| |
| 21st Century Medical advancement
|
|
Non-Surgical treatment for Uterine fibroids
|
(Uterine Artery Embolization for fibroids/ Minimally Invasive Therapy/ Uterine-sparing treatment)
Dr. Pradeep Muley
M.D., Senior Consultant Interventional Radiologist,
Department of Body & Neuro Interventional Radiology
Batra Hospital & Medical Research Center,
|
| |
Uterine fibroids are the most frequent tumors of the female genital tract. 20 to 40% of women of childbearing age have a fibroid. Fibroids range in size from very tiny to the size of an orange or larger. In some cases, they can cause the uterus to grow to the size of a five-month pregnancy or more. Fibroid may be located in various parts of the uterus. There are three primary types of ute rine fibroids; Subserosal, Intramural and Submucosal fibroids.
|
|
| |
|
|
| |
Fibroids are noncancerous(benign) growths that develop in the muscular wall of the uterus. Fibroids do not always cause symptoms. On most cases, there is more than one fibroid in the uterus.
Depending on location, size and number of fibroids, they may cause:
|
|
| |
| |
- Heavy, prolonged menstrual periods and unusual bleeding, sometime with clots. This might lead to anemia.
- Lower abdomen pain or, more accurately, pressure or discomfort in the pelvis that is caused by the bulk or weight of the fibroids pressing on the nearby structures.
- Pain the back , flank or leg as the fibroids press on the nerves that supply the lower abdomen and legs.
- Lower abdominal pressure or heaviness
- Bladder pressure leading to a constant urge to urinate
- Pressure on bowel, leading to constipation and bloating
- Abnormally enlarged(distended) abdomen, which can be misinterpreted as a progressive weight gain.
|
|
| |
Fibroids are usually diagnosed during a gynecologic examination. The presence of fibroids is most often confirmed by a lower abdomen ultrasound. Fibroids can also be confirmed using MRI (magnetic resonance imaging). These imaging techniques serve as a baseline examination for follow-up after uterine fibroid embolization (UFE).
|
|
| |
| |
Treatment options for uterine fibroids:
|
| |
1. Medical Management : Effective medical therapy is not available for management of fibroids. However some hormonal drugs in the form of injections have recently become available which are expensive and this hormonal therapy cannot be used for long term basis of its side effects.
|
| |
2. Surgical Management : Surgical removal of visible fibroids from the uterine wall (myomectomy) or removal of uterus (hysterectomy).
|
| |
3. Non Surgical treatment for fibroids : ( Minimally invasive therapy/ Uterine artery embolization/ Uterine –sparing treatment)
|
| |
Non Surgical treatment for fibroids :
|
| |
( Minimally invasive therapy/ Uterine –sparing treatment / Uterine artery embolization for fibroids) known medically as Uterine artery embolization, this is a fundamentally new approach to the treatment of fibroids. It is a minimally invasive interventional radiological procedure, which means it requires only a tiny nick in the skin. It is performed under sedation and local anesthesia – feeling no pain and usually requires a hospital stay of one night. Many women resume light activities in a few days and the majority of women are able to return to normal activities within one week.
|
| |
Ideal Patient for uterine artery embolization(UAE) meets four basic requirements:
|
|
| |
- They have single or multiple fibroids.
- The fibroids are symptomatic.
- There is no cancer.
- Who do not desire pregnancy.
|
|
| |
UFE treats all uterine fibroids at the same time and is, therefore, an extremely effective.
|
| |
The interventional Radiologist makes a small nick in the skin (less the ¼ of an inch) at groin, inserts a catheter, identifies uterine artery by using angiography with contrast media injection and then inject embolization particles (polyvinyl alcohol) that block the tiny vessels supplying all the fibroids. This blockade of blood supply to fibroids causes infarction(loss of blood supply to the fibroids) and subsequent degeneration of the fibroids and it starts reducing in size reaching half the size in few weeks. Symptoms due to the fibroids (like bleeding and pain) resolve in 85% to 95% of patients within 24 hrs.
|
|
|
|
| |
While embolization to treat uterine fibroids has been performed since 1995, embolization of the Uterus artery is not new. It has been used successfully by interventional radiologist for over 20 years to treat heavy bleeding after childbirth.
|
| |
Advantages of Non surgical treatment of fibroids (Uterine artery embolization)
|
|
| |
- It is performed under Local anesthesia. Not General anesthesia.
- Requires only a tiny nick in the skin (No surgical incision of abdomen).
- Recovery is shorter than from hysterectomy or open myomectomy.
- Virtually no adhesion formation has been found. But in surgery adhesions are common.
- All fibroids are treated at once, which is not the case with myomectomy.
- There has been no observed recurrent growth of treated fibroids.
- Uterine fibroid embolization involves virtually no blood loss or risk of blood transfusion.
- If the presenting complaint was excess vaginal bleeding, 87-90% of cases experiences resolution within 24 hours.
- Emotionally, financially and physically – embolization can have an overall advantage over other procedures for the patient as the uterus is not removed.
|
|
Before and After uterine artery embolization for fibroids.
The reduction in the volume(size) of the fibroids. |
|
|
| |
Our Experience at Batra Hospital
|
Uterine artery embolization avoided major high risk surgery for removal of uterus in 140 kg weight patient
|
A 48 year woman admitted to Batra Hospital & Medical Research Centre, New Delhi with history of heavy, prolonged menstrual bleeding since three months and back & leg pain. Patient was severly anemic. Ultrasonography was performed which showed multiple fibroids in uterus. Patient weighed 140 kg, predominantly central obesity. Patient took hormonal treatment to control bleeding but it was not effective. The treatment option available for patient was surgery (removal of uterus by open surgery or laparoscopic) but she was a high-risk patient.
I decided to treat this patient with “Uterine Artery Embolization for fibroids”, the technique is described above. The bleeding was controlled just after the procedure and patient was discharged after five days. The cost of this procedure is less than open surgery/laparoscopic surgical removal of uterus/fibroids.
The advantages of this procedure have been described above. This technique is considered safe alternative to hysterectomy and myomectomy. It can be offered to patient with symptomatic fibroids who do not desire pregnancy. In patients with a desire for pregnancy, UFE can be considered only if no other alternative is available.
The author has vast experience in interventional radiological procedures and he has performed about 70 uterine artery embolization for fibroids before and in last two months time at Batra about 15 to 20 cases.
Recently Dr Pradeep Muley, Departmant of Interventional Radiology has made the Ist UTERINE FIBROID CLUB OF INDIA for women who are suffering from uterine fibroids & organized a scientific session on “ Non-Surgical Treatment fot Uterine Fibroids” on 18th of October 2006 at India Habitate Centre.
|
|
|
|
|
Minimally invasive breakthrough treatment For (BPH) Benign Prostatic Hyperplasia
