Fibroid Expulsion after Uterine Artery Embolization

Abstract

Uterine artery embolization (UAE) is a ubiquitous procedure, and a broadly recognized alternative to surgical interventions for symptomatic leiomyomata when uterine preservation is desired. Aside from postembolization syndrome (typically considered an expected feature of recovery), the most frequently described complications are temporary or permanent amenorrhea and lingering vaginal discharge. Less frequently described complications include fibroid expulsion (FE), protracted or refractory pain, infection, urinary retention, and access-related injuries. Reported rates of transcervical FE vary in the literature from 3 to 50% but are most often quoted to be around 5 to 15%. Certain features predispose a patient to FE, including size and location of the tumor, with pedunculated submucosal, submucosal, and transmural lesions considered to be “high risk.” While the optimal management of FE has not been definitively determined, high rates of nonoperative management of FE are noted in the literature. This article describes a case in which a fibroid was expulsed following UAE, as well as the management of the complication. A literature review and recommendations for the management of FE is also given.

Observation of Intramural Fibroid Expulsion on MRI after Uterine Artery Embolization

“…Fibroid expulsion typically occurs with submucosal fibroids, with expulsion of intramural fibroids being an uncommon event [ 5 , 6 ]. In this case, the bulk of the intramural fibroid protruded into the uterine cavity after UAE, ultimately leading to fibroid expulsion.…”

“…One of the complications of UAE is fibroid expulsion. Although expulsion of submucosal fibroids after UAE has been reported, expulsion of intramural fibroids is less common [ 5 , 6 ]. We report a case of almost total expulsion of an intramural fibroid following UAE.…”

Myoma Expulsion after Uterine Artery Embolization

“…The existing literature data, regarding mass expulsion of post-UAE fibroids, vary from 5% to 15% and the time period, from days to years. Of all cases of postprocedure expulsion, 95% are symptomatic, 89% of those were expelled in “bulk” form, which consists of total expulsion of the tumor or large pieces, and 11% were in “sloughing,” which consists of “melting” of the tumor surface or dissolving the tumor over a period of time [ 13 , 23 ]. Our patient was discharged 2 days after the procedure, however came back seven days later, due to abdominal pain and tumor exteriorization.…”

Uterine Artery Embolization as an Efficacious Stand-Alone Technique in Management of Symptomatic Uterine Leiomyomata

“…Occasionally, dilatation of the internal os and spontaneous passage may occur, depending on the size of infarcted leiomyoma. Nonetheless, larger leiomyomas might require hysteroscopic resection (27) .…”