Reduction In Uterine Volume Research Articles

Uterine artery embolisation for uterine leiomyomas

Background. Many forms of minimally invasive treatment have gained substantial popularity, both with the medical fraternity and the public. With the correct clinical indications and in skilled hands, uterine artery embolisation (UAE) has been accepted internationally as part of the standard of care that should be offered to patients with symptomatic uterine leiomyomas (fibroids). Objectives. To introduce UAE as an effective and safe treatment option in patients with symptomatic fibroids in the Western Cape Provincial Service, South Africa. Methods. Setting: Groote Schuur and Tygerberg hospitals, Western Cape. Design: Prospective observational multi-centre study. Methods: 36 women (mean age 38 years, range 30 - 47 years) with symptomatic fibroids were treated with UAE between November 2009 and February 2012. Pre-procedure magnetic resonance imaging (MRI) followed by a 6-month clinical follow-up plus MRI or an ultrasound scan were performed. Results. The presenting symptoms were menorrhagia, dysmenorrhoea, pressure symptoms and intermenstrual bleeding. Three women were treated for primary infertility. Uterine artery sub-selection and embolisation was successful in all patients. Complications included low-grade pyrexia (3/36, 8.3%) and readmission (1/36, 2.8%). The average reduction in uterine volume at 6 months was 50%. At followup (mean 15 months, range 7 - 32), 91.7% (33/36) had complete symptomatic resolution and 83.3% (30/36) were ‘completely satisfied’. Participants treated for primary infertility and concurrent adenomyosis did not receive any benefit from UAE. Conclusion. Uterine artery embolisation is associated with a high clinical success rate. This study suggests that UAE should be offered as an attractive alternative to surgery in our practice.

Role of Low-Dose Mifepristone for Managing Uterine Leiomyoma

Objective: The aim of this research was to assess the decrease in uterine volume and fibroid volume in patients with uterine leiomyoma who were receiving low-dose mifepristone for 3 months as well as evaluating relief in symptoms produced by this medication. Design: This was a prospective study carried out in a tertiary-care center. Materials and Methods: Fifty women (ages 30–50) with symptomatic uterine leiomyoma were given 10 mg of mifepristone per day for 3 months. The patients' decrease in menstrual and pressure symptoms and reduction 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 patients' uterine and fibroid volume at the end of 3 months. The mean reductions in uterine and fibroid volume after 1 month were up to 9.6% and 11.1%, respectively; after the second month, they were respectively, 18.3% and 21.4%; and after the third month, they were respectively, 27.8% and 32.1% (p<0.001). Three months after stopping treatment there was a slight increase in these parameters (p<0.001), but uterine and fibroid volume were still 26.25% and 27.24%, respectively, lower than baseline. There was significant reduction of menorrhagia, dysmenorrhea, and pressure symptoms of bladder frequency and pelvic pain at the end of 3 months (p<0.001), which increased slightly (p<0.05) after 6 months. According to the results of endometrial sampling, no patient had any complex hyperplasia or any atypical hyperplasia. The side-effects of the medication were minimal. Conclusions: Low-dose mifepristone had a shrinking effect on the patients' fibroid growths. It produced a definite reduction in the the patients' symptoms with few side-effects. (J GYNECOL SURG 30:70)

Entropy of T2-weighted Imaging Combined with Apparent Diffusion Coefficient in Prediction of Uterine Leiomyoma Volume Response after Uterine Artery Embolization

