UFE procedure
Fibroid MRI
Fibroid Ultrasound

Fibroids are benign tumors of the uterus.  Benign means they do not behave like a cancer and spread to other parts of the body. But that does not mean they do not cause symptoms!

They are a common cause of pelvic pain and can cause back and leg pain, too. They can cause abnormal, heavy menstrual bleeding. So much bleeding that patients with them are often anemic.

They press on the bladder making you feel like you have to pee all of the time. And they press on the rectum, causing constipation and bloating. They can make your abdomen stick out as if you were pregnant. Sex can be painful because of the fibroids.

A classic treatment for fibroids is surgical removal of the uterus: hysterectomy. But a much less radical, yet extraordinarily effective, non-surgical treatment is Uterine Fibroid Embolization (UFE) also known as uterine artery embolization (UAE)

In this diagram, you can see that a fibroid is classified depending on it's location in the uterus. If it is on the surface it is called subserosal. If it is in the muscle it is called intramural. And if it abuts or protrudes into the endometrial cavity it is called submucosal. It turns out that this location is important when it comes to deciding if UFE is right for you.

The procedure blocks the blood supply to the fibroids. These tumors are hypervascular meaning they use more blood than normal tissue, stealing the blood away from adjacent structures. The abnormal arteries supplying the fibroids are larger than the arteries supplying the normal tissue of the uterus. The particles we inject during UFE are sized to tumble into the abnormal large fibroid arteries while sparing the tiny vessels that feed the uterus.  Deprived of their blood supply, the fibroids die and  shrivel into small scars that cease to give you any problems.

The Interventional Radiologists of STRG perform this procedure. Feel free to contact us directly or allow your family physician, internist, or gynecologist to contact us. Make sure to ask your doctor about this alternative! Even though UFE has been around for over a decade, many physicians are unfamiliar with it. Also, some doctors are reluctant to suggest a patient try a new procedure until it has been around for 20 or 30 years...but that is not going to help you!

Walk me through the procedure.

Can I make an appointment to be assessed by Dr. Thomas or one of the other STRG Interventional Radiologists?

Sure, just call our clinic (210) 616-7780; or toll free (800) 317-0774, and ask for an appointment. If your insurance company requires a referral we can help you with that.

Do I have to stay in the hospital?

To keep you comfortable after the procedure we will give you medicine by IV. It is necessary that you stay in the hospital overnight while these medications are given. We admit you to the gynecology floor in the hospital where the nurses are trained to work with UFE patients. Even though you spend the night it is still considered an outpatient procedure (23-hour admit) which saves you money.

Which hospital?

We prefer to perform UFE at the main Methodist hospital in the medical center. Directions to Methodist.

We also provide services at St. Luke's Baptist Hospital, Methodist Specialty & Transplant Hospital (a.k.a. San Antonio Community Hospital), North East Methodist Hospital, the Nix hospital, downtown and South West General Hospital. If your insurance company insists the procedure be performed at one of these hospitals we can accommodate you.

What is the difference between surgery and this embolization procedure?

Your uterus will decrease in size, but it is not removed as is done with hysterectomy.

UFE is performed under conscious sedation. You will be very relaxed and you can talk with me as the procedure is going, listen to music, and watch the monitor that I am using to follow the procedure. There will be a nurse and one or two radiographer technicians in the room with us; you will not be lonely. 

Hysterectomy is performed under general anesthesia. You are unconscious, the anesthesiologist will place a tube in your throat so a machine can breath for you, as you will not be breathing on your own.

UFE is performed through a small nick in the skin, the size of a pencil point, at the groin. A tiny catheter is advanced into the artery and is guided by x-ray to the arteries that feed the uterus and fibroids. When the procedure is over, you will have a band-aid at the site. No stitches. No staples.

Abdominal hysterectomy is performed by making a large cut through the skin, muscle, connective tissue, blood vessels, lymphatics, and nerves to expose and remove your uterus. Your bladder has to pulled out of the way to get to the uterus, and the bladder or the tubes that carry urine from your kidneys to the bladder (the ureters) can be injured during the surgery. Blood vessels are tied off with sutures or metal clips. The connective tissue and muscles are brought back together by more sutures. The large cut in your skin is closed by staples. Your doctor will keep track of how much blood you loose to decide if you need a transfusion. If your uterus is small enough your gynecologist might be able to remove your uterus by laparoscopic resection or through your vagina; either way results in a much faster recovery time than an abdominal hysterectomy. But a uterus with fibroids is often too large to remove this way.

