Advertisement

Myomectomy Following UAE

  • Bruce McLucas
Chapter
Part of the Medical Radiology book series (MEDRAD)

Abstract

Leiomyomas may be treated with UAE followed by myomectomy in a scheduled or unscheduled manner. UAE may be scheduled immediately prior to myomectomies if the patient has large fibroids or pedunculated or subserosal myomas, or wishes to maintain an intact uterus for the possibility of pregnancy within a short time window. UAE may be beneficial in these instances because it reduces blood loss in removal of large fibroids and prevents fibroid recurrence. Patients who benefit from the combination of these procedures include young patients with a high risk of recurrence and patients wanting to achieve pregnancy immediately after 6 months of the surgery. Unscheduled myomectomies occur if the UAE fails to relieve symptoms, if prolapsed of a submucous myoma occurs, or in the event of fibroid necrosis.

Keywords

Uterine Artery Embolization Laparoscopic Myomectomy Combination Procedure Fibroid Volume Submucous Myoma 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. Agdi M, Valenti D, Tulandi T (2008) Intraabdominal adhesions after uterine artery embolization. Am J Obstet Gynecol 199(5):482 e1–3 (PubMed PMID: 18486095)Google Scholar
  2. Al-Fozan H, Tulandi T (2002) Factors affecting early surgical intervention after uterine artery embolization. Obstet Gynecol Surv 57(12):810–815 (PubMed PMID: 12493983)PubMedCrossRefGoogle Scholar
  3. Al-Mahrizi S, Tulandi T (2007) Treatment of uterine fibroids for abnormal uterine bleeding: myomectomy and uterine artery embolization. Best Pract Res Clin Obstet Gynaecol 21(6):995–1005 (PubMed PMID: 17478123)PubMedCrossRefGoogle Scholar
  4. Bradley EA, Reidy JF, Forman RG, Jarosz J, Braude PR (1998) Transcatheter uterine artery embolisation to treat large uterine fibroids. Br J Obstet Gynaecol 105(2):235–240 (PubMed PMID: 9501794)PubMedCrossRefGoogle Scholar
  5. Butori N, Tixier H, Filipuzzi L, Mutamba W, Guiu B, Cercueil JP et al (2011) Interest of uterine artery embolization with gelatin sponge particles prior to myomectomy for large and/or multiple fibroids. Eur J Radiol 79(1):1–6 (PubMed PMID: 19875261)PubMedCrossRefGoogle Scholar
  6. Candiani GB, Fedele L, Parazzini F, Villa L (1991) Risk of recurrence after myomectomy. Br J Obstet Gynaecol 98(4):385–389 (PubMed PMID: 2031897)PubMedCrossRefGoogle Scholar
  7. Chen CL, Guo HX, Liu P, Huang R, Yang ZB, Tang L et al (2009) Three-dimensional reconstruction of the uterine vascular supply through vascular casting and thin slice computed tomography scanning. Minim Invasive Ther Allied Technol: Official J Soc Minim Invasive Ther 18(2):98–102 (PubMed PMID: 19418349)CrossRefGoogle Scholar
  8. Dumousset E, Chabrot P, Rabischong B, Mazet N, Nasser S, Darcha C et al (2008) Preoperative uterine artery embolization (PUAE) before uterine fibroid myomectomy. Cardiovasc Intervent Radiol 31(3):514–520 (PubMed PMID: 17624572)Google Scholar
  9. Gabriel-Cox K, Jacobson GF, Armstrong MA, Hung YY, Learman LA (2007) Predictors of hysterectomy after uterine artery embolization for leiomyoma. Am J Obstet Gynecol 196(6):588 e1–6 (PubMed PMID: 17547908)Google Scholar
  10. Ginsburg ES, Benson CB, Garfield JM, Gleason RE, Friedman AJ (1993) The effect of operative technique and uterine size on blood loss during myomectomy: a prospective randomized study. Fertil Steril 60(6):956–962 (PubMed PMID: 8243699)PubMedGoogle Scholar
  11. Godfrey CD, Zbella EA (2001) Uterine necrosis after uterine artery embolization for leiomyoma. Obstet Gynecol 98(5 Pt 2):950–952 (PubMed PMID: 11704217)PubMedCrossRefGoogle Scholar
  12. Golan A, Zachalka N, Lurie S, Sagiv R, Glezerman M (2005) Vaginal removal of prolapsed pedunculated submucous myoma: a short, simple, and definitive procedure with minimal morbidity. Arch Gynecol Obstet 271(1):11–13 (PubMed PMID: 14999510)PubMedCrossRefGoogle Scholar
