Treatment of symptomatic fibroid disease using uterine fibroid embolisation: An Australian perspective

Abstract

Uterine leiomyomata (fibroids) are symptomatic in up to 35% of women and treatment can be a costly burden to the individual and society. Options for treatment range from non‐hormonal, hormonal, minimally invasive, to surgery. While symptoms from smaller fibroids may respond to simple treatment, those with larger fibroids or with a large volume of disease require a more definitive option. Surgery (hysterectomy or myomectomy) are both well‐established treatment modalities with good clinical outcomes. Since the 1990s, uterine fibroid embolisation has emerged as a less invasive option for women than for surgical techniques, while level 1 evidence shows that in the short to mid‐term, there is a similar improvement in symptom‐related quality of life outcomes to surgery, but with reduced hospital stay and reduced cost. However, in the longer term there may be a need for further treatment or retreatment in some patients compared with surgery. Since its introduction, uptake of this procedure in Australia has been low relative to surgical options. This manuscript reviews the current literature surrounding treatment, along with the trends in uptake of embolisation by Australian women, places this in context of current guidelines from major societies, and encourages gynaecologists and interventional radiologists to be aware of the advantages and limitations of embolisation.

Quality care guidelines for uterine artery embolisation in women with symptomatic uterine fibroids in Australia and New Zealand: According to the AGREE‐II checklist and endorsed by the Interventional Radiology Society of Australasia

“…The incidence of incidental uterine leiomyosarcoma increases with age, particularly over 50 years. 23,24 Treatment of women where histology of fibroids is not assessed should include counselling that the risk of uterine leiomyosarcoma is 1 in 200 to 1 in 500 [23][24][25] and may be potentially undetected at the time of treatment; this may lead to a delayed diagnosis. This holds true for embolisation as it does for all non-surgical fibroid treatments.…”

Clinical Value of Body Mass Index and Waist-Hip Ratio in Clinicopathological Characteristics and Prognosis of Uterine Leiomyomata

“…In recent years, the incidence of UL has increased year by year. Surgery is the main treatment for UL, and its prognosis is the focus of clinical attention [5][6][7]. e prognosis of UL resection is related to many factors such as the patient's physique, menstrual condition, tumor nature, and surgical method [8,9].…”

Long-term evaluation of uterine fibroid embolisation using MRI perfusion parameters and patient questionnaires: preliminary results

“…This may be related to limited exposure to minimally invasive treatment options such as UFE, which should be performed in dedicated centres with on campus availability of interventional radiologists. Clements et al [ 23 ] similarly noticed a low uptake of UFE in Australia and encouraged further exchange between interventional radiologists and gynaecologists in order to broaden the treatment spectrum for symptomatic fibroids. Although hysterectomy is the only definitive therapy for uterine fibroids, more and more women desire organ preservation and therefore choose UFE as an organ-sparing method [ 24 , 25 ].…”