Following abdominal hysterectomy you can expect to miss up to six-weeks of work or other activity, shorter if the uterus is removed through the vagina or by laparoscope.

Our UFE patients are almost always ready to go back to work in a week. 

Adverse effects of the hysterectomy might show up years after the surgery. The most common cause of small bowel obstruction is prior surgery, and hysterectomy is one of the most likely prior surgeries to cause the scar tissue that results in bowel obstruction. Here is an abstract from a study in the American Journal of Obstetrics and Gynecology that discusses this problem.

In the 12 years since the introduction of UFE, there has only been one reported case of small bowel obstruction due to prior UFE in the entire world.

Your chances of getting pregnant after a hysterectomy are zero.

No one can say yet what the chances are after UFE, but they are better than zero. The team that first performed UFE has reported on nine women who became pregnant after UFE. The group in California that first performed UFE in the US have also reported on a series of 14 women who became pregnant after UFE. 10 babies have been delivered. 2 women are still pregnant. Another from Canada reports on 24 pregnancies after UFE and the 14 babies that have so far been delivered.

These two studies account for 31 children in the world who would not have been here without UFE as an alternative to hysterectomy!

Does it work as well as surgery?

Better. Not only will this procedure take care of the symptoms in the vast majority of women, it obviates the need for major surgery and its attendant complications and convalescence. UFE will not substitute for surgery for everyone. If you are one of the rare women whose symptoms do not resolve after our procedure, you still have the option of the hysterectomy. 

Are these my only options? UFE vs. Hysterectomy?

No. Your OB/GYN may be able to surgically remove your fibroid(s) but leave the uterus intact. This procedure is called myomectomy. Also, hormonal therapy is available that may cause your fibroids to stop causing symptoms without having to have any kind of procedure or surgery. You should explore these options with your OB/GYN  or Family Practice doctor. We can refer you to one who is familiar with all of these options, if you wish.

Recently, laser therapy for fibroids has been in the news. This technique has been around for awhile, applied by Gynecologists either via hysteroscope (placed inside the uterus through the cervix) or laparoscope (placed through the front wall of the abdomen/pelvis at surgery). The new excitement has been generated by Radiologists who guide the probe from the skin to the fibroid with MRI. Destruction of the fibroid is monitored by the MRI signal, and it is done as an outpatient procedure. 

Does UFE hurt?

Expect to experience some discomfort (pelvic cramping and back pain) during the first 24 hours. But we will work with you to keep you as pain-free as possible. You will be in control of a pump that you use to self-administer pain medication as you need it. When you are ready to switch to pills for discomfort, you are ready to go home.

If my fibroids are keeping me from getting pregnant, can I have this procedure to increase my chances of pregnancy?

For now we perform UFE for women who have symptomatic fibroids, do not want to become pregnant, and want to avoid hysterectomy.

Believe it or not, research has not been able to definitively show that fibroids interfere with pregnancy. Many doctors, myself included, and patients believe they might. Some research indicates improved ability to carry a pregnancy to term after myomectomy (surgical removal of the fibroids). We are optimistic that women will also be able to carry a pregnancy to term after UFE. 

As stated above, the team that first performed UFE has reported on nine women who became pregnant after UFE. These nine women had 12 pregnancies. Five had early miscarriages but 7 resulted in the birth of children. The team in California who started UFE in the US has reported on 14 women who became pregnant after UFE, 10 of whom have delivered babies. Also, a few women in the larger UFE trials got pregnant, and did OK.  As soon as better data is available we will analyze it and, if appropriate, offer UFE for infertility. 

What is the usual follow-up?

We will contact you at home during the first 2 or 3 days. We want to see you back at the IRC for a follow-up visit at 3 months. We ask that you see your gynecologist or family practitioner 3-6 months after UFE is performed.

After that, there is no need to return to the IRC unless you have a problem or concern. You should continue to see your gynecologist (or primary care doctor) for routine health. If you do not have a OB/GYN, contact us and we will put you in touch with one familiar with UFE patients. 

If at any time you have a question or problem after the UFE we want you to contact us at the IRC

What happens to the particles you inject into the arteries?

They stay in those arteries permanently. They do not break down or go anywhere else in your body. They are very stable and have been in use for many years.

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For more information, please contact me by e-mail or by calling the IRC at 210.616.7780. 

Or visit the Society of Interventional Radiology's www site and follow the links about UFE.

 

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This page was last updated on Tuesday, February 27, 2007

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