Comparative effectiveness of hysterectomy versus myomectomy on one-year health-related quality of life in women with uterine fibroids.

OBJECTIVE: To compare long-term health-related quality of life (HRQOL) 1 year after hysterectomy or myomectomy for treatment of uterine fibroids (UFs) and to determine whether route of procedure, race, or age affected improvements in HRQOL. DESIGN: Prospective cohort study. SETTING: Eight clinical sites throughout the United States. PATIENT(S): A total of 1,113 premenopausal women with UFs who underwent hysterectomy or myomectomy as part of Comparing Options for Management: Patient-Centered Results for Uterine Fibroids. INTERVENTION(S): None. MAIN OUTCOME MEASURE (S): Self-reported HRQOL measures including Uterine Fibroid Symptom Quality of Life, the European QOL 5 Dimension Health Questionnaire, and the visual analog scale at baseline and 1-year after hysterectomy or myomectomy. RESULT (S): Hysterectomy patients were older with a longer history of symptomatic UF compared with myomectomy patients. There were no differences in baseline HRQOL. After adjustment for baseline differences between groups, compared with myomectomy, patients' HRQOL (95% confidence interval [CI], 5.4, 17.2) and symptom severity (95% CI, -16.3, -8.8) were significantly improved with hysterectomy. When stratified across race/ethnicity and age, hysterectomy had higher HRQOL scores compared with myomectomy. There was little difference in HRQOL (95% CI, 0.1 [-9.5, 9.6]) or symptom severity (95% CI, -3.4 [-10, 3.2]) between abdominal hysterectomy and abdominal myomectomy. CONCLUSION (S): HRQOL improved in all women 1 year after hysterectomy or myomectomy. Hysterectomy patients reported higher HRQOL summary scores compared with myomectomy patients. When stratified by route, minimally invasive hysterectomy had better HRQOL scores than minimally invasive myomectomy. There was little difference in scores with abdominal approaches.

Comparative outcomes of hysteroscopic examinations performed after uterine artery embolization or laparoscopic uterine artery occlusion to treat leiomyomas.

Hysteroscopic examination of the uterine cavity revealed that patients previously treated for intramural myoma(s) by uterine artery embolization had a significantly higher incidence of abnormal findings compared with patients treated by laparoscopic occlusion of uterine arteries (59.5% vs. 2.7%). In particular, there was a higher incidence of necrosis in the uterine cavity of patients subjected to uterine artery embolization (43.2%) compared with patients after surgical uterine artery occlusion (2.7%).

Good quality of life after emergency embolisation in postpartum haemorrhage.

Twenty-one women, who were treated for postpartum haemorrhage by embolisation of the uterine artery, filled in a series of questionnaires. The questionnaires assessed personality characteristics, illness perceptions, coping and quality of life (QoL). The women also made drawings of their uterus. The results suggest that women who experience emergency embolisation have good QoL at follow-up.

Presenting features of women with uterine arteriovenous malformations.

OBJECTIVE: To describe the outcome of patients with uterine arteriovenous malformations (AVMs) after uterine artery embolization (UAE). DESIGN: Retrospective case series. SETTING: Tertiary center of a university hospital. PATIENT(S): Thirteen patients were referred to a tertiary medical center from primary care facilities with profuse uterine bleeding. INTERVENTION(S): Uterine artery embolization. MAIN OUTCOME MEASURE(S): Thirteen patients underwent UAE. Eleven patients had no additional vaginal bleeding, whereas two patients underwent hysterectomy after embolization. RESULT(S): Twelve patients developed AVMs after induced abortions. One patient had a congenital uterine AVM. Based on the transfer notes, eight cases had incomplete abortions, three cases had dysfunctional uterine bleeding, one case had a molar pregnancy, and one case had a uterine AVM. Two cases underwent hysterectomy after UAE. One patient delivered a healthy baby after bilateral UAE. CONCLUSION(S): Uterine AVMs should be suspected in patients with abrupt, profuse vaginal bleeding and a medical history of an induced abortion. Primary physicians should consider uterine AVMs with such a medical history. A prompt diagnosis and therapy are essential for favorable outcomes in patients with uterine AVMs.

Fertility after embolization of the uterine arteries to treat obstetrical hemorrhage: a review of 53 cases.

