Skip to main content

Advertisement

SpringerLink
Log in

Stand und Entwicklung der Uterusmyomembolisation in Deutschland

  • Uterusembolisation
  • Published:
Der Radiologe Aims and scope Submit manuscript

Zusammenfassung

Hintergrund

Ziel dieser Arbeit war es, Stand, Entwicklung und Implementierung der Embolisationstherapie von Uterusmyomen (UME) in das Behandlungskonzept von Patientinnen mit symptomatischen Uterusmyomen in Deutschland zu evaluieren.

Material und Methodik

Ein Fragebogen zum Thema der Embolisation von Uterusmyomen wurde an 164 Abteilungen für Gynäkologie und Radiologie im gesamten Bundesgebiet versandt. Erfragt wurden Informationen zur klinischen Symptomatik, mit der sich die Patientinnen vorstellen, zu den empfohlenen Behandlungsstrategien, zur Interventionsvorbereitung, zur technischen Durchführung und zu den Komplikationen der UME.

Ergebnisse

Von den angeschriebenen Abteilungen antworteten 33 radiologische und 19 gynäkologische Abteilungen. Nur 7 Abteilungen für Radiologie berichteten über eigene Erfahrungen bei der Durchführung der UME, während nur 2 gynäkologische Abteilungen die UME in das Repertoire möglicher Therapieoptionen für Patientinnen mit symptomatischen Uterusmyomen aufnehmen. Insgesamt bieten 18 radiologische Abteilungen die UME an, können jedoch nicht alle über eine Zuweisung zur Therapie berichten. Bezüglich der Diagnosesicherung mit Ultraschall und MRT, der Indikationsstellung, der bevorzugten Lokalisation der Myome, des technischen Vorgehens und des Schmerzmanagements herrschte abteilungsübergreifend hohe Übereinstimmung.

Schlussfolgerung

Die UME zur Behandlung von Patientinnen mit symptomatischen Uterusmyomen hat sich trotz der weltweit dokumentierten Behandlungserfolge und niedriger Komplikationsrate in Deutschland bisher nicht etablieren können. Gynäkologen und interventionelle Radiologen müssen gemeinsam die Indikation zur UME stellen, um der UME einen Stellenwert als Alternative zur klassischen chirurgischen Therapie zu verschaffen.

Abstract

Background

To evaluate the current situation and implementation of embolization of uterine leiomyomas into the treatment concept in women with symptomatic uterine leiomyomas in Germany.

Material and methods

A questionnaire addressing the clinical background of uterine myomas, recommended treatment concepts, preclinical evaluation, technical approach and complications was sent to 164 departments of gynecology and radiology in Germany.

Results

33 radiological departments and 19 gynecological departments submitted a completed questionnaire. Only 7 departments of radiology reported to have own experience with embolization of uterine leiomyomas, while only 2 departments of gynecology considered embolization as an alternative treatment option in patients with symptomatic leiomyomas. 18/33 radiological departments offer this treatment option but get no patient referrals. Agreement was found concerning the indications for treatment, preclinical evaluation by ultrasound and MRI, preferable location of treatable fibroids, technical approach and pain management.

Conclusion

The embolization of uterine leiomyomas in patients with symptomatic myomas is regardless of the well documented high efficacy and low complication rate not yet an established treatment option in Germany. Interventional radiologists and gynecologists have to evaluate the indications for the embolization of uterine leiomyomas together before the procedure is advised to the patient, because it seems mandatory to add this procedure to the standard armamentarium of treatment options in uterine myomas.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Literatur

  1. Al-Fozan H, Dufort J, Kaplow M, Valenti D, Tulandi T (2002) Cost analysis of myomectomy, hysterectomy, and uterine artery embolization. Am J Obstet Gynecol 187:1401–1404

    Article  PubMed  Google Scholar 

  2. Baker CM, Winkel CA, Subramanian S, Spies JB (2002) Estimated costs for uterine artery embolization and abdominal myomectomy for uterine leiomyomata: a comparative study at a single institution. J Vasc Interv Radiol 13:1207–1210

    PubMed  Google Scholar 

  3. Buttram VC jr, Reiter RC (1981) Uterine leiomyomata: etiology, symptomatology, and management. Fertil Steril 36:433–445

    PubMed  Google Scholar 

  4. Day Baird D, Dunson DB, Hill MC, Cousins D, Schectman JM (2003) High cumulative incidence of uterine leiomyoma in black and white women: ultrasound evidence. Am J Obstet Gynecol 188:100–107

    Article  PubMed  Google Scholar 

  5. Gimbel H, Ottesen B, Tabor A (2002) Danish gynecologists' opinion about hysterectomy on benign indication: results of a survey. Acta Obstet Gynecol Scand 81:1123–1131

    Article  PubMed  Google Scholar 

  6. Goodwin SC, McLucas B, Lee M, Chen G, Perrella R, Vedantham S, Muir S, Lai A, Sayre JW, DeLeon M (1999) Uterine artery embolization for the treatment of uterine leiomyomata midterm results. J Vasc Interv Radiol 10:1159–1165

