|
|
|
"Little did I know the problems these non-cancerous tumors would cause – affecting my health and lifestyle for the next nine years!"-Marcia (before her UFE)
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 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 procedure until it has been around for 20 or 30 years...but that is not going to help you! Find the answers to these questions on this page:Can I make an appointment without being referred? Do I have to stay in the hospital? What is the difference between surgery and UFE? Does it work as well as surgery? Are these my only options? UFE vs. Hysterectomy? How long does the procedure take? When can I go back to work after UFE? What is the usual follow-up after UFE? What happens to the particles you inject into the arteries?
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. If you are strongly motivated to go home without spending the night in the hospital we can do that, too. Most people are much more comfortable at home than at the hospital so I am happy to work with you on getting you home the same day if that is your wish.
Which hospital?We prefer to perform UFE at the main Methodist hospital in the medical center. Directions to Methodist. We provide services at all hospitals in the Methodist system (Methodist Specialty & Transplant Hospital, Methodist Stone Oak Hospital, North East Methodist Hospital, and Metropolitan Methodist Hospital) as well as St. Luke's Baptist Hospital, the Nix Hospital, 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 UFE?Your uterus will decrease in size after UFE, 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. If the gynecologist uses the Da Vinci robot to assist the surgery, he/she will be able to see much better but will lose the ability to feel...I have personally taken care of several women who were injured by robot assisted hysterectomy...it is not a cure-all but can be very helpful in making the surgery safer.
Our UFE patients are almost always ready to go back to work in a week. 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.
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. It took 12 years after the introduction of UFE before a case of small bowel obstruction due to prior UFE was reported. Now a small handful of case reports show that women with fibroids on the surface of the uterus are in fact at risk for this late complication. Another study has shown that women who go on to have a hysterectomy after UFE may have adhesions between the uterus and other structures. While the investigators found 20% of their patients had these adhesions, you have to keep in mind that these women were undergoing hysterectomy for a reason, most of them pelvic pain. We do not know if women free of symptoms after UFE get adhesions, or if they do how often (Agdi M 2008). So while the problem of adhesions causing bowel obstruction is not even close to being as frequent a problem as with hysterectomy, it can happen.
Your chance of getting pregnant after a hysterectomy is zero. No one can say yet what the chances are after UFE, but they are better than zero. Of the several small studies that address this issue, it appears that between 50 and 60% of women who want to get pregnant after UFE are able to do so. 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. And another report from Portugal (Pisco J. presented at 2010 SIR meeting) showed that of 74 women undergoing UFE wanting to get pregnant, 43 conceived (62%). Of those 43, 1 women elected to have an abortion, 4 women had miscarriage, and 30 women had successful live births. 7 were still pregnant at the time of the report. These studies account for 61 children who would not have been here without UFE as an alternative to hysterectomy! Many more children have been born to women who had prior UFE than are included in these small studies. One of my patients gave birth to healthy baby boy in 2009, 4 years after her UFE.
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, there are many approaches you can try. Here are the most common. Hormonal therapy is available that may cause your fibroids to stop causing symptoms without having to have any kind of procedure or surgery. Myomectomy: Your OB/GYN may be able to surgically remove your fibroid(s) but leave the uterus intact. This procedure is called myomectomy. Myomectomy is still prefered over UFE if your primary issue is wanting to get pregnant. Endometrail Ablation: If your symptom is heavy bleeding and your fibroids are small (less than 3cm) your gynecologist may be able to treat you by Endometrial Ablation. Ablation is very effective; it involves placing a device into your uterus through the cervix that then destroys the lining of the endometrium and stops your period for good. The device uses energy to destroy the lining, usually by heating it. 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. MRIgFUS: In 2004 the FDA approved the use of MRI guided focused ultrasound (MRIgFUS) therapy for treating fibroids. This very interesting techniques is completely non-invasive. You lay on your stomach in the MRI machine and the ultrasound beam is focused on your fibroid, heating it to the point that it dies. The brand name of this device is Exablate. The biggest disadvantage of MRIgFUS is that most insurance companies do not cover it, and it is expensive. I understand it costs around 8 thousand dollars per session and usually 2-3 sessions are required. There is no system in San Antonio; the closest is in Austin. Follow the link if you want to explore the therapy further. Watchful Waiting: Fibroids die on their own after you go into menopasue. It does not happen right away but eventually they will die as your estrogen levels fall. So if your symptoms are mild and you are close to menopause you may wish to let nature take it's course. By the way, when fibroids die after menopause they go through the exact same process as when they die after UFE. In the end you are left with a small ball of scar tissue in your uterus, UFE just makes it happen all at once.
Does UFE hurt?You will not have any pain during your UFE. Most of my patients enjoy watching the progress of the procedure (you can see the same images I am seeing) and chat with me as we progress. We will play the type of music you like to listen to as long as you tell us what you want to hear. And of course you can close your eyes and go to sleep, though I may wake you up from time to time to ask you to hold your breath for just a moment. After your UFE you will experience at least some discomfort (pelvic cramping and back pain). We cannot predict how much discomfort you will have so we prepare for the worse. My patients tell me the pain is anywhere between their usual period pain to as bad as a labor cramp that will not stop. This discomfort starts within 30 minutes after your UFE and gets as bad as it is going to get within 2-3 hours. It stays that way for 8-12 hours and then rapidly dissipates. By the morning after your UFE the pain is usually much improved. 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 can. 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. And another report from Portugal (Pisco J. presented at 2010 SIR meeting) showed that of 74 women undergoing UFE wanting to get pregnant, 43 conceived (62%). Of those 43, 1 women elected to have an abortion, 4 women had miscarriage, and 30 women had successful live births. 7 were still pregnant at the time of the report. As soon as better data is available we will analyze it and, if appropriate, offer UFE for infertility. But for now we still recommend myomectomy if your primary symptom is infertility. If your gynecologist tells you that you are not a candidate for myomectomy we can proceed with UFE. I recommend you wait at least 6 months after UFE before attempting to get pregnant. One of my patients who had never been able to conceive was told she could not have myomectomy due to the nature of her fibroids. 4 years after her UFE she decided to try, became pregnant, and delivered a healthy son. She is now considering a second child!
How long does the procedure take? Usually 30-45 minutes. You will be in the procedure room for about an hour to 90 minutes before you return to the recovery room. If you have a friend or relative with you that person can stay with you right up until the time we bring you into the procedure room. During your procedure they are welcome to stay in the Radiology waiting room or go out for breakfast or a cup of coffee. We will bring them back to see you in the recovery room once you are situated after your UFE.
When can I go back to work after UFE? I recommend you take one week off from work. You will spend the first night in the hospital. When you go home you may feel run down like you have the flu for have several days. If you feel recovered and are not taking narcotic pain medicine you can go back to work early (many women go back after just 3 days) but it is easier to plan on being gone longer and returning early than to ask for more time.
Will UFE affect my sex life? I ask that you not have intercourse for 10 days after your UFE. Many women find that sex is more pleasurable after the bulky, tender fibroids have been treated by UFE, so the procedure most often improves your sex life. Rarely women notice a decrease in their sex drive after UFE, though this does not happen as often as reported with hysterectomy. Another rare side effect of UFE is vaginal dryness.
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.
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.
This page was last updated on Saturday, April 10, 2010 |
These tumors are hypervascular
meaning they use more blood than normal tissue, stealing the blood away from adjacent
structures.