A Scottish study has examined the pros and cons of embolization as opposed to surgery for treatment of uterine fibroids.
It has found that on balance, surgery results in fewer complications, but it requires on average a longer stay in hospital.
The study is by researchers based at Glasgow and Edinburgh, and is published in the current edition of the The New England Journal of Medicine.
Uterine fibroids are benign growths or lesions that form inside the uterus of many women during their reproductive years. It is estimated that some 25 per cent of white women and as many as 50 per cent of black women are affected by them. Some fibroids can be very small, others the size of a walnut, but it is not uncommon for them to get as large as grapefruits and for women to be able to feel them by pressing on the abdomen.
Not all fibroids need to be removed. It is only when they become painful or cause irregular bleeding that a doctor may advise their removal. The most common treatments are either to remove the fibroids (myomectomy), perform a hysterectomy, or by uterine artery embolization (UAE) where the blood supply to the fibroids is blocked.
In this study, the researchers compared a group of 51 women who had surgery (hysterectomy and myomectomy) with 106 that had the embolization (UAE) treatment. After a follow up period of one year, they found that there was no significant difference in a range of quality of life measures between the two groups, and the women who had UAE were in hospital for less time. But, the women who had UAE were more likely to be re-admitted for additional treatment because the UAE had not been successful the first time.
The results showed that after 1 year, the symptom scores in the surgical group were on the whole better than the UAE group. Within the first year period 13 of the UAE women had adverse symptom events (12 per cent of the participants) compared with 10 in the surgery group (20 per cent). And 10 UAE patients needed a repeat treatment, either another UAE or hysterectomy.
After the first year, 14 women in the UAE group (13 per cent) needed to be re-admitted to hospital, 3 for major adverse events and 11 for repeat treatment because the original UAE had not been sucessful.
The researchers assessed the quality of life using a questionnaire known as the Medical Outcomes Study 36-Item Short-Form General Health Survey (SF-36), which the patients completed one year after their treatment.
The main conclusion of the study is that doctors are recommended to balance the faster recovery after embolization against the possibility that a minority of patients may need to have further treatment.
“Uterine-Artery Embolization versus Surgery for Symptomatic Uterine Fibroids.”
The REST Investigators: Writing Committee of the Randomized Trial of Embolization versus Surgical Treatment for Fibroids: Richard D. Edwards, M.B., Ch.B., and Jonathan G. Moss, M.B., Ch.B., et al.
The New England Journal of Medicine, Volume 356:360-370, January 25, 2007, Number 4
Written by: Catharine Paddock
Writer: Medical News Today