Staged Prehysterectomy Uterine Artery Embolization for Symptomatic Uterine Myomas: A Scoping Review

OBJECTIVE: To systematically examine the current literature on staged prehysterectomy uterine artery embolization (SUAE) for symptomatic uterine myomas. DATA SOURCES: Databases were queried from January 2010 to June 2025. A scoping review following the Arksey and O'Malley framework and Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews guidelines was performed. This study was prospectively registered in PROSPERO under CRD42023395014. METHODS OF STUDY SELECTION: Although 1662 records were identified and assessed for eligibility, 914 underwent abstract screening, and only 142 records underwent full article screening. Nine articles met the inclusion criteria. Two independent reviewers evaluated the articles, with a third reviewer refereeing any discrepancies. TABULATION, INTEGRITY, AND RESULTS: The 9 studies corresponded to 34 patients. Only case reports and a single cross-sectional observational study were identified. The average patient age was 44 years, with bleeding and bulk symptoms noted as the most common indications for hysterectomy. The median for the largest myoma diameter was 19 cm (average, 20.9). The median uterine artery embolization-to-hysterectomy interval was 1 day (average, 15.6). Regarding the route, 88.2% were total abdominal, 8.8% total laparoscopic, and 2.9% subtotal laparoscopic. The median blood loss was 352 mL (average, 605.3) compared with the median uterine weight of 2905 g (average, 4439.2). Of the 8 patients receiving blood transfusions, all had undergone a total abdominal hysterectomy. CONCLUSION: This review is the first to systematically examine the literature on SUAE for patients with symptomatic uterine myomas. Because of the limited case studies and observational data available, the true outcomes are uncertain and there is insufficient evidence that SUAE should be added into clinical practice as standard of care. Overall, the findings of this exploratory scoping review best serve to generate future hypotheses while highlighting an urgent need for rigorous research.