The Lublin Protocol of the Uterine Arteries Embolization in the Treatment of Symptomatic Uterine Fibroids

Abstract

Uterine fibroids are benign tumors originating from smooth muscle tissue, constituting uterine muscle stroma. Uterine fibroids are the most common benign tumors found in women. In 20%-50% of women, fibroids are asymptomatic and do not require any treatment. The main symptoms of uterine fibroids are profuse menstrual bleeding, abnormal uterine bleeding, and pressure symptoms. Pressure symptoms can cause pelvic pain syndrome, urination disorders, and constipation. The treatment methods that are currently used include surgical treatment, pharmacological therapy, and minimally invasive procedures. The most commonly applied minimally invasive method is the embolization of uterine arteries. This procedure is currently a widely accepted method of treatment for symptomatic uterine fibroids and has been recognized as such by the National Institute for Health and Clinical Excellence in the guidelines for heavy menstrual bleeding. This is a complicated procedure and requires close cooperation between gynecologists and interventional radiologists. We present a protocol applicable to uterine artery embolization in the treatment of symptomatic uterine fibroids. The protocol is divided into five section. The first two section are intended for gynecologists and interventional radiologists, explaining how to qualify and prepare a patient for embolization in a step-by-step manner. Section three, which is directed at interventional radiologists, explains how embolization should be done. Section four is directed at gynecologists or hospital ward doctors who look after the patients after embolization. This section of the protocol offers a method for treating postembolization pain using the Patient Controlled Analgesia (PCA) pump. Section five completes the procedure with an assessment of the effects and late complications of uterine artery embolization.

Minimally invasive treatment options for uterine fibroids — state-of-the art 2021

“…As UAE is associated with post-embolization pain, further treatment is necessary after the procedure. Patient controlled analgesia is the preferred choice [5].…”

“…UAE is considered a safe procedure. Possible complications include local side-effects associated with the angiography procedure, non-target embolization of other pelvic organs and infections [5].…”

“…Currently used treatment methods include medical therapies [levonorgestrel intrauterine system, gonadotropin-releasing hormone (GnRH) agonists], surgical treatment (myomectomy, hysterectomy) and minimally invasive procedures [5].…”

Magnetic resonance-guided high-intensity ultrasound (MR-HIFU) in the treatment of symptomatic uterine fibroids — five-year experience

“…Notably, Poland has considerable experience in this therapy and sets global standards, e.g. via the development of specialist uniform, protocol for clinicians performing UAE (Lublin Protocol) [33].…”

Magnetic Resonance-Guided High-Intensity Focused Ultrasound Ablation of Uterine Fibroids—Efficiency Assessment with the Use of Dynamic Contrast-Enhanced Magnetic Resonance Imaging and the Potential Role of the Administration of Uterotonic Drugs

“…Other existing treatment options should be directed towards an improvement in symptomatology and the quality of life [ 8 , 9 ]. As regards the conservative interventional treatment options currently available for women with symptomatic UFs, uterine artery embolization (UAE) [ 10 ] and focused energy delivery methods are promising but long-term data are still scarce [ 7 , 8 ].…”