Systematic review and meta-analysis of current evidence in uterine artery embolization vs myomectomy for symptomatic uterine fibroids

Abstract

Purpose This review compares the efficacy of Uterine Artery Embolization (UAE) and Myomectomy (MYO) in managing symptomatic Uterine Fibroids (UFs) in women who do not want hysterectomy. Materials and Methods A meta-analysis was performed on all relative studies. Outcomes evaluated reintervention, UFs scores for quality of life (QOL) and symptom severity, and so on. To determine mean differences (MDs) or odds ratios (ORs) with 95% confidence intervals (CIs), a random or fixed-effects model was utilized. Results A meta-analysis of 13 studies (9 observational and 4 randomized controlled trials) was conducted. The results indicated that UAE had a higher reintervention rate (OR, 1.84; 95% CI, 1.62 to 2.10; P < 0.01; I² = 39%), hysterectomy rate (OR, 4.04; 95% CI, 3.45 to 4.72; P < 0.01; I² = 59%), and symptom-severity score (OR, -4.02; 95% CI, 0.82, 7.22; P = 0.01; I² = 0%) compared to MYO at a four-year follow-up. However, UAE was associated with a lower rate of early complications (OR, 0.44; 95% CI, 0.20 to 0.95; P = 0.04; I² = 25%), and readmission rate (OR, 1.16; 95% CI, 1.01 to 1.33; P = 0.04; I² = 0%) compared to MYO. Furthermore, both procedures had comparable improvement in pregnancy rates and abnormal uterine bleeding. Conclusion In conclusion, UAE and MYO are effective in treating symptomatic UFs but they have different outcomes. The decision on which procedure to choose should be made based on individual preferences and the physician's expertise.