisfaction. Results: Differences in the heart rate between the 2 groups were statistically significant at all readings where group (B) patients developed less significant tachycardia compared to group (A) patients. Differences in systolic blood pressure values between the 2 groups were statistically significant lower in group (B) compared to group (A) at 2 points: after 5 min & after 10 min from induction of anesthesia. Differences in diastolic blood pressure values between the 2 groups were statistically significant lower in group (A) compared to group (B) at all times except preoperative reading. Thus the epidural anesthesia provided more hemodynamic stability than general anesthesia, Postoperative pain severity of the patients significantly decreased in each group at recovery room (time 0) and postoperative 1st, 2nd, 4th, 12th and 24th h (repeated measured variance analysis, p<0.001. However, the reduction of postoperative VAS scores was more in epidural anesthesia group than general anesthesia (repeated measured variance analysis, test, p=0.466. Conclusion: Uterine artery embolization for fibroids is an effective and safe therapeutic modality for symptomatic fibroids especially for those patients who like to preserve their uterus. Recovery and time to return to normal activities is shorter than hysterectomy and open myomectomy. With the results of the present study it can be concluded that epidural anaesthesia was much better in pain relief, less sedating effect and overall patient satisfaction. Thus, epidural anaesthesia technique can be helpful for women undergoing UAE to recover faster providing good symptom relief for most patients.

P10.08: Effect on sexual function after uterine artery embolisation for uterine fibroids

P10.08: Effect on sexual function after uterine artery embolisation for uterine fibroids

Uterine artery embolisation for uterine fibroids: Our experience at a tertiary care service hospital

BackgroundUterine artery embolisation (UAE) has evolved as a minimally invasive and effective alternative, treatment modality for women with symptomatic fibroids. We discuss our initial experience of UAE in the management of symptomatic fibroids. MethodsTwenty five symptomatic patients of uterine fibroids were treated with UAE by selectively cannulating and injecting poly vinyl alcohol particles into the uterine arteries. Post treatment follow up was done at 2 and 6 months respectively. ResultsPre-treatment, the sizes of fibroids were between 3.9 and 10.9 cm (mean 7.4) on ultrasonography. Of the total 25 patients, 49 uterine arteries were embolised with a technical success rate of 98%. Menorrhagia persisted in 7 patients, dysmenorrhea in 4 patients and pressure symptoms in 2 patients respectively in follow up study of six months which corresponds to a reduction in symptoms by 68% for menorrhagia, 71% for dysmenorhoea and 75% for those with pressure symptoms respectively. At 2 months follow-up post embolisation, the mean diameter of the fibroid was 4.03 cm (range 2–5.2 cm) and at 6 months 3.2 cm (range 1.3–4.1 cm), corresponding to size reduction of 45.5% and 57%, respectively. Follow up with ultrasonography at 2 and 6 months period showed successful fibroid reduction in 24 patients with corresponding reduction in the symptomatology. One patient remained symptomatic with increase in fibroid size and had to undergo hysterectomy. ConclusionUterine artery embolisation can be considered as an alternative to hysterectomy in appropriately selected symptomatic patients of uterine fibroids.

Efficacy of Ovarian Artery Embolization for Uterine Fibroids: Clinical and Magnetic Resonance Imaging Evaluations

PurposeThe objective of the study was to assess the efficacy of ovarian artery embolization (OAE) treatment for symptomatic uterine leiomyomas. MethodsA retrospective review of 17 patients who underwent OAE in conjunction with uterine artery embolization in a 6-year period (2006-2012) was performed. Ten patients had previous failed embolization, while 7 had not received any embolization therapy before. Percent uterine volume change, percent dominant fibroid volume change, and percent dominant fibroid infarction were assessed with magnetic resonance (MR) imaging. Resolution of menorrhagia, dysmenorrhea/pain, and bulk and/or pressure symptoms including urinary frequency were evaluated clinically. Change in menopausal state was also an outcome of interest. ResultsMean MR imaging follow-up was performed 3 months post-OAE. MR images showed complete infarction in the majority of cases (64.7%; n = 11), with infarction rates of 90%-100% in 3 cases, 1 case with 30%-50% infarction, and 2 cases with 0%-10% infarction. Average uterine size reduction on MR was 32.3% (95% confidence interval [CI]: 22.5%-42.2%; P < .001). The average size reduction for the dominant fibroid was 42.4% (95% CI: 27.7%-57.0%; P = .01). The mean time to final follow-up visit was 11 months. At this point complete symptom resolution (menorrhagia, dysmenorrhea and bulk-related) was achieved in 82.4% (n = 14) of cases. At the final follow-up 11.8% (n = 2) of cases reported menopause. ConclusionsWe observed OAE to be an effective and safe adjunct to uterine artery embolization when hypertrophic ovarian artery(ies) require intervention. However, incomplete fibroid infarction of 23% remains a concern with a potential for long-term treatment failure. In addition, long-term effect on ovarian function is uncertain.

Robotic Catheterization: The Importance of Evaluation by Interventional Radiologists

Uterine-artery embolization versus surgery for symptomatic uterine fibroids. N Engl J Med 2007; 356:360–370. 14. Hehenkamp WJ, Volkers NA, Birnie E, Reekers JA, Ankum WM. Symptomatic uterine fibroids: treatment with uterine artery embolization or hysterectomy-results from the randomized clinical Embolisation versus Hysterectomy (EMMY) Trial. Radiology 2008; 246:823–832. 15. Mara M, Maskova J, Fucikova Z, Kuzel D, Belsan T, Sosna O. Midterm clinical and first reproductive results of a randomized controlled trial comparing uterine fibroid embolization and myomectomy. Cardiovasc Intervent Radiol 2008; 31:73–85. 16. Pron G, Bennett J, Common A, et al, Ontario UFE Collaborative Group. Technical results and effects of operator experience on uterine artery embolization for fibroids: the Ontario Uterine Fibroid Embolization Trial. J Vasc Interv Radiol 2003; 14:545–554. 17. Bratby MJ, Hussain FF, Walker WJ. Outcomes after unilateral uterine artery embolization: a retrospective review. Cardiovasc Intervent Radiol 2008; 31:254–259.

