| Most women with symptomatic fibroids believe that they need a hysterectomy, one of the most commonly performed operations on women. Although hysterectomy provides a total and permanent cure for fibroids, this surgery is typically associated with a 6 week recovery period, has a complication rate of 20% and can also have devastating psychological effects. Now, interventional radiologists can embolize fibroids, in many places as an outpatient procedure. Patients arrive in the morning, undergo the procedure and go home at days end. They end up with nothing but a tiny nick in the skin and a band-aid. It´s been shown to be as effective, safer and have fewer complications.
Uterine Fibroids are common benign tumors arising within the womb (uterus). They are found in 20-40% of women in the reproductive age group. Often they are of no consequence and are found at the time a pelvic ultrasound is done for other reasons. Depending upon their size and location, they can cause symptoms such as heavy menstrual bleeding (which may lead to anemia), urinary problems, constipation, or pelvic pain.
Embolization (UFE) as a treatment alternative for fibroids was first described in 1995. It is now widely practiced world wide (and covered by OHIP in Ontario). Briefly, this procedure can be performed without the need for general anesthetic, or admission to hospital. It involves injecting small plastic particles into the arteries supplying the uterus in order to block the blood supply and cause the fibroids to die. It results in symptom improvement in up to 92% of patients, with a significant complication rate in the order of 2%. Follow up studies have shown the majority of women expressed satisfaction with UFE.
Dr. Murray Asch and Dr. Mark Otto Baerlocher shed some light on this important medical development.
Has embolization been used as a treatment for uterine fibroids long enough to be considered a safe alternative?
Yes – although it´s a relatively new procedure, there has been a large amount of studies published on the procedure. In fact, one of the largest was a Canadian study – e.g. see 2 abstracts here:
Abstract 1 and Abstract 2
Research has shown that uterine fibroid embolization is safe, very effective, leads to high patient satisfaction, much shorter hospital stays, much quicker return-to-work/return-to-regular activities, and is also significantly cheaper from a Health Care Cost perspective. Some interventional radiologists now perform the procedure as an outpatient procedure – you arrive in the morning, undergo the procedure, spend several hours in the Recovery Unit, and go home after dinner if everything is ok. Research has shown these patients do just as well as those who stay overnight after the procedure (e.g. see http://www.carj.ca/issues/2006-Apr/95/95.pdf).
What type of medical specialists performs it?
Interventional Radiologists. These are radiologists who underwent additional specialized training to perform minimally-invasive procedures, which includes not only uterine fibroid embolization, but also many many other minimally-invasive treatments such as tumour embolization, angioplasty and stenting, vertebroplasty, venous access devices, chemotherapy delivery devices, etc. Interventional radiologists use their expertise in interpreting xrays, ultrasound, CAT scans, and MRIs to guide small instruments to treat diseases, WITHOUT surgically opening up patients.
This is really the new frontier of medicine – these minimally-invasive treatments are rapidly replacing many traditional surgical treatments. More information about this field can be found here, or here.
If you have a disease, and you could undergo either:
1. a full operation, with a post-surgery hospital stay of days at least (i.e. hysterectomy); or
2. a minimally-invasive treatment performed by an interventional radiologist in which you end up with only a small 3 mm cut that´s covered with a band-aid, and both treatments were equally effective, but the minimally-invasive treatment is safer, which would you choose?
How does the success rate compare with that of hysterectomy?
Uterine fibroid embolization is as successful, or in many cases more successful. And because of the intrinsic difference where the patient does not undergo an actual operation (instead ending up with a small nick in the skin covered by a band-aid), the complication rate is lower, hospital stay is shorter, and return-to-regular-activities is quicker.
Hysterectomy is 100% successful in treating symptoms caused by fibroids, but there is a price to pay (surgery, risk, psychosocial). When patients are worked up and treated by an experienced radiologist, UFE is highly successful (92% for bleeding, 60% for bulk related symptoms). Although symptom relief is not 100%, most women do get improvement in symptoms so they are happy with their choice to avoid hysterectomy.
How does recovery compare with recovery following a hysterectomy?
The recovery is much quicker with fibroid embolization. Instead of an operation where skin, fat, and abdominal wall muscle are cut through, and an entire organ (i.e. the uterus) is removed, uterine fibroid embolization involves a small nick over the groin/inguinal area, which is covered with a small band-aid afterwards. Hysterectomy involves a post-operative hospital stay of days… Fibroid embolization patients leave the next morning, and in some hospitals, the patients actually leave the same day!
What happens when the procedure is not successful?
It is essential to confirm that the patient does have fibroids and that the residual symptoms are from lack of fibroid death post UFE. This is done using MRI. Depending upon the specific clinical case, the procedure can be performed again (typically more successful the second time), or the patient can have one of a number of other therapies (D&C, myomectomy, hysteroscopy, endometrial ablation, medical therapy, or hysterectomy). Undergoing uterine fibroid embolization does NOT mean you cannot undergo hysterectomy down the road if you need it.
Why shouldn´t a woman just have a hysterectomy?
For a number of reasons – there is usually not a need to remove the uterus for fibroids. Most may be successfully treated with uterine fibroid embolization, which is a less invasive procedure that is as successful or more successful, has fewer complication rates, shorter hospital stay, leads to high patient satisfaction, and leads to a quicker return-to-regular-activities/work.
Ask your family physician or gynecologist today about uterine fibroid embolization. You have nothing to lose. You will be seen by the interventional radiologist before the procedure itself, where they will determine if you are a good candidate for the procedure. If so, they can answer your questions.
This is really the future of much of medicine – minimally-invasive treatments. Though there is a large amount of evidence demonstrating how great this procedure is, because it´s still a relatively new procedure, some do not know about it yet. So we would encourage women to take charge of their own health, and actively look into and ask about uterine fibroid embolization.
Further information and a list of some of the interventional radiologists who perform uterine fibroid embolization may be found by following this link .
Murray Asch MD, FRCPC
Director of Interventional Radiology
Lakeridge Health Oshawa
1 Hospital Court
Oshawa, Ontario
L1G 2B9
Tel: 905-576-8711 x 3497
Fax: 905-721-4770
masch@lakeridgehealth.on.ca
Past President Canadian Interventional Radiology Association (www.car.ca/cira)
Dr. Mark O. Baerlocher
Radiology Residency Training Pogram
University of Toronto
mark.baerlocher@utoronto.ca
22.08.2007
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The walk was cut short by the lure of a slick storefront. Before we knew it, we were seated in front of a video presentation with drinks and nibbles at our fingertips. They’re selling fractional ownership at the Ritz Carlton.
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Dr. Marla Shapiro is a Certificant of the College of Family Physicians of Canada and a Specialist in Community Medicine. She is an Associate Professor in the Department of Family and Community Medicine at the University of Toronto and has her own family practice. The medical consultant for CTV National News and Canada AM, she also hosts the show Balance: Television for Living Well and has a bi-weekly column in The Globe and Mail. Dr. Shapiro is the recipient of the 2005 Media Award from the North American Menopause Society for her work in expanding the understanding of menopause, and won the Society of Obstetricians and Gynaecologists of Canada/Canadian Foundation for Women’s Health Award for Excellence in Women’s Health Journalism in 2006 for her documentary Run Your Own Race. She lives in Toronto with her family. Visit her website here: http://www.drmarla.ca/
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