OBJECTIVE: To study subsequent fertility of patients who underwent embolization of the uterine arteries to treat postpartum hemorrhage. DESIGN: Retrospective cohort study between January 2000 and June 2006 with two patient groups: exposed and nonexposed to embolization for postpartum hemorrhage. SETTING: Level 3 maternity unit. PATIENT(S): Fifty-three patients exposed to embolization and 106 nonexposed patients were included and paired according to several criteria: date of delivery, age, parity, whether the pregnancy was spontaneous or with fertility assistance, and mode of delivery. INTERVENTION(S): None. MAIN OUTCOMES MEASURE(S): Occurence of pregnancy. RESULT(S): Among patients exposed to embolization, 14 had been exposed to pregnancy and 12 had been pregnant. There was no statistically significant difference of occurrence of pregnancy between the nonembolized and embolized groups (P=.30). CONCLUSION(S): According to the results, it seems that embolization does not alter subsequent fertility. This study nevertheless suggests a trend toward fewer pregnancies in the embolization group and reports three severe complications in that group. This trend deserves to be explored by further studies with higher statistical power. However, even if it would be difficult to provide complete reassurance to patients who have undergone embolization, better information regarding their subsequent fertility and potential risks could relieve them of their worries regarding a new pregnancy.

Long-term effects of uterine fibroid embolization on ovarian reserve: a prospective cohort study.

OBJECTIVE: To determine whether uterine fibroid embolization may advance ovarian follicular depletion in reproductive-aged women with apparently normal baseline ovarian function. DESIGN: Prospective cohort study. SETTING: University tertiary care center. PARTICIPANT(S): Thirty-six patients aged 26 to 39 years with fibroids, regular menstrual cycles, and day 3 serum FSH levels<10 mIU/mL and 36 matched control women. INTERVENTION(S): Day 3 serum FSH and E2 levels and ultrasound-based antral follicle count and ovarian volume were determined before (baseline) and at 12, 24, 36, 48, and 60 months after embolization and compared with those of the control group. Menstrual status was determined annually on the basis of prospectively recorded menstrual calendars. MAIN OUTCOME MEASURE(S): Longitudinal changes in hormone levels, ultrasound measures, and bleeding patterns. RESULT(S): Although the FSH and E2 levels increased significantly and the antral follicle count and ovarian volume values declined significantly over time within the groups, no significant differences were found between the groups. The cycle remained regular in all but two women (one in the embolization group and one in the control group), who started having cycle irregularity after 24 months and 36 months follow-up, respectively. CONCLUSION(S): This long-term follow-up study suggests that fibroid embolization does not lead to an accelerated decline in ovarian reserve in younger patients.

Basal FSH level changes after different types of uterine vessel occlusion in the management of uterine fibroids.

OBJECTIVE: To assess the effect on FSH of the application of different types of uterine vessel blockage (uterine artery occlusion alone [UAO] or with blockage of vessel anastomosis [UVO]) in the management of women with fibroids. DESIGN: Case-control study. SETTING: Medical center. PATIENT(S): One hundred ten women with uterine fibroids. INTERVENTION(S): Forty-four consecutive patients undergoing UAO were compared with 66 matched subjects who underwent UVO during the same period. MAIN OUTCOME MEASURE(S): Surgery types and FSH levels were compared. RESULT(S): At the first month after surgery, FSH levels were elevated from 5.5 mIU/mL to 14.2 and 8.7 mIU/mL in the UVO and UAO groups, respectively. The difference between the 2 groups continued up to 6 months and disappeared thereafter. More patients (38%) in the UVO group had an increased FSH level of >10 mIU/mL, compared with 5% in the UAO group at the first month after surgery, which contributed to the high percentage of women with irregular menstruation. CONCLUSION(S): Women treated with UVO were associated with a greater risk of a significant increase in FSH level at the first month after operation than those treated with UAO, which may be a reflection of diminished ovarian function. The long-term effect was uncertain, because of the lack of difference in the FSH levels between the two groups.

Late occurrence of severe hyponatremia followed by extrapontine osmotic demyelination syndrome after successful conservative management of postpartum hemorrhage due to placenta accreta by uterine artery embolization.

Development of severe hyponatremia followed by extrapontine osmotic demyelination syndrome was reported as a significant late complication after successful conservative management of postpartum hemorrhage due to placenta accreta by uterine artery embolization.