Uterine Fibroid Embolization
Patient Information by Dr Eisen LiangWhat are uterine fibroids?
Fibroids are the most common benign (non-cancerous) tumours in women. Up to 25% of women of reproductive age may harbour one or more fibroids. Not all women with fibroids suffer from symptoms. Between 10-40% women with fibroid may be symptomatic and requiring treatments.
What are the symptoms of fibroids?
Heavy and prolonged period may lead to anaemia. Bulk related symptoms such as frequent urge to urinate, constipation, pelvic pressure and enlarged abdomen.What are the medical treatment options?
Your GP and gynecologist might have tried different medical therapies such as non-steroidal anti-inflammatory agents (such as Naprosyn), birth control pills, or progesterone agents. If the above fail, the decision for further medical treatment depends on your age, the size of the fibroids, the desire for future pregnancy, and the severity of symptoms. In certain circumstances a Gonadotropin Releasing Hormone (GnRH) agonist may be used. However it may cause hot flashes and mood changes and osteoporosis. The use is usually limited to 6 months. Fibroids usually regrow after GnRH agonists are stopped.What are the surgical treatment options?
If the fibroids are pedunculated submucousal (projecting into the uterine cavity), a hysteroscopic (fiber-optic scope via the vagina and cervix) resection is possible.The two conventional surgical choices are myomectomy and hysterectomy. Myomectomy is an operation in which only the fibroid(s) are removed leaving the rest of the uterus in place, potentially preserving the ability to have children. Bleeding and other complications are somewhat higher than hysterectomy. It may not be possible to remove all fibroids. New fibroids may appear after myomectomy. The procedure may cause pelvic scarring making future surgery difficult and may contribute to infertility.
Hysterectomy used to be the standard therapy for fibroids that fail to respond medical therapy, in women who do not wish to have further children. It is a safe procedure with low complications.
Both myomectomy and hysterectomy are major surgical procedures, requiring general anaesthetics, 2-7 day hospital stay, followed by 4 to 6 week convalescence before returning to work or normal activities.
Click the link to see more on treatment options: http://www.fibroidoptions.com/treat.htm
What is UFE (uterine artery embolization)?
It is an angiographic procedure used by interventional radiologist to embolize(block) the blood supply to the uterus. By limiting blood supply to the uterus, the fibroid will shrink and its symptoms subside.
What are the advantages of UFE?
It is highly effective in treating the symptoms of fibroid without removing the fibroid or uterus. It is a minimally invasive procedure performed under local anaesthetic. Compare to surgery, it requires shorter hospital stay (typically 1-2 days versus 2-7 days) and much shorter convalescence (typically 1 week versus 4-6 weeks) before returning to work or normal activities.Click the link to watch a short video by Society of Interventional Radiology:
http://www.sirweb.org/video/UFE.mpg (*** Invalid link ****)
How is UFE performed?
The procedure is performed in an angiography suite. The patient is conscious but sedated with IV medications. Local anaethetic is given at the groin where a tiny nick in the skin is made. Catheter less than 2mm diameter is inserted and guided under X-ray to reach the uterine arteries. Tiny particles are injected to block the uterine arteries.How effective is UFE?
Studies suggests UAE is as effective as hysterectomy in controlling primary symptoms of menorrhagia, bulk related symptoms and pain. UAE and surgery are equivalent in improvement of quality of life. On average, 85-90 percent of women who have had the procedure experience significant or total relief of heavy bleeding, pain and/or bulk-related symptoms. The procedure is effective for multiple fibroids and large fibroids. Recurrence of treated fibroids is very rare. Short and mid-term data show UFE to be very effective with a very low rate of recurrence. Long-term (10-year) data are not yet available, but in one study in which patients were followed for six years, no fibroid regrew after embolization.What are the risks?
Like other minimally invasive procedures, UFE is very safe compare with major surgery. Low risk dose not mean no risk. Infection of the uterus, spillage of particle away from uterine artery, vessel injury at the groin are all rare complications, each occur in less than 1 %. Fibroid expulsion through the cervix occurs < 3%, majority can be passed successfully, some may require dilatation and curratage (D and C).Can I loose my period?
Transient amenorrhea occurs in 5-10 % of patient after UFE. Younger patient tends to regain periods within 6 months. Permanent amenorrhea (menopause) is less than 3% in patient younger than age 45, but more frequent (7-14%) in age > 45. This may reflect the fact that women in mid forties or older is already nearing menopause.Is UFE painful?
Most part of the procedure is pain free. The local anaesthetic stings for about ten seconds before taking effect. Once the artery is blocked, you will experience varying degree of post-embolization syndrome for 4 to 5 days. This includes pelvic pain, nausea, and possibly fever. Patients are hospitalized overnight for pain control. The pain can be moderately severe and usually requires PCA (patient controlled analgesia) intravenously, especially the first 6 to 8 hours. Rarely, a second night of hospitalization is needed for pain control. Cramping pain, fatigue, and possibly fever are common during the subsequent few days. Most symptoms resolve within 4 to 5 days. Patient should anticipate returning to work and normal activities 7 days after the procedure.Can I get pregnant after UFE?
UAE does not appear to affect ovarian function in younger women. Permanent amenorrhea tend to occur in older women close to natural menopause. Although there are numerous reports of pregnancies following UFE, effect of UAE on fertility is not yet thoroughly studied. The aim of UAE is to treat fibroid symptoms in situ with a minimally invasive technique, retaining the uterus as a patient perceived benefit. UAE is not intended to maintain uterine viability for pregnancy, although pregnancy is possible after UAE. Miscarriage rate after UAE is not different to background miscarriage rate in a population of similar age.What are the pre-procedural evaluations required?
- All patients will be required to have a pre-procedure consultation by the interventional radiologist. This allows us to obtain a gynecologic and general medical history, a brief physical examination, and to review the imaging findings and to discuss the procedure with the patient.
- An MRI of the pelvis is preferred. We prefer that this be done at SAN Radiology or Gosford hospital to ensure uniformity of imaging.
Do I need to see a gynaecologist?
You need to be jointly cared by an interventional radiologist and a gynaecologist, in conjunction with your GP. You need to see your own gynaecologist or we can recommend one to you for the following assessment:- A pelvic examination by a gynecologist within six months of the procedure.
- A Pap smear within the last year and should be normal.
- If you have abnormal uterine bleeding (periods lasting longer than 10 days or periods more frequently than every 21 days), an endometrial (inner lining of the uterus) biopsy is needed, preferably within the preceding 3 to 6 months. This is to be certain that the bleeding is not due to abnormal growth.
- If you have a history of pelvic infection, cultures for Gonorrhea and Chlamydia need to be obtained.
What are the preparations needed?
On the day of your procedure, you need to avoid solid food from midnight. Clear fluid and medications are allowed up to the time of procedure. We will start an intravenous line to give you fluid, sedatives and pain relief medications. You must not be pregnant. A pregnancy test is needed if the procedure is done more than 10 days since the beginning of your last menstrual cycle. Full blood count and FSH will be obtained before the procedure.We also need to place a catheter in your bladder, so that the bladder will remain empty during the procedure. Since the bladder is directly in front of the uterus, X-ray dye collected in the bladder would obscure our view.
We will arrange PCA (Patient Controlled Analgesia) pump through an anaethetist.