title: Hysteroscopy after uterine fibroid embolization: evaluation of intrauterine findings in 127 patients.
abstract: OBJECTIVE
  Several atypical hysteroscopy findings have been described in association with uterine artery embolization (UAE). The purpose of this study was to evaluate the types and frequency of these findings in the largest published series of patients.
  
  
  METHODS
  Premenopausal patients after bilateral UAE for symptomatic intramural fibroid underwent subsequent hysteroscopic examination 3-9 months following UAE. The uterine cavity was examined with focus on specific post-embolization changes. Biopsy of endometrium was obtained and evaluated together with a biopsy of abnormal foci if present.
  
  
  RESULTS
  UAE was performed in a total of 127 women with an average size of dominant fibroid 63.1 mm in diameter and an average patient age of 35.1 years. Even though the majority of patients were asymptomatic at the time of hysteroscopy (78.0%), the post-embolization hysteroscopic examination was normal in only 51 patients (40.2%). The most frequent abnormalities included tissue necrosis (52 women, 40.9%), intracavitary myoma protrusion (45 women, 35.4%), endometrium 'spots' (22.1%), intrauterine synechiae (10.2%) and 'fistula' between the uterine cavity and intramural fibroid (6.3%). Histopathological examination showed normal, secretory or proliferative endometrium in 83.5% patients. Necrosis and/or hyalinization prevailed in the results of biopsy of abnormal loci (45 cases, 35.4%).
  
  
  CONCLUSIONS
  Frequency of abnormal hysteroscopic findings several months after UAE for primary intramural myomas is high. Alarmingly high is the percentage of patients with a histopathologically verified necrosis. Performing hysteroscopy in selected patients after UAE is necessary before eventual surgical re-intervention, especially in women with reproductive plans.
authors.affiliation: Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University and General Faculty Hospital, Prague, Czech Republic.
authors.forename: Michal
authors.initials: M
authors.lastname: Mara
authors.forename: Petr
authors.initials: P
authors.lastname: Horak
authors.forename: Kristyna
authors.initials: K
authors.lastname: Kubinova
authors.forename: Pavel
authors.initials: P
authors.lastname: Dundr
authors.forename: Tomas
authors.initials: T
authors.lastname: Belsan
authors.forename: David
authors.initials: D
authors.lastname: Kuzel
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D015907:Hysteroscopy; D018231:Leiomyomatosis / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D016896:Treatment Outcome; D055357:Uterine Artery Embolization; D014594:Uterine Neoplasms / Q000473:pathology / Q000601:surgery*; D014599:Uterus / Q000098:blood supply / Q000473:pathology* / Q000601:surgery