Uterine Fibroid Embolization

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Talk on uterine fibroid embolization presented to the Memorial Hermann Family Practice residents.

Talk on uterine fibroid embolization presented to the Memorial Hermann Family Practice residents.

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  • 1. Uterine Fibroid Embolization
    Carlos R. Hamilton III, M.D.
    Vascular and Interventional Radiology
    The Hamilton Institute
    1415 Hwy 6, A200
    Sugar Land, TX 77478
  • 2. What are Uterine Fibroids?
    Benign tumor of uterine smooth muscle
    Fibroids are not considered to be pre-cancerous
    Also referred to as myomas or leiomyomas
    Types: submucosal, intramural, and subserosal
  • 3. What are Uterine Fibroids?
  • 4. What Causes Uterine Fibroids?
    • Exact cause currently unknown
    • 5. Fibroids linked to estrogen
    • 6. Evidence that progesterone may stimulate fibroid growth
    • 7. Genetic Predisposition ?
  • How Common are Uterine Fibroids?
    • Estimated that 25 to 50% or greater of all women eventually develop fibroids
    • 8. Fibroids most frequently diagnosed in 30s & 40s
    • 9. Most common tumor of the pelvis in females
    • 10. About 10% to 30% of these women are symptomatic
  • Who Gets Fibroids?
    • Incidence increases with age
    • 11. 20% of women in their 20’s
    • 12. 40% of women in their 40’s
    • 13. Genetic predisposition
    • 14. African-American women at higher risk
    • 15. Familial tendencies
  • What Symptoms Occur With Uterine Fibroids?
    • Heavier prolonged menstrual bleeding, sometimes with passage of blood clots. Anemia can occur if bleeding is severe
    • 16. Pain, pressure, or feeling of fullness in the pelvis, abdomen, or lower back
    • 17. Frequent urination or constipation
    • 18. Pain during or bleeding after intercourse
    • 19. Infertility or miscarriage
    • 20. Abnormally enlarged abdomen
    • 21. Bladder pressure leading to a constant urge to urinate
  • What Symptoms Occur With Uterine Fibroids?
    Image courtesy of Mark Cockerill, MD, www.ufecenter.com
  • 22. How are Uterine Fibroids Diagnosed?
    • Fibroids are usually diagnosed during a gynecologic internal examination
  • How are Uterine Fibroids Diagnosed?
    • The presence of fibroids is most often confirmed by an abdominal ultrasound
    • 23. Fibroids also can be confirmed using magnetic resonance (MR)
    • 24. Other conditions such as adenomyosis or ovarian cysts may be mistaken for fibroids
  • How are Uterine Fibroids Treated?
    • Most fibroids do not cause symptoms and are not treated
    • 25. When they do cause symptoms, drug therapy often is the first step in the treatment
    • 26. This might include a prescription for birth-control pills or other hormonal therapy, or the use of non-steroidal anti-inflammatory drugs, such as ibuprofen or naproxen sodium
  • How are Uterine Fibroids Treated?
    • In many patients, symptoms are controlled with these treatments and no other therapy is required
    • 27. Some hormone therapies do have side effects and other risks when used long-term so they are generally used temporarily
    • 28. Fibroids often grow back after therapy is discontinued
  • How are Uterine Fibroids Treated?
    • LUPRON
    GNRH agonist blocks ovarian estrogen production
    Advantages:
    • Not Invasive, shrinks fibroids, often improves symptoms
    Disadvantages:
    • Induces premature menopause and associated symptoms
    • 29. Fibroids usually return to original size after cessation of therapy. Only used for short periods of time because of side effects
  • How are Uterine Fibroids Treated?
    The next step is to move to more invasive therapy. The most common treatment options include:
  • How are Uterine Fibroids Treated?
    • Myomectomy
    Individual fibroids are resected through an abdominal incision or sometimes with a laparoscope or hysteroscope.
    Advantages:
    • Fertility can be preserved
    • 32. Well established procedure, less invasive if laparoscopic or hysteroscopic
    Disadvantages:
    • Potential surgical complications
    • 33. Only part of uterus is treated and recurrence can occur; 15 to 25 % need repeat procedure
    • 34. Not all fibroids are treated via myomectomy
  • How are Uterine Fibroids Treated?
    • Myomectomy - Abdominal
  • How are Uterine Fibroids Treated?
    • Hysterectomy
    Surgical removal of uterus and fibroids, performed through an abdominal incision, vaginally, or laparoscopically
    Advantages:
    • 100% Curative
    • 35. No risk of future fibroids
    • 36. Well established procedure
  • How are Uterine Fibroids Treated?
    • Hysterectomy
    Disadvantages:
    • Major surgery with potential surgical complications: infection, hemorrhage, injury to adjacent organs, adhesions
    • 37. Loss of child bearing potential
    • 38. General anesthesia
    • 39. 2 days to 6 weeks recovery time
    • 40. Hormonal changes (if ovaries are removed)
    • 41. Long term side effects have been reported
    • 42. Emotional
    • 43. Sexual
  • How are Uterine Fibroids Treated?
    • Hysterectomy
    • 44. Over 600,000 hysterectomies per year
    • 45. 40,000 myomectomies, 25,000 UFE
    • 46. 2nd most frequent surgical procedure in women of reproductive ages (after C-section)
    • 47. 90% for benign reasons
