Conservative two-step procedure including uterine artery embolization with embosphere and surgical myomectomy for the treatment of multiple fibroids: preliminary experience.
OBJECTIVE
To evaluate the feasibility and safety of combined uterine artery embolization (UAE) using embosphere and surgical myomectomy as an alternative to radical hysterectomy in premenopausal women with multiple fibroids.


METHODS
Mid-term clinical outcome (mean, 25 months) of 12 premenopausal women (mean age, 38 years) with multiple and large symptomatic fibroids who desired to retain their uterus and who were treated using combined UAE and surgical myomectomy were retrospectively analyzed. In all women, UAE alone was contraindicated because of large (>10 cm) or subserosal or submucosal fibroids and myomectomy alone was contraindicated because of too many (>10) fibroids.


RESULTS
UAE and surgical myomectomy were successfully performed in all women. Myomectomy was performed using laparoscopy (n=6), open laparotomy (n=3), hysteroscopy (n=2), or laparoscopy and hysteroscopy (n=1). Mean serum hemoglobin level drop was 0.97 g/dL and no blood transfusion was needed. No immediate complications were observed and all women reported resumption of normal menses. During a mean follow-up period of 25 months (range, 14-37 months), complete resolution of initial symptoms along with decrease in uterine volume (mean, 48%) was observed in all women. No further hysterectomy was required in any woman.


CONCLUSIONS
In premenopausal women with multiple fibroids, the two-step procedure is safe and effective alternative to radical hysterectomy, which allows preserving the uterus. Further prospective studies, however, should be done to determine the actual benefit of this combined approach on the incidence of subsequent pregnancies.
Obstetrics and Gynecology unit, Hôpital Lariboisière, AP-HP & University Diderot-Paris 7, 2 rue Ambroise Paré, 75010 Paris, France.
Cécile
C
Malartic
Olivier
O
Morel
Yann
Y
Fargeaudou
Olivier
O
Le Dref
Afchine
A
Fazel
Emmanuel
E
Barranger
Philippe
P
Soyer
D000180:Acrylic Resins / Q000627:therapeutic use*; D000328:Adult; D003131:Combined Modality Therapy; D005260:Female; D005780:Gelatin / Q000627:therapeutic use*; D006801:Humans; D015907:Hysteroscopy / Q000379:methods*; D018231:Leiomyomatosis / Q000175:diagnosis / Q000628:therapy*; D010865:Pilot Projects; D016896:Treatment Outcome; D055357:Uterine Artery Embolization / Q000379:methods*; D014594:Uterine Neoplasms / Q000175:diagnosis / Q000628:therapy*
D000180:Acrylic Resins; C496735:trisacryl gelatin microspheres; D005780:Gelatin