A Retrospective Study of Clinical Outcomes and Complications Following Uterine Artery Embolisation for Fibroids

A Retrospective Study of Clinical Outcomes and Complications Following Uterine Artery Embolisation for Fibroids

Value of hysteroscopy prior to uterine artery embolisation for fibroids: a hospital based retrospective study

This study was undertaken to evaluate the value of routine hysteroscopy prior to uterine artery embolisation (UAE) for symptomatic uterine fibroids. The study design used is hospital-based retrospective study, and the setting is in a large teaching hospital. We analysed the hospital record of 115 women who were scheduled to undergo UAE at our institution between January 2008 and April 2011. All women had outpatient hysteroscopic assessment of uterine cavity prior the decision to carry out UAE. The mean uterine size on palpation was 15.4 (standard deviation (SD) 3.5) weeks gestation equivalent. Hysteroscopy was successfully completed in 112 (97.4 %). In the women who were hysteroscoped, 50 (44.6 %) had no submucous fibroids; 50 (44.6 %) had type II fibroids, and 12 (10.7 %) were found to have type I or 0 fibroids. All 12 women with type 0 or I submucous fibroids were offered hysteroscopic (n = 11) or vaginal (n = 1) myomectomy prior to UAE, but only four agreed. Of these four cases, two cancelled their planned UAE because of symptomatic improvement. The remaining two women, as well as the eight, who declined surgery, underwent UAE. There were no cases of infection, spontaneous expulsion of a fibroid or the need for surgical intervention in this group. This pilot study shows that hysteroscopy prior to UAE changes management in only a small proportion of cases. Selective hysteroscopy, following MRI scanning, may be a more logical protocol to identify women with intracavitary fibroids, who may benefit from hysteroscopic or vaginal myomectomy.

Perforation of Transverse Colon: A Catastrophic Complication of Uterine Artery Embolization for Fibroids

We report a case of a 43-year-old woman who underwent uterine artery embolization (UAE) for a symptomatic large fibroid uterus and had spontaneous perforation of the transverse colon 3months after embolisation with near-fatal consequences. We believe this is the first reported case in the literature of this serious complication of UAE. We briefly review the literature on bowel complications after UAE and discuss lessons to be learned regarding patient selection and postprocedure follow-up.

Complications of Uterine Fibroids and Their Management

Uterine fibroids are the most common gynaecological tumours found in women. These tumours are said to be present in 80% of Caucasian women and are even more common in women of African origin. In 50% of women with fibroids symptoms usually occur, leading to complications from the presence of these fibroids. Although they are mainly a problem in the reproductive years, there are reports of problems from fibroids in postmenopausal women. The management of patients with fibroids is quite variable including conservative oral and parenteral treatment, conservative and radical surgery, and newer techniques such as uterine artery embolisation and radiofrequency ablation. All of these techniques can also cause complications for the patient, and as a result careful evaluation of patients must be done to decide on the correct treatment option for a particular patient. The focus of this special issue is to highlight the complications which are caused by fibroids and also those which can arise as a result of the treatment options available. This is intended to assist clinicians and their patients in making informed decisions about the management of this common problem. The journal is the effort of a truly international group of clinicians giving varied experiences from across the world. The paper entitled “Complications of uterine fibroids and their management” is from Jamaica and outlines the entire spectrum of complications of fibroids and their treatment. This is a good review of the modern methods available and should be helpful to clinicians to assist them in counseling their patients. The paper entitled “Innovative oral therapy for uterine leiomyomas” is a collaborative effort of clinicians from Egypt and the United States of America (USA) reviewing the use of oral therapy for the treatment of fibroids. This paper gives an update on the modern use of drugs to treat fibroids to avoid surgery. The paper entitled “Surgical management of uterine fibroids at Aminu Kano Teaching Hospital” is from Nigeria, and this paper discusses use of myomectomy versus abdominal hysterectomy in their setting. The authors have outlined their experience and given the reader an idea of their methodology and complication rates comparing the two procedures. The paper entitled “Intrauterine adhesions following conservative treatment of uterine fibroids” is from Sweden and Spain discussing the complication of intrauterine adhesions reminding readers how to diagnose and treat this often forgotten complication of surgical treatment of fibroids. The paper entitled “Indications and outcomes of uterine artery embolization in patients with uterine leiomyomas” is from Japan, and the paper entitled “Complications associated with uterine artery embolisation for fibroids” is from the United Kingdom. Both papers discuss their experience with uterine artery embolisation. The complications from both sites are outlined. The paper entitled “Radiofrequency ablation for treatment of symptomatic uterine fibroids” is from the United States and the United Kingdom and reviews the use of radiofrequency ablation to treat fibroids. This is an excellent review detailing older now archaic methods and outlining the more modern safer techniques used in their setting. Overall this journal is an excellent resource for physicians who wish to review uterine fibroids as well as all the methods available to treat them. The complications of fibroids are outlined in detail, and the different treatment modalities and possible complications are also outlined. This should become a standard compendium on fibroids for students and physicians for the benefit of increasing knowledge for examinations as well as the proper counseling and management of patients. Horace Fletcher Celia Burrell Bharat Bassaw Earlando Thomas