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CardioVascular and Interventional Radiology

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01-06-2012 | Clinical Investigation

Uterine Artery Embolization versus Myomectomy: Impact on Quality of Life—Results of the FUME (Fibroids of the Uterus: Myomectomy versus Embolization) Trial

Authors: Isaac T. Manyonda, Mark Bratby, Jessica S. Horst, Nassera Banu, Maha Gorti, Anna-Maria Belli

Published in: CardioVascular and Interventional Radiology | Issue 3/2012

Abstract

Purpose

This study was designed to compare quality of life (QoL) outcomes after uterine artery embolization (UAE) or myomectomy.

Methods

Women with symptomatic fibroids diagnosed by ultrasound who wished to preserve their uterus were randomized to myomectomy (n = 81) or UAE (n = 82). Endpoints at 1 year were QoL measured by a validated questionnaire, hospital stay, rates of complications, and need for reintervention.

Results

UAE patients had shorter hospitalization (2 vs. 6 days, p < 0.001). By 1 year postintervention, significant and equal improvements in QoL scores had occurred in both groups (myomectomy n = 59; UAE n = 61). There had been two (2.9%) major complications among UAE versus 6 (8%) among myomectomy patients (not significant). By 2 years, among UAE patients (n = 57) there were eight (14.0%) reinterventions for inadequate symptom control compared with one (2.7%) among myomectomy patients (n = 37). Half of the women who required hysterectomy had concomitant adenomyosis missed by US.

Conclusions

UAE and myomectomy both result in significant and equal improvements in QoL. UAE allows a shorter hospital stay and fewer major complications but with a higher rate of reintervention.

Mukhopadhaya N, De Silva C, Manyonda IT (2008) Conventional myomectomy. Best Pract Res Clin Obstet Gynaecol 22(4):677–705PubMedCrossRef

Bratby MJ, Belli AM (2008) Radiological treatment of symptomatic uterine fibroids. Best Pract Res Clin Obstet Gynaecol 22(4):717–734PubMedCrossRef

Office of National Statistics (2009) Birth statistics. Report no.: Series FM1 no. 37. London: Office of National Statistics

Olufowobi O, Sharif K, Papaionnon S et al (2004) Are the anticipated benefits of myomectomy achieved in women of reproductive age? A 5-year review of the results at a UK tertiary hospital. J Obstet Gynaecol 24(4):434–440PubMedCrossRef

Vercellini P, Maddalena S, Giorgi OD, Aimi G, Crosignani PG (1998) Abdominal myomectomy for infertility: a comprehensive review. Hum Reprod 13:873–879PubMedCrossRef

Sawin SW, Pilevsky ND, Berlin JA, Barnhart KT (2000) Comparability of perioperative morbidity between abdominal myomectomy and hysterectomy for women with uterine leiomyomas. Am J Obstet Gynecol 183(6):1448–1455PubMedCrossRef

Tulandi T, Murray C, Guralnick M (1993) Adhesion formation and reproductive outcome after myomectomy and second look laparoscopy. Obstet Gynecol 82(2):213–215PubMed

Thompson LB, Reed SD, McCrummen BK et al (2006) Leiomyoma characteristics and risk of subsequent surgery after myomectomy. Int J Gynaecol Obstet 95(2):138–143PubMedCrossRef

Pron G, Bennett J, Common A, Wall J, Asch M, Sniderman K (2003) The Ontario Uterine Fibroid Embolization Trial. Part 2. Uterine fibroid reduction and symptom relief after uterine artery embolization for fibroids. Fertil Steril 79:120–127PubMedCrossRef

10.

Pron G, Mocarski E, Bennett J et al (2003) Tolerance, hospital stay, and recovery after uterine artery embolization for fibroids: the Ontario Uterine Fibroid Embolization Trial. J Vasc Interv Radiol 14:1243–1250PubMedCrossRef

11.

Walker WJ, Pelage JP (2002) Uterine artery embolisation for symptomatic fibroids: clinical results in 400 women with imaging follow up. BJOG 109:1262–1272PubMedCrossRef

12.

Siskin GP, Shlansky-Goldberg RD, Goodwin SC et al (2006) A prospective multicenter comparative study between myomectomy and uterine artery embolization with polyvinyl alcohol microspheres: long-term clinical outcomes in patients with symptomatic uterine fibroids. J Vasc Interv Radiol 17:1287–1295PubMedCrossRef

13.

Hirst A, Dutton S, Wu O, Briggs A, Edwards C, Waldenmaier L, Maresh M, Nicholson A, McPherson K (2008) A multi-centre retrospective cohort study comparing the efficacy, safety and cost-effectiveness of hysterectomy and uterine artery embolisation for the treatment of symptomatic uterine fibroids. (HOPEFUL) Health Technol Assess 12(5):1–248PubMed

14.

Volkers NA, Hehenkamp WJ, Birnie E, Ankum WM, Reekers JA (2007) Uterine artery embolization versus hysterectomy in the treatment of symptomatic uterine fibroids: 2 years’ outcome from the randomized EMMY trial. Am J Obstet Gynecol 196:519.e1–519.e11CrossRef

15.