  13. Goldberg J, Pereira L (2006) Pregnancy outcomes following treatment for fibroids: uterine fibroid embolization versus laparoscopic myomectomy. Curr Opin Obstet Gynecol 18(4):402–406 (PubMed PMID: 16794420)PubMedCrossRefGoogle Scholar
  14. Guarnaccia MM, Rein MS (2001) Traditional surgical approaches to uterine fibroids: abdominal myomectomy and hysterectomy. Clin Obstet Gynecol 44(2):385–400 (PubMed PMID: 11345000)PubMedCrossRefGoogle Scholar
  15. Hanafi M (2005) Predictors of leiomyoma recurrence after myomectomy. Obstet Gynecol 105(4):877–881 (PubMed PMID: 15802421)PubMedCrossRefGoogle Scholar
  16. Hehenkamp WJK, Volkers NA, Donderwinkel PFJ, de Blok S, Birnie E, Ankum WM et al (2005) Uterine artery embolization versus hysterectomy in the treatment of symptomatic uterine fibroids (EMMY trial): Peri- and postprocedural results from a randomized controlled trial. Am J Obstet Gynecol 193(5):1618–1629PubMedCrossRefGoogle Scholar
  17. Katsumori T, Akazawa K, Mihara T (2005) Uterine artery embolization for pedunculated subserosal fibroids. AJR Am J Roentgenol 184(2):399–402 (PubMed PMID: 15671352)PubMedCrossRefGoogle Scholar
  18. Levy BS (2008) Modern management of uterine fibroids. Acta Obstet Gynecol Scand 87(8):812–823 (PubMed PMID: 18607823)PubMedCrossRefGoogle Scholar
  19. Liu WM, Ng HT, Wu YC, Yen YK, Yuan CC (2001) Laparoscopic bipolar coagulation of uterine vessels: a new method for treating symptomatic fibroids. Fertil Steril 75(2):417–422 (PubMed PMID: 11172850)PubMedCrossRefGoogle Scholar
  20. Lumsden MA (2002) Embolization versus myomectomy versus hysterectomy: which is best, when? Hum Reprod 17(2):253–259 (PubMed PMID: 11821260)Google Scholar
  21. Madhuri TK, Kamran W, Walker W, Butler-Manuel S (2010) Synchronous uterine artery embolization and laparoscopic myomectomy for massive uterine leiomyomas. J Soc Laparoendosc Surg 14(1):120–122 (PubMed PMID: 20529536. Pubmed Central PMCID: 3021304)Google Scholar
  22. Mara M, Horak P, Kubinova K, Dundr P, Belsan T, Kuzel D (2012) Hysteroscopy after uterine fibroid embolization: evaluation of intrauterine findings in 127 patients. J Obstet Gynaecol Res 38(5):823–831 (PubMed PMID: 22413922)PubMedCrossRefGoogle Scholar
  23. McLucas B (1991) Intrauterine applications of the resectoscope. Surg Gynecology Obstetrics 172(6):425–431 (PubMed PMID: 2035130)Google Scholar
  24. Mclucas B (2013) Pregnancy following uterine artery embolization: an update. Minim Invasive Ther Allied Technol, 22(1):39–44Google Scholar
  25. McLucas B, Adler L, Perrella R (1999) Predictive factors for success in uterine fibroid embolisation. Minim Invasive Ther Allied Technol 8(6):429–432CrossRefGoogle Scholar
  26. McLucas B, Adler L, Perrella R (2001) Uterine fibroid embolization: nonsurgical treatment for symptomatic fibroids. J Am Coll Surg 192(1):95–105 (PubMed PMID: 11192931)PubMedCrossRefGoogle Scholar
  27. McLucas B, Sostrin S (2002) Uterine necrosis after uterine artery embolization for leiomyoma. Obstet Gynecol 100(6):1357–1358 (PubMed PMID: 12468189)PubMedCrossRefGoogle Scholar
  28. Nabeshima H, Murakami T, Sato Y, Terada Y, Yaegashi N, Okamura K (2003) Successful pregnancy after myomectomy using preoperative adjuvant uterine artery embolization. Tohoku J Exp Med 200(3):145–149 (PubMed PMID: 14521257)PubMedCrossRefGoogle Scholar
  29. Ngeh N, Belli AM, Morgan R, Manyonda I (2004) Pre-myomectomy uterine artery embolisation minimises operative blood loss. BJOG: Int J Obstet Gynaecol 111(10):1139–1140 (PubMed PMID: 15383118)CrossRefGoogle Scholar
  30. Park AJ, Bohrer JC, Bradley LD, Diwadkar GB, Moon E, Newman J et al (2008) Incidence and risk factors for surgical intervention after uterine artery embolization. Am J Obstet Gynecol 199(6):671 e1–6 (PubMed PMID: 18986639)Google Scholar
  31. Paxton BE, Lee JM, Kim HS (2006) Treatment of intrauterine and large pedunculated subserosal leiomyomata with sequential uterine artery embolization and myomectomy. J Vasc Intervent Radiol 17(12):1947–1950 (PubMed PMID: 17185691)CrossRefGoogle Scholar