    • 48. 35% for fibroids
    • 49. 20% of women by age 40
    • 50. 33% of women by the age of 65
    • 51. A very common procedure, often offered to women promptly following a diagnosis
  • Why Not Have a Hysterectomy?
  • How are Uterine Fibroids Treated?
    Uterine Fibroid Embolization performed by an Interventional Radiologist
    What is an Interventional Radiologist?
    Interventional radiologists are physicians who are specially trained to diagnose and treat conditions using tiny, miniaturized tools, while watching their progress on X-ray or other imaging equipment
    Typically, the interventional radiologist performs procedures through a very small nick in the skin, about the size of a pencil tip
    Interventional radiology treatments are generally better tolerated by the patient than surgery because they involve no surgical incisions, less pain, shorter hospital stays, and a faster recovery
  • 63. How are Uterine Fibroids Treated?
    • Uterine Fibroid Embolization (UFE)
    • 64. The interventional radiologist makes a small nick in the skin (less than 1⁄4 of an inch) in the groin and inserts a catheter into an artery.
    • 65. The catheter is guided through the artery to the uterus while the interventional radiologist watches the progress of the procedure using a moving X-ray (fluoroscopy).
    • 66. The interventional radiologist injects tiny plastic particles the size of grains of sand into the artery that is supplying blood to the fibroid tumor.
    • 67. This cuts off the blood flow and causes the tumor (or tumors) to shrink.
  • How are Uterine Fibroids Treated?
    • Uterine Fibroid Embolization
    • 68. Angiography Suite, like an OR with a modern X-ray machine, sterile conditions
    • 69. Conscious sedation
    • 70. Procedure typically takes one hour to complete
    • 71. Fibroid embolization usually done on an out patient basis
  • How are Uterine Fibroids Treated?
    Uterine Fibroid Embolization
    Post Procedure Expectations
    • Pain-management medications and drugs that control swelling typically are administered intravenously immediately post-procedure to treat cramping and pain, which are common side effects
    • 72. Fever is an occasional side effect, and is usually treated with acetaminophen - Starts a few hours after the procedure and may last 3 to 5 days
    • 73. Many women resume light activities in a few days and the majority of women are able to return to normal activities within one week
  • How are Uterine Fibroids Treated?
    Uterine Fibroid Embolization
    Post Procedure Expectations
    • Approximately 90% of women are satisfied from the procedure
    and require no further treatment for their fibroids.
    • The procedure is effective for multiple fibroids
    • 74. Recurrence of treated fibroids is very rare
  • How are Uterine Fibroids Treated?
    Uterine Fibroid Embolization
    Mechanism of Action
  • 75. How are Uterine Fibroids Treated?
    Uterine Fibroid Embolization
    Mechanism of Action
  • 76.
    • Uterine Fibroid Embolization
    Advantages:
    Treats all fibroids simultaneously
    Minimally invasive, complications infrequent
    Recurrence of treated fibroids rare
    Shorter recovery period than open surgery
    No adhesion (scar) formation
    Minimal blood loss. No need for transfusion
    Epidural or conscious sedation vs. general anesthesia
    Emotionally, physically, and sexually - UAE can have advantages over surgery
  • 77.
    • Uterine Fibroid Embolization
    Disadvantages
    • 10-15% do not respond despite technical success
    • 78. Pelvic pain or cramping after procedure can remain moderate to severe for several days
    • 79. 1% to 2% chance of serious complication i.e. hysterectomy
    • 80. 2% of patients can slough a fibroid into the endometrial cavity
    • 81. Patients over 45 have potential for ovarian failure
    • Uterine Fibroid Embolization
    • 82. FAQ
    Q. Will my fertility be affected?
    Conclusive studies with large numbers lacking
    Dozens of reported healthy pregnancies, with no reports of any adverse outcome due to UAE
    If infertility due to fibroids, fertility may improve in select patients after UAE. Research ongoing.
    Women with symptomatic fibroids desiring fertility probably should consider myomectomy first, especially if relatively uncomplicated.
    Q. Will my insurance pay for the Uterine Fibroid Embolization procedure?
    • Most insurance companies cover UFE. You will want to speak with your interventional radiologist about this before your procedure
  • 30-45 Year old woman or younger if done with child bearing.
    Heavy menstrual bleeding, severe pelvic pain during menstrual cycle.
    Wants to avoid long painful recovery from hysterectomy.
    Does not want to be away from work for 4-6 weeks.
    Poor surgical candidate.
    IDEAL PATIENT FOR UFE
  • 83.
    • Uterine Fibroid Embolization
    • 84. Results
    • 85. Friday, November 19, 2004 Posted: 4:07 PM EST (2107 GMT)
    • 86. WASHINGTON (CNN) -- National security adviser Condoleezza Rice, President Bush's nominee to be the next secretary of state, is doing well after successful surgery, Jim Wilkinson, deputy national security advisor, told CNN Friday
    • 87. Rice 'resting comfortably' after surgery
    • 88. Expected to return to work on Monday