Uterine Artery Embolisation in Management of Symptomatic Uterine Fibroid

INTRODUCTION: Fibroid (also called uterine leiomyoma, myoma, leiofibromyoma, fibroleiomyoma and fibroma) is a benign tumour that originates from the smooth muscles of myometrium and the accompanying connective tissue of the uterus. Fibroids are the most common benign tumour in females and typically found during the middle and later reproductive years seen in 40-50% of women older than 35 years1. It is estimated to occur in 40% of menstruating women older than 50 years. Symptoms caused by uterine fibroids are frequent indication for hysterectomy. Fibroids are often multiple. Most patients with uterine fibroids are asymptomatic. Most common presenting symptoms of fibroids are: • Abnormal uterine bleeding. • Dysmenorrhoea. • Pelvic pain, possibly resulting from intramural degeneration, torsion of pedunculated fibroid or uterine contractions. • Pelvic pressure. • Abdominal distension in case of large fibroid • Genitourinary dysfunction, which may manifest as the following: o Increased urinary frequency resulting from bladder compression. o Acute urinary retention. o Flank pain resulting from urethral compression and hydronephrosis. • Infertility. • Rarely, lower extremity edema, constipation, or intestinal obstruction. According to the location fibroids are called Intramural fibroids, Subserosal fibroid (sometimes pedunculated), Sub mucosal fibroids and cervical fibroids. Intra mural fibroids are the most common type causing menorrhagia and dysmenorrhoea. These intra mural fibroids can be treated with uterine fibroid embolisation. Various Medical and surgical therapies are used to treat fibroids. Medical therapy includes hypo estrogenic drugs, which causes temporary reduction in size and relief of symptoms. Surgical treatment includes myomectomy or hysterectomy. Uterine fibroid is one of the leading causes for hysterectomy today in India and worldwide. Transcatheter embolisation of the uterine arteries for symptomatic fibroids has become an increasingly important alternative treatment. It is highly effective and well tolerated by most patients. Most notably, uterine artery embolisation is minimally invasive associated with a short recovery period and is uterine sparing. Estimated 13,000-14,000 UFE procedures are performed annually in U.S. (as of 2004). In India uterine fibroid embolization is less popular and done in very few centres. This study is to determine the benefits and effectiveness of uterine artery embolization in symptomatic uterine fibroid and use the same as an alternate primary treatment for uterine fibroids. AIMS OF THE STUDY: The aim of this study is to analyse the effectiveness, technique, complication and outcome after uterine artery embolisation in patients with symptomatic uterine fibroid. MATERIALS AND METHOD: In this study 32 patients with fibroid uterus having at least one of the following symptoms are selected; 1. Menorrhagia 2. Dysmenorrhoea 3. Pressure symptoms like; • Lower abdominal heaviness • Increased frequency of micturation • Constipation Patients were explained about the uterine fibroid embolisation, an alternate method to treat fibroid without hysterectomy. Patients were explained about the expected outcomes, side effects and risks involved like perforation of arteries, need for emergency laprotomy, possibility of treatment failure and need for future hysterectomy. They were also informed about alternative treatment options available. Written consent obtained from all patients who were ready to participate in the study. Those who accepted to undergo uterine fibroid embolisation were subjected to further investigations. Inclusion Criteria: 1. Women with symptomatic fibroid (menstrual disturbances or pressure symptoms due to size or pain) who want to retain their uterus and avoid surgery. 2. Solitary or multiple intramural fibroids of less than 7 cm. 3. Parous women who completed family and age less than 40 yrs. 4. Women who give consent to undergo uterine artery embolisation and participate in study. Exclusion Criteria:1. Women with asymptomatic fibroid. 2. Infertile women or parous women who want to conserve uterus for future pregnancy. 3. Fibroids of more than 7 cm or with degenerative changes or hypovascularity on Doppler study. 4. Sub mucous or pedunculated Subserosal fibroid. 5. Previous history of anaphylaxis to contrast. 6. Systematic illness like HIV, HbsAg +ve, abnormal renal profile, Coagulation disorders. CONCLUSION: From this study we have found that Uterine Artery Embolisation for the patients having symptomatic uterine fibroid is an effective and safe alternate treatment with significant reduction in patient’s symptoms and good patient’s satisfaction. It has less failure rates in short term follow up. Although long term follow needed to confirm it. Single femoral puncture technique can be used to embolise both uterine arteries successfully in most of the patients. Both the embolizing agents (Gel foam & PVA) are equally effective in relieving the symptoms. This procedure has good patient’s tolerance, short recovery time, quick and sustained symptomatic improvement. As the previous studies do not support future fertility it should be used with caution in patients who want future conception. Careful selection of cases and proper counselling before embolisation can bring maximum success to the procedure. This procedure may reduce the need for invasive surgery in many patients. From this study we conclude that UFE is a minimally invasive, safe and effective treatment for properly selected patients with uterine fibroids.