Embolotherapy for myoma-induced menorrhagia.

Uterine fibroids are a common cause of abnormal uterine bleeding. Uterine artery embolization has proven to be highly effective in controlling fibroid related menorrhagia and triggering tumor degeneration.

Selective uterine artery embolization as primary treatment for symptomatic leiomyomata uteri.

STUDY OBJECTIVE: To analyze initial experience with uterine artery embolization for treatment of symptomatic leiomyomata. DESIGN: Prospective, longitudinal study (Canadian Task Force classification II-2). SETTING: Private practice, university-affiliated hospital. PATIENTS: Three hundred five women (age 26-52 yrs). INTERVENTIONS: Uterine artery embolization, performed over 2 years by a single radiologist working in collaboration with a single gynecology practice. MEASUREMENTS AND MAIN RESULTS: Embolization was technically successful in 96% of patients. No major complications occurred. Average reduction in uterine volume was 48%. Control of menorrhagia was reported by 86% of patients at 3 months, 85% at 6 months, and 92% at 12 months after the procedure. Bulk symptoms were satisfactorily controlled in 64% of patients at 3 months, 77% at 6 months, and 92% at 12 months. Six women subsequently underwent hysterectomy and five had myomectomy. CONCLUSION: Uterine artery embolization appears to be a highly effective treatment for symptomatic uterine leiomyomata. Its impact on fertility and pregnancy remain to be investigated fully. (J Am Assoc Gynecol Laparosc 6(3):279-284, 1999)

Vaginal expulsion of submucosal fibroids after uterine artery embolization. A report of three cases.

BACKGROUND: Since October 1996, at our fibroid center, we have been using the uterine artery embolization (UAE) procedure as a nonsurgical means to treat patients with fibroids and menorrhagia. We have performed this procedure on over 180 patients, 3 of whom experienced vaginal expulsion of submucosal fibroids from two to seven months later. CASES: A 37-year-old woman underwent UAE in November 1997 and expelled five submucosal fibroids two to three months later. A 43-year-old woman underwent UAE in August 1997 and expelled a submucosal fibroid four months later. A 46-year-old woman underwent UAE in April 1997 and expelled a submucosal fibroid seven months later. CONCLUSION: The use of UAE to treat patients with fibroids and menorrhagia is relatively new. Our experience has revealed that a significant percentage of patients who have had the embolization procedure will have reduction in menorrhagia and also in the volume of their fibroids. Complications and side effects have been few. Vaginal expulsion of submucosal fibroids can be viewed as a side effect of the procedure, and, to the best of our knowledge, these are the first reported cases of this postembolization occurrence.

Uterine arterial embolization for the management of leiomyomas: quality-of-life assessment and clinical response.

PURPOSE: To determine the effectiveness of uterine arterial embolization as a primary therapy in the management of symptomatic leiomyomas. MATERIALS AND METHODS: Uterine arterial embolization was performed in 53 patients (age range, 33-58 years) with menorrhagia, bulk-related symptoms (frequency of urination, sensation of pressure, sensation of mass), or both, due to leiomyomas. The effectiveness of this therapy in the control of symptoms and the patients' acceptance of the treatment were measured by means of the information from patient interviews 3 months after the procedure. RESULTS: Fifty-two (98%) of the 53 patients had technically successful procedures and were interviewed 3 months after embolization. Forty-six (88%) of these patients reported marked improvement in their abnormal bleeding. Twenty-nine (94%) of the 31 patients with bulk-related symptoms reported marked improvement in these symptoms. Follow-up ultrasonographic examinations showed a mean 46% reduction in uterine volume. Forty-one patients interviewed (79%) would choose this procedure again, eight (15%) would consider choosing this procedure again, and only three (6%) would choose another treatment option. CONCLUSION: Uterine arterial embolization is an effective therapy in the management of symptomatic leiomyomas and may prove to be a valuable alternative to myomectomy, hysterectomy, or other surgical procedures. Further investigation is warranted.

Retained myoma after laparoscopic supracervical hysterectomy with morcellation.

Laparoscopic myomectomy and, more recently, laparoscopic supracervical hysterectomy are practical alternatives to traditional surgical management of uterine fibroids. With the advent of mechanical morcellation these procedures are now much more feasible. A 6-cm fibroid was lost at the time of laparoscopic-assisted supracervical hysterectomy and caused persistent, severe abdominal pain over the next 3 weeks. The fibroid was lodged in the region of the liver and gallbladder and required removal by laparotomy. Although retention of fibroids after operative laparoscopy has been reported, it has not been associated with complications. Technical alternatives at the time of operative laparoscopy involving morcellation should be considered to prevent this event.

Laparoscopic myomectomy-an unusual cause of meralgia paresthetica.