To determine the potential value of entropy of T2-weighted imaging combined with apparent diffusion coefficient (ADC) before uterine artery embolization (UAE) for prediction of uterine leiomyoma volume reduction (VR) after UAE. In this prospective study, 11 patients with uterine leiomyomas who underwent pelvic magnetic resonance imaging including diffusion-weighted imaging before and 6 months after UAE were included. A total number of 16 leiomyomas larger than 2 cm in diameter were evaluated. The volume of each leiomyoma before and after UAE was determined, and the percentage change in volume was calculated. Entropy of T2-weighted imaging and ADC before UAE were assessed. Pearson correction coefficients were calculated between leiomyoma VR after UAE and age, leiomyoma volume, ADC, and entropy, respectively. Multiple regression analysis was performed to investigate the parameters that determine the VR after UAE. Receiver operating characteristic curve analysis was used to determine the sensitivity and specificity of ADC, entropy and the combination of ADC and entropy for predicting volume response. The mean leiomyoma VR was 58.9% (range 25.8%-95.0%) in the 6-month follow-up. The mean ADC of leiomyomas was 1.37 × 10(-3) mm(2)/s (range 1.05 × 10(-3)-2.32 × 10(-3) mm(2)/s) and the mean entropy of T2-weighted imaging was 5.36 (range 4.62-5.91) before UAE. ADC and entropy were significantly correlated with leiomyoma VR, respectively (r = 0.61, P = .012; r = 0.73, P = .001). On multiple regression analysis, a combination of ADC and entropy constituted the best model for determining leiomyoma VR using Akaike information criterion. For predicting ≥50% VR, the optimal cutoff value of ADC was 1.39 × 10(-3) mm(2)/s (sensitivity 45.5%, specificity 80.0%) and the optimal cutoff value of entropy was 5.15 (sensitivity 90.9%, specificity 60.0%). The combination of ADC and entropy (area under the curve [AUC] 0.86) provided better classification accuracy than ADC or entropy alone (AUC 0.69 and 0.82, respectively). Pre-UAE entropy of T2-weighted imaging and ADC of leiomyomas were significantly correlated with the leiomyoma VR 6 months after embolization. Higher entropy and higher ADC may be related to greater leiomyoma VR after UAE. A combination of entropy and ADC may have predictive value for leiomyoma VR after UAE.

Predictive factors for pelvic magnetic resonance in response to arterial embolization of a uterine leiomyoma

OBJECTIVE:Minimally invasive methods are used as alternatives to treat leiomyomas and include uterine artery embolization, which has emerged as a safe, effective method. This study aims to evaluate the magnetic resonance imaging predictors for a reduction in leiomyoma volume in patients undergoing uterine artery embolization.METHODS:This prospective longitudinal study was performed at a university hospital. We followed 50 symptomatic premenopausal women with uterine leiomyomas who underwent uterine artery embolization. We examined 179 leiomyomas among these patients. Magnetic resonance imaging was performed one month before and six months after uterine artery embolization. Two radiologists who specialized in abdominal imaging independently interpreted the images. Main Outcome Measures: The magnetic resonance imaging parameters were the uterus and leiomyomas volumes, their localizations, contrast perfusion pattern and node-to-muscle ratio.RESULTS:Six months after treatment, the average uterine volume reduction was 38.91%, and the leiomyomas were reduced by 55.23%. When the leiomyomas were submucosal and/or had a higher node-to-muscle ratio in the T2 images, the volume reduction was even greater (greater than 50%). Other parameters showed no association.CONCLUSIONS:We conclude that symptomatic uterine leiomyomas in patients undergoing uterine artery embolization exhibit volume reductions greater than 50% by magnetic resonance imaging when the leiomyomas are submucosal and/or had a high node-to-muscle ratio in the T2 images.

8:00 AM; Abstract No. 3 - Assessing the efficacy, complications, and re-intervention incidence following uterine fibroid embolization in patients with large fibroids

8:00 AM; Abstract No. 3 - Assessing the efficacy, complications, and re-intervention incidence following uterine fibroid embolization in patients with large fibroids

1:30 PM; Abstract No. 4 - Modified-BRTO (balloon-occluded retrograde transvenous obliteration) for the treatment of portal hypertensive variceal bleeding

