Uterine Fibroid Embolization

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

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Uterine Fibroid Embolization

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

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