|
Fibroid embolisation
What are fibroids?
Fibroids (also known as uterine fibroids or leimyomata) are benign overgrowths of uterine (womb) muscle. They can cause excessive menstrual bleeding and pain (“dysmenorrhoea”), pressure on neighbouring organs (pressure on bladder) and affect fertility (hard to get pregnant).
Fibroids have a strong blood supply which can be blocked off (“embolised”) . This procedure avoids abdominal surgery and general anaesthetic and is carried out via “pinhole surgery”.
Uterine Fibroid Embolisation (UFE) (a.k.a. uterine artery embolisation UAE a.k.a. fibroid embolisation)
Uterine Fibroid Embolization (UFE) is a fully recognized alternative to both Myomectomy and Hysterectomy in UK (see NICE guidelines for UFE 2004 and Heavy Menstrual Bleeding (HMB) Jan 2007).
www.nice.org.uk/IPG094
Below is a summary of the HMB guidelines from Jan 2007.
1.7 Further interventions for uterine fibroids associated with HMB
1.7.1 For women with large fibroids and HMB, and other significant symptoms such as dysmenorrhoea or pressure symptoms, referral for consideration of surgery or uterine artery embolization (UAE) as first-line treatment can be recommended.1
See ’Uterine artery embolization for the treatment of fibroids’ (NICE interventional procedure guidance 94), www.nice.org.uk/IPG094
UAE, myomectomy or hysterectomy should be considered in cases of HMB where large fibroids (greater than 3 cm in diameter) are present and bleeding is having a severe impact on a woman’s quality of life.
1.7.3 When surgery for fibroid-related HMB is felt necessary then UAE, myomectomy and hysterectomy must all be considered, discussed and documented.
1.7.4 Women should be informed that UAE or myomectomy may potentially allow them to retain their fertility.
1.7.5 Myomectomy is recommended for women with HMB associated with uterine fibroids and who want to retain their uterus.
UAE is recommended for women with HMB associated with uterine fibroids and who want to retain their uterus and/or avoid surgery.2
Prior to scheduling of UAE or myomectomy, the uterus and fibroid(s) should be assessed by ultrasound. If further information about fibroid position, size, number and vascularity is required, MRI should be considered
Hysterectomy
1.8.1 Hysterectomy should not be used as a first-line treatment solely for HMB. Hysterectomy should be considered only when:
other treatment options have failed, are contraindicated or are declined by the woman
there is a wish for amenorrhoea
the woman (who has been fully informed) requests it
the woman no longer wishes to retain her uterus and fertility.
Women offered hysterectomy should have a full discussion of the implication of the surgery before a decision is made. The discussion should include: sexual feelings, fertility impact, bladder function, need for further treatment, treatment complications, the woman’s expectations, alternative surgery and psychological impact.
Women offered hysterectomy should be informed about the increased risk of serious complications (such as intraoperative haemorrhage or damage to other abdominal organs) associated with hysterectomy when uterine fibroids are present.
Women should be informed about the risk of possible loss of ovarian function and its consequences, even if their ovaries are retained during hysterectomy.
2 separate published Randomized controlled trials have shown no significant difference in outcome between conventional surgery and UFE with UFE having a significantly shorter hospital stay and recovery time.
Contact us for more details
|
