Outcomes following fibroid expulsion after uterine artery embolization.
OBJECTIVE
To evaluate retrospectively the sequelae of fibroid expulsion (FE) after uterine artery embolization (UAE).


METHODS
From a population of 759 UAE procedures performed from July 1999 to June 2009, 37 patients were found to have a uterine fibroid communicating with the endometrial cavity resulting in "bulk" FE with the passage of large fragments or an entire tumor or "sloughing" FE with shedding or "melting" of the tumor. Medical records and magnetic resonance images were evaluated for clinical information and tumor characteristics, respectively.


RESULTS
The mean age of patients with FE was 43 years ± 5 (SD), with 12 nulliparous and 25 parous. Expulsion took place a mean of 14.8 weeks ± 17.7 after UAE (range, 1.6-105.9 wk). FE was asymptomatic in 5% of cases (n = 2) and symptomatic in 95% (n = 35). Among symptomatic cases, 89% (n = 31) had bulk expulsion and 11% (n = 4) had sloughing expulsion. Forty-nine percent of patients (n = 18) had tumor expulsion at home or had an office/emergency room transvaginal myomectomy (TVM), 27% (n = 10) underwent operative TVM, and 8% (n = 3) had hysteroscopic resection. Urgent and elective hysterectomies were performed in 11% (n = 4) and 5% of cases (n = 2), respectively. Nulliparous women showed a trend toward undergoing hysterectomy compared with parous women (33% vs 8%; P =.07, Fisher exact test).


CONCLUSIONS
Most women tolerate FE well, with approximately half needing no operative intervention, but some may need to undergo hysteroscopy, operative TVM, or even hysterectomy. Nulliparous women are potentially at greater risk to require hysterectomy.
Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA. shlanskr@uphs.upenn.edu
Richard D
RD
Shlansky-Goldberg
Lee
L
Coryell
S William
SW
Stavropoulos
Scott O
SO
Trerotola
Jeffrey
J
Mondschein
Mathew
M
Beshara
Samantha F
SF
Butts
Steven
S
Sondheimer
Richard W
RW
Tureck
Mark
M
Rosen
D000328:Adult; D005260:Female; D006801:Humans; D007044:Hysterectomy; D015907:Hysteroscopy; D007889:Leiomyoma / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D010298:Parity; D015143:Philadelphia; D011247:Pregnancy; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D055357:Uterine Artery Embolization / Q000009:adverse effects; D014594:Uterine Neoplasms / Q000473:pathology / Q000601:surgery / Q000628:therapy*