Uterine artery embolisation for symptomatic fibroids in a tertiary hospital in Singapore.
BACKGROUND
Transcatheter uterine artery embolisation (UAE) for the treatment of symptomatic uterine enlargement due to fibroids has been performed in several overseas centres with promising results. We report our experience with UAE in Singapore General Hospital.


METHODS
Twenty women with symptomatic uterine fibroids who declined surgery were treated by transcatheter UAE. The uterine arteries were selectively catheterised and embolised with polyvinyl alcohol particles. Post-procedure analgesia was administered via a patient-controlled analgesia pump. The patients were followed up at regular intervals clinically and with transabdominal ultrasonography.


RESULTS
Transcatheter UAE was performed on all patients with no major complications. Nineteen patients had both uterine arteries embolised while 1 patient had only the right uterine artery embolised on account of hypoplasia of the left uterine artery. The mean hospital stay was 3.5 days (range, 2 to 9). At a mean follow-up of 56 weeks (range, 6 to 168), all patients reported improvements in their presenting symptoms. Objective improvement in terms of reduction of uterine and fibroid sizes was determined on ultrasonography. The median size of the uterine volume decreased from 308 to 187 mL while the median diameter of the largest fibroid reduced from 6.2 to 4.6 cm. The median haemoglobin level increased to 12.7 g/dL from the pre-procedural median of 9.9 g/dL. One patient, who initially responded with a decrease in uterine and dominant fibroid size, became symptomatic (menorrhagia) at 6 months post-embolisation. She underwent a repeat procedure with complete resolution of symptoms. A second patient had recurrence of symptoms at 12 months, but was subsequently lost to follow-up.


CONCLUSIONS
Mid-term results of UAE for the treatment of symptomatic fibroids in our hospital indicate this to be a safe and effective therapeutic option.
Mohan
P C
PC
Department of Diagnostic Radiology, Singapore General Hospital, Singapore.
Tan
B S
BS
Kwek
B H
BH
Abu
J
J
Koh
D
D
Tay
K H
KH
Lau
T N
TN
Ong
D
D
Yu
S L
SL
D000328:Adult; D000792:Angiography; D001158:Arteries; D002406:Catheterization, Peripheral; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006769:Hospitals, General; D006801:Humans; D007269:Injections, Intra-Arterial; D007889:Leiomyoma / Q000000981:diagnostic imaging / Q000628:therapy*; D008875:Middle Aged; D011142:Polyvinyl Alcohol / Q000008:administration & dosage; D012846:Singapore; D016896:Treatment Outcome; D014463:Ultrasonography; D014599:Uterus / Q000098:blood supply*
D011142:Polyvinyl Alcohol