Purpose: To assess the efficacy, complications, and reintervention incidence of uterine fibroid embolization (UFE) on patients with large uterine fibroids. Materials and Methods: A retrospective cohort study of 333 women (mean age, 44.2 years; range 26-58 years) who underwent UFE for uterine fibroids between January 2009 – January 2013 was undertaken. They were divided into two groups based on ultrasound or serial MRI findings, those with a dominant fibroid Z10cm on its longest axis and/or a uterine volume Z700cm (group 1, n1⁄4130) and the control group (group 2, n1⁄4203). Dominant fibroid and uterine volume reduction were determined by comparing baseline and follow-up ultrasound and MRI findings. Symptoms improvement and satisfaction with both the procedure and their outcome were assessed using standardized Likert scale questionnaires completed at followup (mean, 6.8 months). Post-procedural complications and reinterventions were recorded. All post-procedural continuous variables were compared using the Mann-Whitney U test, while categorical variables were compared using the chisquared test. Results: o significant differences were observed between the groups in dominant fibroid reduction (median 43% in group 1, 51% in group 2, p 1⁄4 .332), patient reported symptom improvement (bleeding, p 1⁄4 .076; pain, p 1⁄4 .551; pelvic pressure, p 1⁄4 .763; urinary frequency or urgency, p 1⁄4 .486), complications (p 1⁄4 .171), and patient satisfaction of the procedure (p 1⁄4 .915) and outcome (p 1⁄4 .731). However, a significant difference was observed in uterine volume reduction (median 46% in group 1, 34% in group 2, p 1⁄4 .000). Conclusion: Apart from uterine volume reduction, outcomes of UFE on patients with large fibroids are comparable to those with small fibroids. Patients with large fibroids can expect greater uterine volume reduction. Fibroid size and uterine volume are not key factors in determining suitability for UFE and successful outcomes can be obtained in patients with large fibroids.

Comparison of Embolic Agents Used in Uterine Artery Embolisation: A Systematic Review and Meta-Analysis

This study was designed to undertake systematic review and meta-analysis of published comparative trials comparing embolic agents used in uterine artery embolisation (UAE) for uterine leiomyomata. Systematic literature searches were performed in MEDLINE, Embase, PubMed, and Cochrane Central databases from database inception to July 2012. Randomised and nonrandomised trials comparing two or more embolic agents used in UAE were included. Assessment included five widely used embolic agents: nonspherical polyvinyl alcohol (PVA) (Contour PVA, Boston Scientific or PVA Cook Medical); spherical PVA (Contour SE, Boston Scientific); acrylamido PVA (Beadblock, Biocompatibles, Terumo); tris-acryl gelatin microspheres (TAGM) (Embospheres, Merit Medical Inc); and polyzene-F hydrogel microspheres (Embozenes, CeloNova Biosciences). Outcomes assessed included: quality of life (QOL), assessment, magnetic resonance imaging (MRI), uterine and fibroid volumes and degrees of MRI fibroid enhancement and devascularisation. A total of 262 citations were reviewed with 5 randomised, controlled trials involving 295 women and 5 non-RCTs involving 617 women included. No evidence of superiority of any embolic agent was demonstrated. Meta-analysis was performed between TAGM (Embospheres) and spherical PVA microspheres. Two RCTs found a trend toward greater uterine and dominant fibroid volume reductions with Embospheres but the combined differences were not statistically significant (p = 0.78 and p = 0.94 respectively). Embospheres demonstrated greater percentage fibroid devascularisation than spherical PVA (p = 0.039). This study confirms that the current evidence demonstrates superiority of Embospheres over spherical PVA but no reported differences in outcomes between any of the other agents. Comparison of embolic agents was limited by lack of RCT data and further research is warranted.

