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Uterine Artery Embolisation

Uterus Conserving Treatment for Women with Symptomatic Fibroids

Uterine fibroids are common

and although they are not

always associated with

symptoms, they often present

with significant symptoms

– heavy and painful periods

and pressure-related urinary

symptoms due to the

enlarged fibroid uterus.

Hysterectomy is a very effective

treatment but, as it involves major

surgery, it necessitates a five to

seven-day hospital stay and a

lengthy recovery period. Many

women for a variety of reasons,

do not want to lose their uterus

or take time off work. Medical

treatment has a limited but only

short-term role when it is used

to shrink fibroids prior to surgery.

Myomectomy is a uterus-conserving

treatment, where individual fibroids

are excised, usually via an abdominal

approach. Its success depends on

the number and size of the fibroids.

The procedure

Uterine Artery Embolisation (UAE)

first emerged as an alternative

treatment in 1996 and it has been

carried out at London Bridge

Hospital since then. It is a global

treatment treating all the fibroids

and it has since developed as

an effective low-risk treatment

for the majority of women with

symptomatic fibroid disease. UAE

is an arteriographic procedure

performed by Interventional

Radiologists in a specialised

angiographic unit. It is performed

under local anaesthesia and

sedation and involves selectively

catheterising both uterine arteries

and embolising or occluding them

with small inert particles to the

point of near-total exclusion.The

effect depends on fibroids being

more susceptible to ischemia than

normal myometrium, so that the

fibroids undergo ischaemic necrosis

and then shrink. If it was not for

the pain that invariably follows the

embolisation, these procedures

could be done as day cases

but strong analgesics are often

needed before women are

discharged home the next day.They

may then resume normal activities,

but are advised that they may need

up to 2 weeks off work.

Who is suitable for Uterine

Artery Embolisation?

All patients need to be seen and

assessed by a Gynaecologist to

confirm the diagnosis and establish

that the fibroids are causing

significant symptoms. Ultrasound

is routinely used and, if there are

any doubts about the diagnosis, an

MRI scan is necessary. The only

absolute contraindication to UAE

is the presence of pendunculated

subserosal fibroids.There are

concerns for younger women, who

are concerned about the possibility

of future fertility, but this applies to

all treatment as well as UAE.There

is, however, better data supporting

fertility and normal pregnancies

after myomectomy, compared with

UAE. However, if myomectomy

is not being considered and the

woman then accepts that there

are some small concerns for future

pregnancy following UAE, it is

reasonable to then proceed.

What are the results

after UAE?

Approximately 85% of women

are satisfied with the results after

UAE.The best results are for

period-related symptoms. Fibroid

shrinkage occurs and this is of the

order of 50%.There is a low risk of

complications, which are detailed to

women prior to the procedure.

Arteriogram with selective

injection into the right uterine

artery. Note the abnormal

vascularity of the enlarged

fibroid uterus.

This shows the principle of

the embolisation procedure.

Under X-ray control, the

microparticles in X-ray contrast

are injected through the

catheter and flow-directed into

the small branches which they

sludge up and block.

To book an appointment

with Dr John Reidy, call

020 7188 5565

.

Treatments

10

New Day Case

Brachytherapy Treatment

London Bridge Hospital is now offering

a new day case treatment for patients

with early prostate cancer using a pinhole

surgery Brachytherapy single-stage

procedure.

The enhanced Brachytherapy operation,

which is performed under a light general

anaesthetic, enables urologists to map and

treat a tumour with greater accuracy. Most

patients can return to work in a couple of

days and experience little discomfort from

the procedure.

Consultant Urological Surgeon, Mr Rick

Popert, said that cure rates are comparable

to radical surgery and radiotherapy

without the risks of urinary incontinence

or impotence.“We have refined this

procedure using advanced computer

software for the placement of very fine

needles used to implant the radioactive

seeds. It also enables us, with the help of a

planning computer programme, to achieve

a better quality implant and to produce

more detailed mapping.

“We can then position the radioactive

seeds more accurately, to achieve better

dosimetry. This also reduces the risk of

collateral damage of healthy tissue and

nerves.We call it pinhole surgery.

“This is a safer technique than many of

the other options and is just as effective

at curing prostate cancer which is now

the most common cancer in men. Better

planning means we can minimise the

dosage too.”

Brachytherapy is recommended

for men with early stage localised

cancer that has not spread from

the prostate. The procedure

can also be used as a booster to external

beam radiotherapy in high-risk cases.

For more information, please

call London Bridge Urology on

020 7357 6466

.

Fig 1:

Inserting of

radioactive

seeds.