Transcaheter uterine artery embolisation to treat large uterine fibroids with MRI quantitative assessment

Fibroids are benign tumours of the uterus which occur more commonly and earlier in black women. We do not know what causes the fibroids to grow, but their growth seems to be hormone dependant. Some women may have asymptomatic fibroids and be unaware of their presence. However, many others seek help from gynaecologists due to menorrhagia, sometimes leading to anaemia and pressure symptoms leading to pain, sciatica, urinary infrequency and constipation. Fibroids may also contribute towards infertility and cause problems in pregnancy. Treatment of fibroids is notoriously difficult. Drug treatment has proved unsuccessful in the long term treatment of fibroids and has been reserved for preoperative treatment. Myomectomy is a difficult operation for women which may require blood transfusions, unacceptable to Jehovah's Witnesses and rarely lead to hysterectomy due to uncontrollable bleeding. Women above child bearing age are usualy offered hysterectomy, but many women are unhappy to loose their uterus as this has cultural and social implications. At St. Thomas' and Guy's Hospital we have pioneered a new treatment for fibroids whereby the uterine arteries are embolised bilaterally and by cutting off the blood supply to the fibroids, they shrink in size and degenerate. An interventional radiologist inserts a catheter into the femoral artery in the groin and passes a guide wire under x-ray control into the uterine artery. Non-biodegradable particles are introduced into the artery until flow is reduced or stopped. This is repeated on the second side. The procedure is performed under sedation and takes about an hour. The patients are admitted for 24-36 hours for analgesia. Ten women have been treated to date, nine were Afro-Caribbean and we have three month follow-up on eight. MRI scans were performed before the procedure and at three months to obtain quantitative assessment of reduction in volume. The uterine volume reduced by a mean of 51 percent and further shrinkage is expected. All but one of the patients noticed improvement in one or all of their symptoms. Patient satisfaction was high. The main side effects of the procedure were pain, controlled with simple analgesia and vaginal discharge. This seems a good treatment for women with symptomatic fibroids who are not suitable for or unwilling to undergo surgery. It avoids a general anaesthetic major surgery and blood transfusions. The procedure is tolerated well and has good symptomatic cure rates.(AU)