  32. Rajan DK, Beecroft JR, Clark TW, Asch MR, Simons ME, Kachura JR et al (2004) Risk of intrauterine infectious complications after uterine artery embolization. J Vasc Intervent Radiol 15(12):1415–1421 (PubMed PMID: 15590799)CrossRefGoogle Scholar
  33. Reed SD, Newton KM, Thompson LB, McCrummen BA, Warolin AK (2006) The incidence of repeat uterine surgery following myomectomy. J Women’s Health 15(9):1046–1052 (PubMed PMID: 17125423)CrossRefGoogle Scholar
  34. Sabatini L, Atiomo W, Magos A (2003) Successful myomectomy following infected ischaemic necrosis of uterine fibroids after uterine artery embolisation. BJOG: Int J Obstet Gynaecol 110(7):704–706 (PubMed PMID: 12842064)CrossRefGoogle Scholar
  35. Seracchioli R, Colombo FM, Bagnoli A, Govoni F, Missiroli S, Venturoli S (2003) Laparoscopic myomectomy for fibroids penetrating the uterine cavity: is it a safe procedure? BJOG: Int J obstet Gynaecol 110(3):236–40 (PubMed PMID: 12628260)Google Scholar
  36. Seracchioli R, Rossi S, Govoni F, Rossi E, Venturoli S, Bulletti C et al (2000) Fertility and obstetric outcome after laparoscopic myomectomy of large myomata: a randomized comparison with abdominal myomectomy. Hum Reprod 15(12):2663–2668 (PubMed PMID: 11098042)PubMedCrossRefGoogle Scholar
  37. Serradilla LN, Gomez-Rios MA, Nicolas C (2011) Ramon y Cajal L. Embolization before surgery of a large pedunculated submucosal myoma prolapsed into the vagina. Acta Obstet Gynecol Scand 90(5):554–555 (PubMed PMID: 21332453)PubMedCrossRefGoogle Scholar
  38. Spies JB, Spector A, Roth AR, Baker CM, Mauro L, Murphy-Skrynarz K (2002) Complications after uterine artery embolization for leiomyomas. Obstet Gynecol 100(5 Pt 1):873–880PubMedCrossRefGoogle Scholar
  39. Subramanian S, Clark MA, Isaacson K (2001) Outcome and resource use associated with myomectomy. Obstet Gynecol 98(4):583–587 (PubMed PMID: 11576571)PubMedCrossRefGoogle Scholar
  40. Tixier H, Loffroy R, Filipuzzi L, Grevoul J, Mutamba W, Cercueil J et al (2008) Uterine artery embolization with resorbable material prior to myomectomy. Journal de radiologie. 89(12):1925–1929 (PubMed PMID: 19106850. Embolisation arterielle uterine par materiel resorbable avant myomectomie)Google Scholar
  41. Toor SS, Tan KT, Simons ME, Rajan DK, Beecroft JR, Hayeems E et al (2008) Clinical failure after uterine artery embolization: evaluation of patient and MR imaging characteristics. J Vasc Intervent Radiol 19(5):662–667 (PubMed PMID: 18440453)CrossRefGoogle Scholar
  42. van der Kooij SM, Ankum WM, Hehenkamp WJ (2012) Review of nonsurgical/minimally invasive treatments for uterine fibroids. Curr opin Obstet Gynecol 24(6):368–375Google Scholar
  43. Vashisht A, Studd J, Carey A, Burn P (1999) Fatal septicaemia after fibroid embolisation. Lancet 354(9175):307–308Google Scholar
  44. Volkers NA, Hehenkamp WJ, Birnie E, Ankum WM, Reekers JA (2007) Uterine artery embolization versus hysterectomy in the treatment of symptomatic uterine fibroids: 2 years’ outcome from the randomized EMMY trial. Am J Obstet Gynecol 196(6):519 e1–11 (PubMed PMID: 17547877)Google Scholar
  45. Walker WJ, Barton-Smith P (2006) Long-term follow up of uterine artery embolisation – an effective alternative in the treatment of fibroids. BJOG: Int J Obstet Gynaecol 113(4):464–468 (PubMed PMID: 16553656)CrossRefGoogle Scholar
  46. Walker W, Green A, Sutton C (1999) Bilateral uterine artery embolisation for myomata: results, complications and failures. Minim Invasive Ther Allied Technol 8(6):449–454CrossRefGoogle Scholar
  47. Wamsteker K, Emanuel MH, de Kruif JH (1993) Transcervical hysteroscopic resection of submucous fibroids for abnormal uterine bleeding: results regarding the degree of intramural extension. Obstet Gynecol 82(5):736–740 (PubMed PMID: 8414318)PubMedGoogle Scholar
  48. Weed HG (2003) Antimicrobial prophylaxis in the surgical patient. Med Clin North Am 87(1):59–75 (PubMed PMID: 12575884)PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  1. 1.Department of Obstetrics and GynecologyUniversity of California, Los Angeles David Geffen School of MedicineLos AngelesUSA

Personalised recommendations