For Health Professionals - Uterine Fibroid Embolization UFE
Uterine fibroid embolization (UFE) is an innovative procedure utilizing well-established embolization techniques as a minimally invasive treatment alternative for symptomatic uterine fibroids. Embolization has been used effectively to treat postpartum hemorrhage for over 20 years.
UFE is indicated for women with fibroid-related menorrhagia or "bulk" related symptoms of pelvic pressure, urinary frequency, constipation or pain. While some women have been able to conceive and give birth after UFE, the long-term effects on fertility, labor and delivery remain unknown. Therefore until further research has been done, myomectomy remains the treatment of choice for symptomatic fibroids in women who still want to have children.
Post-embolization syndrome consisting of fever, abdominal pain and nausea occurs in 50% of UFE patients. Therefore, patients are admitted overnight for observation. Post-procedure pain and cramping are managed with aggressive pain control including PCA pumps. Most patients are discharged the next morning on an oral pain regimen. Patients typically return to their normal activities, including work within one week.
UFE complications: <5% vascular access complications such as hematoma, <5% non target embolization of the ovary resulting in temporary or permanent amenorrhea, <2% delayed uterine infection, 1 in 200 hysterectomy for infection not susceptible to standard IV antibiotics.
Results: 85 -90% symptomatic relief of bleeding, 90-95% symptomatic relief for pain, 40-60% reduction in size of the largest fibroid (up to mean of 78%).
|Reference||Number of Patients||Menorrhagia
|Andersen||62||96% @ 6 mo||70% @ 6 mo||68% @ 6 mo|
|Ravina||88||89%||55% @ 2 mo||69% @ 6 mo|
|Worthington / Kirsch||53||88%||94%||42%|
|Hutchins||305||86% @ 3 mo
92% @ 12 mo
|64% @ 3 mo
92% @ 12 mo
|Spies||61||89%||96%||50% @ 4 mo
78% @ 12 mo
|Siskin||49||89%||-||48 % @ 6 mo|
|Pelage||76||94%||20% @ 2 mo||52% @ 6 mo|
UM Uterine Fibroid Embolization Protocol
Patient workup; establish that symptoms are caused by fibroids and exclude cancer.
- Gynecologic exam:
- To determine that the patient's symptoms are related to fibroids
- Negative pap smear within 6 months
- Negative cervical cultures if a history of PID
- Endometrial biopsy:
- To exclude endometrial cancer/hyperplasia
- Required in women with atypical bleeding patterns
- bleeding >10 days or >every 21 days
- CBC, PT/PTT, Chemistry panel, FSH
- Avoid menses and pregnancy
- Do at least 4-6 weeks post any invasive procedure: i.e. endometrial biopsy or polypectomy
- Patients off Lupron >6 weeks