Dr Shuvro Roy Choudhury, Consultant Interventional Radiologist, RTIICS, Kolkata, gives an insight about the treatments to cure fibroids
The problem
Fibroids are very common, seen in one in three women of child bearing age with menorrhagia, pressure symptoms and abdominal pain. If conservative treatment fails, it is traditionally treated by hysterectomy or myomectomy, which are major surgeries.
The solution
Fibroid embolisation (UFE) is a state-of-the-art, minimally invasive, image guided technique that is an alternative to hysterectomy and myomectomy. Over 400,000 procedures have been performed worldwide. Increasingly, fibroids are being managed in a multidisciplinary setting that offers patients a better choice of treatment options.
Who gets affected?
Women of child bearing age who have symptomatic fibroids.
Indications
- < Single or multiple (number not a limitation) intramural fibroids.
- < Non-pedunculated submucous or subserous fibroid
- < Ideally have completed her family although uterine fibroid embolisation (UFE) is often performed to preserve fertility.
- < To aid in laparoscopic myomectomy or hysteroscopic excision
- < Symptomatic adenomyosis, although this is less well proven
- < Uterine artery embolisation is also now the procedure of choice in life threatening post partum haemorrhage to preserve uterus and stop. In this scenario, uterine artery embolisation (UAE) offers staggering benefits in reducing maternal mortality
Advantages / benefits
- < Minimally invasive, precise technique
- < Low risk of complications, short hospital stay
- < High patient satisfaction
- < Uterus and fertility preserved. Door for surgery not closed.
- < Avoids long-term functional problems associated with hysterectomy
Contraindications
Evidence
Several large, randomised trials (EMMY, REST), including five-year results have shown UFE to be safe and highly effective treatment for fibroids with 90 per cent success rates, similar to myomectomy. Studies show high patient satisfaction, improved social and physical function at one month and less defaecatory distress at five years. Few patients need hysterectomy over long-term follow up. The American College of Gynaecologists rate the literature evidence as Level 1 or Level A (highest possible).
Did you know?
Ex US Secretary of State Condoleeza Rice underwent UFE for symptomatic fibroids on a Friday and was back at work on the following Monday!!
Peripheral vascular disease:
- < Angioplasty and stenting
- < Venous disease: Varicose veins, DVT
- < Vascular embolisation: Bronchial, prostate, bladder, mesenteric etc
- < Fibroid embolisation
- < Fallopian tube recanalisation
- < Varicocele and ovarian vein embolisation
- < Chemoembolisation – liver, lung
- < TIPSS
- < Percutaneous biliary interventions
- < Nephrostomy and ureteric stenting
- < Percutaneous tumour ablation – liver, lung, kidney, bone
- < Needle biopsies and drainages
- < US or fluoroscopic guided joint injections and arthrographies.
- < Vascular access and ports
Treating Fibroids
- It’s safe: More than 100,000 women have been successfully treated
- It’s simple: Most procedures take about half an hour
- It’s cost effective: No lengthy hospital stays or the fees that come with them
- Symptom relief is immediate: Pain, heavy bleeding, anaemia, fatigue will end with embolisation
- No hospital stay: This is an out-patient treatment
- No cutting: With embolisation there are no scalpels, sutures or scarring
- No ‘going under’: You won’t be unconscious or exposed to the risks of general anaesthetic
- Less downtime: Most patients return to work in a matter of days
- No recurrence: Fibroids don’t return, as they often do with surgeries like myomectomy
- Keep your fertility: There’s no trauma to, or removal of, the uterus