Vaginal mifepristone for the treatment of symptomatic uterine leiomyomata: an open-label study

To evaluate the efficacy and safety of 3 months of vaginal mifepristone treatment on leiomyoma volume and related symptoms. Prospective, open-label, two tertiary centers, phase II clinical trial. Two tertiary medical centers in Israel. Thirty-three enrolled women, ages 30-53 years, diagnosed with symptomatic uterine fibroids. Patients received 10 mg mifepristone vaginally daily for 3 months. Reduction in uterine leiomyoma volume. Improvement in symptoms related to uterine fibroids was assessed with the use of the "Uterine Fibroid Symptoms Quality of Life Questionnaire" (UFS-QoL). The number of bleeding days, safety, and tolerability were secondary measures. Mifepristone treatment significantly reduced leiomyoma volume from 135.3 ± 22.9 cc at enrollment to 101.2 ± 22.4 cc after 3 months of treatment. The UFS-QoL Score significantly decreased from 20.7 ± 0.7 at enrollment to 14.0 ± 0.8 after 3 months of treatment. The number of bleeding days significantly decreased by 3.5 days. Endometrial biopsies showed no evidence of endometrial hyperplasia or cellular atypia. There were no major side effects during the course of the study, and treatment was well tolerated. Vaginal mifepristone may offer an effective treatment option for women with symptomatic uterine leiomyoma and can improve the patients' quality of life. NCT00881140.

Embolização das artérias uterinas com partículas de PVA-PVAC esférico como preparo para posterior ressecção cirúrgica de miomas

To evaluate the use of a new spherical particle of polyvinyl alcohol and polyvinyl acetate (PVA-PVAc) for uterine artery embolization in patients with myoma with surgical indication. twelve patients underwent uterine myoma embolization with PVA-PVAc particles. Three to nine months later, they were submitted to laparotomy with myomectomy. We analyzed the following parameters: volume of the uterus and of the bigger myoma; concentrations of follicle stimulating hormone and hemoglobin; menstrual bleeding (number of days and used absorbents), signs and symptoms before treatment, after embolization and after myomectomy. The mean age was 37 years and mean uterine volume prior to treatment, 939.3 cc. Three years after embolization, there was reduction in uterine volume (p = 0.0005), increase in hemoglobin concentration after embolization (p = 0.0004), without variation after the myomectomy. There was no significant variation of the follicle stimulating hormone (p = 0.17). There was no case of ovarian failure, but one of the patients had endometrial atrophy. Two patients became pregnant, with good obstetric indicators. Signs and symptoms improved after embolization, and remained after myomectomy. Arterial embolization with spherical PVA-PVAc particles is promising in the preparation for myoma surgery, since it was associated with a reduction in uterine volume, decrease in intraoperative bleeding and made possible the use of smaller incisions, increasing the chance of preserving the uterus.

Abstract No. 249 - Assessing the link between MRI imaging and short term outcome in uterine fibroid embolisation (UFE)

Purpose A poor correlation between reduction in fibroid size and uterine volume following UFE, and patient symptoms has been previously described using US imaging. The information provided by MRI imaging is significantly greater than US. The aim of this study is to identify whether there are features identifiable on either pre or post UFE MRI that are associated with patient outcome. Materials and Methods All patients at our institution have MRI pre and post UFE. Patient are also asked to complete a Quality of Life questionnaire at their booking clinic appointment. Patients are also assessed six months following UFE with MRI and repeat clinic asessment. At the clinic they are again requested to complete a Quality of life questionnaire. All patients who underwent UFE and had both pre and post MRI and had completed pre and post embolisation Quality of life questionnaires were included in the study. Various factors including pre-embolisation fibroid size, presence of adenomyomatosis, ovarian artery parasitization, post embolisation necrosis and post-embolisation changes in fibroid and uterine size were correlated with outcome factors. Results 172 patients were included in the study. Increasing size of the dominant fibroid and presence of adenomyomatosis were not found to be associated with a poorer outcome. The uterine volume reduced by 23% overall (SD 52%) and the dominant fibroid reduced in volume by 42% overall. The degree of necrosis in the dominant fibroid also showed significant increase (2.9). The Symptom severity score showed a marked improvement of -28 as did HRQL (26). However, despite overall improvement in all, no significant correlation with any of the imaging variables was demonstrated with the symptomatic scores. Conclusion The identification of ovarian parasitisation and adenomyosis pre-intervention were not associated with a poorer short-term post-embolisation outcome. Degree of fibroid necrosis, reduction in fibroid volume, and reduction in overall uterine size do not correlate with patient's symptomatic improvement post UFE. MRI may be of more use in assessing long term prognosis, and further investigation is needed.