    PubMed  Google Scholar 

  7. Iverson RE jr, Chelmow D, Strohbehn K, Waldman L, Evantash EG (1996) Relative morbidity of abdominal hysterectomy and myomectomy for management of uterine leiomyomas. Obstet Gynecol 88:415–419

    Article  PubMed  Google Scholar 

  8. Koutsilieris M (1992) Pathophysiology of uterine leiomyomas. Biochem Cell Biol 70:273–278

    CAS  PubMed  Google Scholar 

  9. LaMorte AI, Lalwani S, Diamond MP (1993) Morbidity associated with abdominal myomectomy. Obstet Gynecol 82:897–900

    CAS  PubMed  Google Scholar 

  10. Lepine LA, Hillis SD, Marchbanks PA, Koonin LM, Morrow B, Kieke BA, Wilcox LS (1997) Hysterectomy surveillance—United States, 1980–1993. MMWR CDC Surveill Summ 46:1–15

    CAS  Google Scholar 

  11. Pinto I, Chimeno P, Romo A, Paul L, Haya J, de la Cal MA, Bajo J (2003) Uterine fibroids: uterine artery embolization versus abdominal hysterectomy for treatment—a prospective, randomized, and controlled clinical trial. Radiology 226:425–431

    PubMed  Google Scholar 

  12. Pron G, Bennett J, Common A, Wall J, Asch M, Sniderman K (2003) The Ontario Uterine Fibroid Embolization Trial. Part 2. Uterine fibroid reduction and symptom relief after uterine artery embolization for fibroids. Fertil Steril 79:120–127

    Article  PubMed  Google Scholar 

  13. Pron G, Cohen M, Soucie J, Garvin G, Vanderburgh L, Bell S (2003) The Ontario Uterine Fibroid Embolization Trial. Part 1. Baseline patient characteristics, fibroid burden, and impact on life. Fertil Steril 79:112–119

    Article  PubMed  Google Scholar 

  14. Ravina JH, Bouret JM, Fried D, Benifla JL, Darai E, Pennehouat G, Madelenat P, Herbreteau D, Houdard E, Merland JJ (1995) [Value of preoperative embolization of uterine fibroma: report of a multicenter series of 31 cases]. Contracept Fertil Sex 23:45–49

    CAS  PubMed  Google Scholar 

  15. Ravina JH, Herbreteau D, Ciraru-Vigneron N, Bouret JM, Houdart E, Aymard A, Merland JJ (1995) Arterial embolisation to treat uterine myomata. Lancet 346:671–672

    CAS  PubMed  Google Scholar 

  16. Reidy JF, Bradley EA (1998) Uterine artery embolization for fibroid disease. Cardiovasc Intervent Radiol 21:357–360

    Article  CAS  PubMed  Google Scholar 

  17. Sawin SW, Pilevsky ND, Berlin JA, Barnhart KT (2000) Comparability of perioperative morbidity between abdominal myomectomy and hysterectomy for women with uterine leiomyomas. Am J Obstet Gynecol 183:1448–1455

    Article  CAS  PubMed  Google Scholar 

  18. Spies JB, Ascher SA, Roth AR, Kim J, Levy EB, Gomez-Jorge J (2001) Uterine artery embolization for leiomyomata. Obstet Gynecol 98:29–34

    Article  CAS  PubMed  Google Scholar 

  19. Spies JB, Spector A, Roth AR, Baker CM, Mauro L, Murphy-Skrynarz K (2002) Complications after uterine artery embolization for leiomyomas. Obstet Gynecol 100:873–880

    Article  PubMed  Google Scholar 

  20. Subramanian S, Spies JB (2001) Uterine artery embolization for leiomyomata: resource use and cost estimation. J Vasc Interv Radiol 12:571–574

    CAS  PubMed  Google Scholar 

  21. Vollenhoven B (1998) Introduction: the epidemiology of uterine leiomyomas. Baillieres Clin Obstet Gynaecol 12:169–176

    CAS  PubMed  Google Scholar 

  22. Wilcox LS, Koonin LM, Pokras R, Strauss LT, Xia Z, Peterson HB (1994) Hysterectomy in the United States, 1988–1990. Obstet Gynecol 83:549–555

    CAS  PubMed  Google Scholar 

  23. Worthington-Kirsch RL, Popky GL, Hutchins FL jr (1998) Uterine arterial embolization for the management of leiomyomas: quality- of-life assessment and clinical response. Radiology 208:625–629

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Institut für Klinische Radiologie, Klinikum der Universität München—Großhadern

    T. F. Jakobs, T. K. Helmberger & M. F. Reiser

  2. Institut für Klinische Radiologie, Klinikum der Universität München—Großhadern, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377 , München

    T. F. Jakobs

Authors
  1. T. F. Jakobs
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. T. K. Helmberger
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. F. Reiser
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to T. F. Jakobs.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Jakobs, T.F., Helmberger, T.K. & Reiser, M.F. Stand und Entwicklung der Uterusmyomembolisation in Deutschland. Radiologe 43, 651–655 (2003). https://doi.org/10.1007/s00117-003-0937-0

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00117-003-0937-0

Schlüsselwörter

Keywords

Search

Navigation