Meralgia paresthetica may be associated with diabetes, trauma, infection, and use of self-retaining retractors. Our patient experienced left upper thigh paresthesia after undergoing laparoscopic myomectomy with extensive dissection of the left retroperitoneal space. Neurologic evaluation confirmed meralgia paresthetica. The patient was observed for 4 months, by which time the neuropathy resolved spontaneously.

Uterine fibroids. Diagnosis and indications for treatment.

Although uterine myomas are extremely common, the majority are asymptomatic and therefore require no treatment. Pelvic ultrasound, hysteroscopy, and infrequently MR imaging are useful in the confirmation of this diagnosis especially when long-term expectant management is to be used. Many indicators previously recommended for treatment are empiric in nature and have been discarded in modern times. Current standards dictate that prophylactic intervention seldom is warranted.

Abdominal myomectomy as a treatment for symptomatic uterine fibroids.

Using the previously described approach, I find abdominal myomectomy in general to be a procedure quite comparable with other major pelvic procedures, such as hysterectomy. My postoperative course is associated with a 12% complication rate, the majority of which represents transient febrile morbidity, which resolves quite promptly. In addition, my transfusion rate is 3% or less and my postoperative length of stay is 2 to 3 days. This is consistent with other currently reported series and in my estimation justifies the continued philosophy of offering abdominal myomectomy as a primary treatment for symptomatic uterine fibroids regardless of future childbearing options.

Myomectomy after selective preoperative treatment with a gonadotropin releasing hormone analog.

In 1988 and 1989, 67 women (mean age, 36.7 years) underwent myomectomy to remove uterine fibroids; selection of the procedure was based on the presence of symptoms and the patient's desire to avoid hysterectomy. For 8 weeks before myomectomy, 48 patients with a uterine size greater than or equal to 16 weeks' gestation received the gonadotropin releasing hormone (GnRH) analog leuprolide acetate, 0.5 mg self-administered daily by subcutaneous injection or 3.75 mg as the depot form every 28 days by intramuscular injection; the remaining 19 patients were used for a comparison. In the leuprolide-treated patients, the mean uterine size and mean number of fibroids removed per patient were significantly higher, and the mean postoperative hemoglobin concentration was significantly lower than in the non-leuprolide-treated group. The mean estimated blood loss and mean length of hospital stay were equivalent for the two groups. Eight patients (12%), all but one in the leuprolide-treated group, developed postoperative complications, primarily infections that were treated successfully with antibiotics; one patient, the only one undergoing a repeat myomectomy, experienced pelvic hematoma, infection and pelvic thrombophlebitis. There were no significant adverse reactions attributable to leuprolide administration.

Experience with teenage pregnancy.

A retrospective study of 4224 deliveries to women age 19 or younger was conducted. The purpose of the study was to evaluate the characteristics of teenage pregnancy in an urban, predominantly nonwhite, socioeconomically depressed population. A total of 10,011 infants were delivered during the study period, with 42% (4224) of the infants born to teenagers. It is concluded that teenage pregnancy among the urban, nonwhite poor is characterized by poor outcome, primarily as a reflection of the high-risk obstetric population from which it derives, and only secondarily due to any risk inherent to maternal age. In addition, a striking characteristic of pregnancy in this age group is its tendency to repeat itself. Teenage pregnancy is a sociologic problem with medical consequences, and medical programs as they presently exist are incapable of bringing about the ultimate solution--prevention.

Teenage pregnancy and the black community.

PIP: The incidence of teenage pregnancy has increased dramatically since 1950 in the US. Increases in numbers of pregnant 15-19 year olds have been higher for whites than for blacks, but the percentage of sexually active 15-19 year olds remains much higher for blacks than for whites. Characteristics of the sexually active teenager related to frequency of intercourse and use of contraception are described. The phenomenon of repeat pregnancy, pregnancy characteristics and outcomes are discussed. Few teenagers choose to place their babies for adoption. About 50% of pregnant teenagers opt for abortion, and most of the others raise their babies. Poor prenatal care is typical for a pregnant teenager. The higher rate of maternal mortality for young mothers is quantified, as is the high incidence of preeclampsia, which is especially marked in predominantly black populations. Incidence of prematurity and perinatal mortality are also higher for teenage pregnancies, especially for nonwhite mothers. The socioeconomic consequences of pregnancy for the black teenager are numerous and negative. A significant gap between articulated and realized goals occurs with pregnancy. Child neglect and abuse are common and serious problems for teenage mothers. In addition, the offspring often have low IQs; IQ diminishes with the age of the mother. Causes probably include prematurity, poor maternal nutrition, poor parenting and child abuse. Concluding remarks stress the seriousness of the threat posed by teenage pregnancy for black youth today.^ieng