Uterine fibroids are the most common tumor of the reproductive tract in women of reproductive age. Although they are benign tumors that are often asymptomatic, uterine fibroids may cause debilitating symptoms in many women, such as abnormal uterine bleeding, abdominal pain, increased abdominal girth, urinary frequency, constipation, pregnancy loss, dyspareunia, and in some cases infertility. Several approaches are available for the treatment of uterine fibroids. These include pharmacologic options, such as hormonal therapies and gonadotropin-releasing hormone agonists; surgical approaches, such as hysterectomy, myomectomy, myolysis, laparoscopic uterine artery occlusion, magnetic resonance imaging-guided focused ultrasound surgery, and uterine artery embolization. The choice of approach may be dictated by factors such as the patient's desire to become pregnant in the future, the importance of uterine preservation, symptom severity, and tumor characteristics. New treatment options for uterine fibroids would be minimally invasive, have long-term data demonstrating efficacy and safety, have minimal or no incidence of fibroid recurrence, be easy to perform, preserve fertility, and be cost effective. New treatment approaches are under investigation, with the goals of being effective, safe, and less invasive.

Modern management of uterine fibroids.

Objective. To compare the efficacy, feasibility and morbidity of two preparation techniques for conservative uterine myoma surgery: temporary embolization and temporary surgical ligature of the uterine arteries. Design. Retrospective study. Setting. Gynecological Surgery and Interventional Radiology departments, Centre Hospitalier Universitaire of Dijon, France. Population. A total of 100 women undergoing myomectomy between 2000 and 2008. Methods. Three groups were constituted: (1) no preparation (43 patients), (2) uterine artery embolization (UAE) (30 patients) and (3) temporary surgical ligature of the uterine arteries (SLUA) (27 patients). The choice of technique depended on the number, size and topography of the fibromas. Main outcomes measures. Quantification of peroperative blood loss, delta hemoglobin, complications, subsequent fertility. Results. Blood loss and delta hemoglobin were both lower in group 2 (p = 0.026 and p = 0.0002) and in group 3 (p = 0.048 and p = 0.001), respectively, than in group 1. The two preparation techniques were efficient. SLUA increased the duration of the operation (p < 0.0001). Hospitalization was longer following UAE (p = 0.0001). The rate of complications was 16.3, 23.3 and 3.7%, and of synechiae 9.3, 13.3 and 0% for groups 1, 2 and 3, respectively. The number of pregnancies was 8, 5 and 6 after a mean postoperative period of 5.6, 4.3 and 3.9 years, respectively. Conclusion. Both UAE and SLUA for myomectomy are feasible, reproducible and effective techniques for reducing peroperative blood loss. Use of these techniques must be generalized in patients with a high risk of hemorrhage, but may be compatible with subsequent fertility.

https://obgyn.onlinelibrary.wiley.com/doi/pdf/10.3109/00016349.2010.512060

Preoperative embolization or ligature of the uterine arteries in preparation for conservative uterine fibroma surgery.

Uterine artery embolization immediately preceding laparoscopic myomectomy

Purpose Purpose of this paper to present results of a group of 21 consecutive patients who underwent uterine artery embolization (UAE) immediately before myomectomy. Surgical myomectomy can lead to a substantial blood loss in case of large or multiple tumors due to the hypervascularization of the tumors. This may lead to multiple blood transfusion or hysterectomy. In cases were the preservation of the uterus is demanded, pre-operative embolization could reduce the risk of substantial bleeding. Materials and Methods Between January 2011 and March 2016, 21 patients underwent UAE 24 hours before myomectomy. All patients were asked by questionnaire about post-surgical follow-up, complications, the length of the scar, satisfaction and improvement of symptoms. Data of the operation and embolization were retrospectively assessed. Results UAE could be performed in all patients without complications. Mean diameter of the largest myoma was 12.7 ± 3.2 cm, primary preservation of the uterus succeeded in all cases. In none of the cases a perioperative blood transfusion was necessary. One patient underwent hysterectomy in another hospital after primary successful resection, one patient received transfusion of 2 bags of red blood cell concentrate during her stay in hospital. 11 of 21 patients responded to the questionnaire. 10 of 11 had subjective symptom improvement. Mean inability to work was 31 days, the mean self-measured length was 12 cm. 9 of 11 patients would recommend the procedure, one patient was in the second trimester of pregnancy. Conclusion Preoperative uterine artery embolization facilitates a safe and uterus-preserving myomectomy in patients with very large or multiple fibroids. Key Points  Citation Format

/pdf/analysis-of-presurgical-uterine-artery-embolization-puae-for-4b2q3jbheg.pdf

Analysis of presurgical uterine artery embolization (PUAE) for very large uterus myomatosus; patient's desire to preserve the uterus; case series and literature review.

Journal de Gynecologie Obstetrique et Biologie de la Reproduction - Vol. 40 - N° 8 - p. 918-927

Place de l’embolisation dans le traitement des fibromes

Purpose
To evaluate the potential of uterine artery embolization to minimize blood loss and facilitate easier removal of fibroids during subsequent myomectomy

Preoperative uterine artery embolization (PUAE) before uterine fibroid myomectomy.

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Preoperative uterine artery embolization (PUAE) before uterine fibroid myomectomy.