Randomized Comparison of Uterine Artery Embolization (UAE) with Surgical Treatment in Patients with Symptomatic Uterine Fibroids (REST Trial): Subanalysis of 5-Year MRI Findings

To report 5-year contrast-enhanced magnetic resonance imaging findings of the REST trial recruits who underwent either uterine artery embolization (UAE) or myomectomy. A total of 157 patients were randomized to UAE or surgery (hysterectomy or myomectomy). Ninety-nine patients who had UAE and eight patients who had myomectomy were analyzed. MRI scans at baseline, 6 months, and 5 years were independently interpreted by two radiologists. Dominant fibroid diameter, uterine volume, total fibroid infarction (complete 100 %, almost complete 90-99 %, partial <90 %), and new fibroid formation were the main parameters assessed and related to the need for reintervention. In the UAE group, mean ± standard deviation uterine volume was 670 ± 503, 422 ± 353, and 292 ± 287 mL at baseline, 6 months, and 5 years, respectively. Mean dominant fibroid diameter was 7.6 ± 3.0, 5.8 ± 2.9, and 5 ± 2.9 cm at baseline, 6 months, and 5 years. Fibroid infarction at 6 months was complete in 35 % of women, almost complete in 29 %, and partial in 36 %. Need for reintervention was 19, 10, and 33 % in these groups, respectively (p = 0.123). No myomectomy cases had further intervention. At 5 years, the prevalence of new fibroid was 60 % in the myomectomy group and 7 % in the UAE group (p = 0.008). There is a further significant reduction in both uterine volume and dominant fibroid diameter between 6 months and 5 years after UAE. Complete fibroid infarction does not translate into total freedom from a subsequent reintervention. New fibroid formation is significantly higher after myomectomy.

Reduction in Uterine and Fibroid Volumes in 135 Consecutive Subjects Following Laparoscopic and Ultrasound-Guided Radiofrequency Ablation of Fibroids: 12-Month Follow-Up

To assess outpatient radiofrequency volumetric thermal ablation (RFVTA) in women with symptomatic fibroids and moderate-to-severe menorrhagia, in terms of uterine and fibroid volume reduction (measured by contrast-enhanced MRI) and incidence of surgical re-intervention within 12 months posttreatment.

Observational evaluation of preoperative, intraoperative, and postoperative characteristics in 117 Brazilian women without uterine prolapse undergoing vaginal hysterectomy

BackgroundDespite the introduction of minimally invasive approaches for various benign uterine problems, hysterectomy is often still performed abdominally, but the vaginal route should be used whenever possible. The aim of this study was to identify the preoperative, intraoperative, and postoperative characteristics of women undergoing vaginal hysterectomy in the absence of uterine prolapse.MethodsA prospective, descriptive, quantitative, noncomparative study was conducted in 117 women between August 2009 and February 2011 in Petropolis, Rio de Janeiro, Brazil. The women included had a uterine indication for hysterectomy, their surgeries were performed by the same team, and they were followed up for 12 months. An adapted Pelvic Organ Prolapse Quantification system was used to check for uterine prolapse.ResultsThe age range of the women was 33–59 years, uterine volume was 300–900 mL, and 73.50% has undergone prior cesarean section. The main indication for hysterectomy was uterine myoma (64.95%), with a surgery time of 30–60 minutes in 55 (59.82%) and 19 (15.98%) cases, respectively. Uterine volume reduction was performed in 41 (35.05%) cases, salpingectomy was the most common associated surgery (81.19%), and anesthesia was subdural (68.37%). Common intraoperative complications included bladder lesions (8.54%), with conversion to the abdominal route being necessary in one case (1.28%), and the most common postoperative complication being vaginal cupola granuloma (32.47%). There was a statistically significant relationship between surgery time and uterine volume (χ2 = 17.367; P = 0.002).ConclusionThis study suggests that vaginal hysterectomy is a safe surgical procedure in view of its good performance and low complication rate.

