Uterine Fibroid Embolization for Symptomatic Fibroids: Study at a Teaching Hospital in Kenya

Mutai, John Kiprop; Vinayak, Sudhir; Stones, William; Hacking, Nigel; Mariara, Charles

doi:10.4103/2156-7514.154351

Cited by 9 publications

(8 citation statements)

References 28 publications

(37 reference statements)

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“…We did not observe any association between change in symptom severity score and uterine volume, consistent with an earlier report from our group [ 12 ]. However, an interesting observation is that those with a higher number of fibroids prior to UFE have reported a greater improvement in symptoms.…”

Section: Discussionsupporting

confidence: 93%

“…The uterine volume, volume of the dominant fibroid and number of fibroids prior to UFE were ascertained independently by two radiologists using the pre-UFE pelvic MRI examination. Volumes were determined by measuring the maximum extent of the uterus and dominant leiomyoma in three planes and multiplying the product by 0.5233 (ellipsoid volume formula) [ 12 ]. An experienced interventional radiologist (NH) carried out embolisation under conscious sedation using spongostan gelfoam (ETHICON) in the hospital’s cardiac catheterization suite via a transfemoral approach.…”

Section: Methodsmentioning

confidence: 99%

“…Pain relief was undertaken using a UFE pain relief protocol previously described [ 13 ] and participants were discharged from hospital within 24 h of the procedure and provided with oral pain medication. Participants did not undergo routine follow up MR imaging as previous work in our unit indicated that the extent of shrinkage did not correlate directly with symptomatic improvement [ 12 ]. We based our sample size calculation on the outcomes from the FIBROID Registry [ 14 ] in which the mean change in symptom severity score was −38.94 (SD ± 24.79), SE 0.52.…”

Section: Methodsmentioning

confidence: 99%

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One year symptom severity and health-related quality of life changes among Black African patients undergoing uterine fibroid embolisation

et al. 2017

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Background:The main aim in the treatment of symptomatic fibroids by various modalities including uterine fibroid embolisation (UFE) is to alleviate symptoms and ultimately improve the quality of life. The efficacy of this modality of treatment in Black African women with significant fibroid burden and large uterine volumes is not clear. The main objective of the study was to examine potential changes in symptom severity among Black African patients 1 year following UFE for symptomatic uterine fibroids in a resource-constrained setting, rated using a validated questionnaire (UFS-QOL). Secondary outcomes examined were changes in quality of life and potential associations with age, parity, uterine volume and fibroid number prior to UFE. Additional interventions after UFE were also recorded. Methods:A prospective before and after study of Black African patients undergoing UFE was undertaken. Participants underwent pelvic MR imaging prior to UFE and completed the UFS-QOL, a validated condition-specific questionnaire at baseline and at 1 year. Ninety five participants were recruited and data from 80 completing 1 year of follow up were available for analysis of changes in the symptom severity scores. Results:The mean reduction in symptom severity score was 29.6 [95% CI 23.6 to 35.6, P < 0.001] and the mean improvement in HRQOL score was 35.7 [95% CI 28.4 to 42.9, P < 0.001]. A greater number of fibroids identified prior to UFE was associated with a more substantial improvement in symptom severity score (r s = 0.28, n = 80, P = 0.013) and participants of higher parity reported a greater improvement in HRQOL score (r = 0.336, P = 0.002). Major and minor surgical interventions were needed in 5 (6.3%) and 10 (12.5%) participants respectively.Conclusions: UFE is associated with clinically useful and statistically significant symptom relief in Black African patients. Symptom improvement following UFE is not compromised by a large fibroid burden and the rate of subsequent intervention is within an acceptable range. UFE is a safe alternative and efforts are needed to widen access to this non-surgical treatment modality.

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Section: Discussionsupporting

confidence: 93%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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One year symptom severity and health-related quality of life changes among Black African patients undergoing uterine fibroid embolisation

et al. 2017

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“…Uterine fibroid embolization is a relatively new technology in Africa with few studies documenting its use. The studies identified on UFE have studied other UFE aspects such as radiological features and response of fibroids after UFE and short-term quality of life changes for up to a year [18,29]. Our study has sought to document the long-term quality of life following UFE in a predominantly black population in sub-Saharan Africa.…”

Section: Discussionmentioning

confidence: 99%

Title: Long-term health related quality of life following Uterine Fibroid Embolization 1 in a predominantly black African population: A retrospective Cohort study