Edwards RD, Moss JG, Lumsden MA et al (2007) Uterine-artery embolization versus surgery for symptomatic uterine fibroids. N Engl J Med 356:360–370PubMedCrossRef

16.

Mara M, Fucikova Z, Maskova J, Kuzel D, Haakova L (2006) Uterine fibroid embolization versus myomectomy in women wishing to preserve fertility: preliminary results of a randomized controlled trial. Eur J Obstet Gynecol Reprod Biol 126:226–233PubMedCrossRef

17.

Matson M, Nicholson A, Belli AM (2000) Anastomoses of the ovarian and uterine arteries: a potential pitfall and cause of failure of uterine embolization. Cardiovasc Intervent Radiol 23(5):393–396PubMedCrossRef

18.

Spies JB, Coyne K, Guaou GN, Boyle D, Skyrnarz-Murphy K, Gonzalves SM et al (2002) The UFS-QOL, a new disease-specific symptom and health-related quality of life questionnaire for leiomyomata. Obstet Gynecol 99(2):290–300PubMedCrossRef

19.

Goodwin SC, Bonilla SM, Sacks D, Reed RA, Spies JB et al (2003) Reporting standards for uterine artery embolization for the treatment of uterine leiomyomata. J Vasc Interv Radiol 14:S467–S476PubMedCrossRef

20.

van der Kooij SM, Hehenkamp WJK, Volkers NA et al (2010) Uterine artery embolization vs hysterectomy in the treatment of symptomatic uterine fibroids: 5-year outcome from the randomized EMMY trial. Am J Obstet Gynecol 203:105.e1–105.e13CrossRef

21.

Moss JG, Cooper KG, Khaund A et al (2011) Randomized comparison of uterine artery embolization (UAE) with surgical treatment in patients with symptomatic uterine fibroids (REST trial):5-year results. BJOG. doi:10.1111/j.1471-0528

22.

Narayan A, Lee AS, Kuo GP et al (2010) Uterine artery embolization versus abdominal myomectomy: a long-term clinical outcome comparison. J Vasc Interv Radiol 21(7):1011–1017PubMedCrossRef

23.

Bratby MJ, Walker WJ (2009) Uterine artery embolization for symptomatic adenomyosis–mid-term results. Eur J Radiol 70(1):128–132PubMedCrossRef

24.

Kim MD, Kim S, Kim NK et al (2007) Long-term results of uterine artery embolization for symptomatic adenomyosis. Am J Roentgenol 188(1):176–181CrossRef

25.

Pelage JP, Guaou NG, Jha RC et al (2004) Uterine fibroid tumours: long-term MR imaging outcome after embolization. Radiology 230:803–809PubMedCrossRef

26.

Katsumori T, Kasahara T, Kin Y, Nozaki T (2008) Infarction of uterine fibroids after embolization: relationship between post-procedural enhanced MRI findings and long-term clinical outcomes. Cardiovasc Intervent Radiol 31:66–72PubMedCrossRef

27.

Candiani GB, Fedele L, Parazzini F, Villa L (1991) Risk of recurrence after myomectomy. Br J Obstet Gynaecol 98(4):385–389PubMedCrossRef

28.

Hanafi M (2005) Predictors of leiomyoma recurrence after myomectomy. Obstet Gynecol 105(4):877–881PubMedCrossRef

29.

Seracchioli R, Rossi S, Govoni F, Rossi E, Venturoli S, Bulletti C et al (2000) Fertility and obstetric outcome after laparoscopic myomectomy of large myomata: a randomized comparison with abdominal myomectomy. Hum Reprod 15(12):2663–2668PubMedCrossRef

30.

Griffiths A, D’Angelo A, Amso N (2006) Surgical treatment of fibroids for subfertility. Cochrane Database Syst Rev 3:CD003857

31.

Kolankaya A, Arici A (2006) Myomas and assisted reproductive technologies: when and how to act? Obstet Gynecol Clin N Am 33(1):145–152CrossRef

32.

Mara M, Maskova J, Fucikova Z et al (2008) Midterm clinical and first reproductive results of a randomized controlled trial comparing uterine fibroid embolization and myomectomy. Cardiovasc Intervent Radiol 31(1):73–85PubMedCrossRef

33.

Homer H, Saridogan E (2010) Uterine artery embolization for fibroids is associated with an increased risk of miscarriage. Fertil Steril 94(1):324–330PubMedCrossRef

Title: Uterine Artery Embolization versus Myomectomy: Impact on Quality of Life—Results of the FUME (Fibroids of the Uterus: Myomectomy versus Embolization) Trial
Authors: Isaac T. Manyonda
Mark Bratby
Jessica S. Horst
Nassera Banu
Maha Gorti
Anna-Maria Belli
Publication date: 01-06-2012
Publisher: Springer-Verlag
Published in: CardioVascular and Interventional Radiology / Issue 3/2012
Print ISSN: 0174-1551
Electronic ISSN: 1432-086X
DOI: https://doi.org/10.1007/s00270-011-0228-5

At a glance: The STEP trials

Springer Medicine

Uterine Artery Embolization versus Myomectomy: Impact on Quality of Life—Results of the FUME (Fibroids of the Uterus: Myomectomy versus Embolization) Trial

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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