Diffusion-weighted imaging in uterine artery embolisation: do findings correlate with contrast enhancement and volume reduction?

The objective of this study was to determine the role of diffusion-weighted imaging (DWI) in uterine artery embolisation (UAE), and to assess the apparent diffusion coefficient (ADC) of the dominant fibroid and its relationship to contrast enhancement and fibroid volume reduction. We carried out a retrospective study of 15 patients who underwent UAE. Calculations were performed at baseline and 6 months post-embolisation. Fibroid ADC (expressed in 10(-3) mm(2) s(-1)) was calculated using b=0 and b=1000 DWI values. Fibroid enhancement was compared with background myometrium by measuring signal-difference-to-noise ratio (SDNR). Fibroid volume was calculated using a prolate ellipse formula. There was a significant reduction (p<0.001) in fibroid ADC at 6 months (0.48; standard deviation, SD=0.26) as compared with baseline (1.01; SD=0.39). No significant change (p=0.07) was identified in 6-month myometrial ADC (1.09; SD=0.28) as compared with baseline (1.24; SD=0.20). Moderately strong and significant positive correlation was identified between baseline ADC and 6-month percentage volume reduction of the fibroid (correlation=0.66, p=0.007). No correlation was identified between SDNR and ADC at baseline or 6 months (r=0.01, p=0.97 and r=-0.13, p=0.64, respectively) or SDNR and percentage volume reduction at 6 months (correlation r=0.18, p=0.51). Baseline ADC of dominant fibroids shows a moderately strong correlation with subsequent volume reduction at 6 months following UAE. No correlation was identified between ADC values and contrast enhancement on the baseline or 6-month scans. Further prospective evaluation is needed before DWI can be utilised in clinical practice. Advances in knowledge DWI imaging may provide additional information about UAE and possibly help to predict uterine volume reduction.

MR imaging evaluation of fibroid clearance following open myomectomy for massive/multiple symptomatic fibroids

To evaluate the technical success of total fibroid clearance at open myomectomy for massive and/or multiple symptomatic fibroids using MR imaging (MRI) as the imaging modality. The study group comprised 27 women [mean age 37.4 ± 6.9 years (range 27-53)] who underwent open myomectomy for the treatment of massive/multiple symptomatic fibroids at our institution between January 2009 and April 2010. Myomectomy was performed with the intention of achieving complete fibroid clearance. Pre- and postmyomectomy MRI was performed to assess changes in uterine volume and fibroid burden. Periprocedural data (including blood loss and complications) and relief of clinical symptoms at follow-up were also recorded. The mean time to MRI and clinical follow-up was 10 months (range 6-15 months). The mean uterine volume premyomectomy was 795 ± 580 cc and postmyomectomy was 123 ± 70 cc (p < 0.001). The mean percentage reduction in uterine volume was 80.3 % (range 43.0-98.1 %). Of the 10/27 (37.0 %) women with residual fibroids at follow-up: 7 patients had fibroids measuring up to 1 cc in volume, 3 patients had fibroids measuring up to 6 cc. Postoperative adnexal seromas were observed in 6/27 (22.2 %) patients. The clinical success rates of myomectomy amongst the 22/27 (81 %) responders were: 73 % for menorrhagia, 64 % for pain, and 36-64 % for mass-related symptoms. Using MRI, we have confirmed that open myomectomy can achieve total or near-total fibroid clearance in the majority of patients with massive and/or multiple fibroids.