Temmerman¹,

Obura²,

Lusambili³

et al. 2021

Preprint

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Background: Uterine Fibroid Embolization (UFE) is one of the effective options available for treatment of symptomatic uterine fibroids with documented improvement in the quality of life and reduction in symptoms. Most of the studies have demonstrated an improvement in the quality of life over a short to intermediate period. We carried out this study to assess the long-term quality of life following uterine fibroid embolization in a predominantly black population. There are no identified studies locally or in Africa addressing this issue whereas studies done elsewhere indicate a probable increased fibroid disease burden among black women. Methods: This was a retrospective single cohort study that recruited patients who had UFE between 2009-2014. Study participants were sampled consecutively, invited to the study and asked to fill an online general demographic tool and the UFS-QOL. Wilcoxon signed rank tests were done to test for statistical significance between HRQOL scores. Pearson correlation analysis was carried out to evaluate possible association between various independent factors and specific outcomes of interest such as quality of life and symptom severity score. Results: Data was obtained from 77 participants. The median duration after the initial UFE was eight years. The median health related quality of life was 88.6 (62.9-98.3). This was statistically significant from baseline median scores of similar studies. The median symptom severity score decreased from a baseline score of 54.7 (43.8-65.6) to 21.9 (6.3-42.2). This decrease was statistically significant (p-value <0.001). Twenty-four participants (31.1%) reported follow up fibroid treatments after the initial UFE procedure. Eleven participants (14.3%) reported major repeat procedures (myomectomy, hysterectomy and UFE) .Seventeen participants (22%) reported a pregnancy after the UFE procedure with ten participants (13 %) reporting to have had children after the UFE procedure. Conclusion: UFE results in clinically sustained improvement in health related quality of life and symptom control among patients with uterine fibroids.

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“…The protocol and procedures for UAE at the Aga Khan University Hospital are reported elsewhere. [7] Blood was collected in plain vacutainers, and delivered to the biochemistry laboratory within 60 minutes. This was centrifuged, and sera frozen at -20°C until analysis using the Beckman Coulter Gen. II assay (Beckman Coulter Inc., USA).…”

Section: Study Protocolmentioning

confidence: 99%

Anti-Mullerian hormone before and after uterine artery embolisation in reproductive-age women seeking treatment for symptomatic fibroids

2018

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Background. Uterine fibroids are the most common of the benign gynaecological tumours, the definitive traditional treatment for which is either myomectomy or hysterectomy. Uterine artery embolisation (UAE) offers an alternative non-invasive option for treatment. There remain concerns as to the effects of UAE on ovarian reserve in women desirous of preserving ovarian function. Objectives. To determine the effect of UAE on ovarian reserve, as assessed by anti-Mullerian hormone (AMH) measured before and after embolisation, and to assess the trend in serum AMH in the medium term, up to 12 months post UAE. Methods. A cohort study between October 2012 and May 2015 recruited 40 women with symptomatic uterine fibroids. Serum AMH was measured prior to embolisation and post embolisation, at 2 weeks, 6 months and 12 months. Using descriptive statistics and bivariate analysis, pre-embolisation and post-embolisation AMH concentrations were compared. P<0.05 was considered statistically significant. Results. The median participant age was 38.5 years (range 31-45). Of the women recruited, 47.5% (19) were nulliparous, and 72.5% (29 women) of the total desired a pregnancy in the future. The median (standard deviation) AMH immediately prior to embolisation was 1.3 ng/mL (1.53), and post embolisation at 2 weeks, 0.9 ng/mL (1.98); at 6 months, 2.2 ng/mL (2.63); and 12 months, 3.5 ng/mL (1.54) (p= 0.96). Conclusion. In the short to medium term, UAE for treatment of symptomatic fibroids was not found to be detrimental to ovarian reserve. There is a need for longer-term studies evaluating its effects on fecundity, considering that most women in the present study had a strong desire to maintain their fertility.

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Uterine Fibroid Embolization for Symptomatic Fibroids: Study at a Teaching Hospital in Kenya

Cited by 9 publications

References 28 publications

One year symptom severity and health-related quality of life changes among Black African patients undergoing uterine fibroid embolisation

One year symptom severity and health-related quality of life changes among Black African patients undergoing uterine fibroid embolisation

Title: Long-term health related quality of life following Uterine Fibroid Embolization 1 in a predominantly black African population: A retrospective Cohort study

Anti-Mullerian hormone before and after uterine artery embolisation in reproductive-age women seeking treatment for symptomatic fibroids

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