Efficacy of uterine artery embolisation for treatment of symptomatic fibroids and adenomyosis – An interim report on an Australian experience

Uterine artery embolisation (UAE) has been widely described internationally, however there is a paucity of data reported from Australia. To conduct a local audit on the efficacy and safety of UAE treating symptomatic fibroids and adenomyosis. Clinical data of 76 consecutive UAEs were reviewed. Degree of fibroid-related symptoms before embolisation and at follow-up visits were compared. Procedural and subsequent complications were recorded. Uterine and fibroid volumes were measured on MRI at baseline and six months post-UAE. Seventy-six UAEs were performed in 75 women. Fifty-nine women had follow-up duration of more than six months, and one woman was lost to follow-up. Clinical success was 93% overall (n = 59) and 96% for menorrhagia (n = 49). For dysmenorrhoea (n = 36), 89% of women had at least some improvement, 75% had significant improvement and 56% had resolution of pain. For urinary symptoms (n = 32), 97% of women had at least some improvement and 50% had resolution of all urinary symptoms. Adenomyosis was found in 17 (29%) women treated. The primary success rate was 96%, and secondary success rate (after repeat UAE) was 100%. MRI showed 50% uterine volume reduction and 60% dominant fibroid volume reduction. There were no significant procedural-related acute complications. There were three possible cases of endometritis, two managed conservatively and one required hysterectomy. This audit, based on local Australian experience, has confirmed that UAE is a safe and highly effective treatment for women with symptomatic fibroids and/or adenomyosis.

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.

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

Impacto da embolização arterial do leiomioma uterino no volume uterino, diâmetro do mioma dominante e na função ovariana

To evaluate the impact of uterine artery embolization (UAE) on uterine volume (UV), greater myoma diameter (GMD) and ovarian function three months after the procedure, by transvaginal pelvic ultrasonography (TVPUS) and by the determination of follicle-stimulating hormone (FSH). Thirty patients with leiomyomas were submitted to UAE. TVPUS and FSH determination were performed before and three months after UAE. UV was determined in cm³, GMD in cm and FSH in IU/mL. Data are reported as as mean standard deviation (SD) and were analyzed statistically by the nonparametric Mann-Whitney test. Twenty-nine patients were analyzed. Before UAE, mean UV was 402.4 165.9 cm³ and GMD was 5.9 2.1 cm. After UAE, mean UV was 258.9 118.6 cm³ and GMD was 4.6 1.8 cm. Mean FSH concentration was 4.9 3.5 IU/mL before UAE and 5.5 4.7 IU/mL after UAE, with p=0.5. There was a 35% reduction of UV and a 22% reduction of GMD, with no changes in FSH values after three months. The procedure significantly reduced UV and GMD but did not cause a significant increase in FSH levels, thus causing no changes in ovarian function.

Comparison of clinical and MR imaging outcomes after uterine fibroid embolization with Bead Block and Embosphere

To compare clinical and imaging outcomes after uterine fibroid embolization (UFE) with Embosphere versus Bead Block microspheres. Our institutional review board approved this HIPAA-compliant study. We conducted a retrospective review of all consecutive UFEs performed for symptomatic uterine fibroids at our academic institution from 2001 to 2008. UFE was performed using Embosphere (n = 70) or Bead Block (n = 55) microspheres. Patient symptoms and MR images were reviewed before and following UFE. The MR images were analyzed for changes in the size and contrast enhancement of the dominant fibroid and the uterus. 125 patients underwent UFE. Pre-treatment characteristics (patient age, presenting symptoms, fibroid location, and volume of the largest fibroid) were similar across groups. Procedure endpoint (near-stasis, reached in 94% of cases), duration, and sedation medication doses were also similar. Clinical follow-up was available in 69 (55%) patients (mean duration: 13.6 months). Of these, 92% had clinical improvement of their main presenting symptom(s) and 3% developed early menopause. MRI follow-up was available in 105 (84%) patients (mean 7.8 months). Mean volume reduction of the largest fibroid was similar after Embosphere (48%) and Bead Block (53%, p = NS). Residual enhancement ≥ 5% in the dominant fibroid was similarly uncommon after Bead Block (19%) or Embosphere (16%, p = NS). Mean uterine volume reduction was similar across groups (38%); no myometrial infarction occurred. This retrospective study showed no superiority of Embosphere over Bead Block microspheres in terms of clinical and imaging outcomes after UFE.