UFE information for Medical Professionals
Uterine Fibroid Embolization (UFE), performed in the U.S. since 1995, is a minimally invasive therapeutic alternative to hysterectomy or myomectomy.
The FDA approved embolics for UFE in 2002.
The American Congress of Obstetrics and Gynecology (ACOG) has long held that UFE is a safe and effective alternative to hysterectomy.
The following is a quote from pages 8 and 9 of the August 2008 ACOG Practice Bulletin:
"The following recommendations and conclusions are based on good and consistent scientific evidence (Level A) Based on long- and short-term outcomes, uterine artery embolization is a safe and effective option for appropriately selected women who wish to retain their uteri."
If you have any questions, feel free to email me.
The FDA approved embolics for UFE in 2002.
The American Congress of Obstetrics and Gynecology (ACOG) has long held that UFE is a safe and effective alternative to hysterectomy.
The following is a quote from pages 8 and 9 of the August 2008 ACOG Practice Bulletin:
"The following recommendations and conclusions are based on good and consistent scientific evidence (Level A) Based on long- and short-term outcomes, uterine artery embolization is a safe and effective option for appropriately selected women who wish to retain their uteri."
If you have any questions, feel free to email me.
UFE is NOT experimental.
If you have a patient with dysfunctional uterine bleeding, pelvic pain or pressure attributable to leiomyomata, she may be a candidate for UFE. Ask her to call my clinic or review this web site for more information.
If you want more information on the procedure or our clinical service, call my clinic (210) 616-7780 or email me
I would be happy to set up a time to come to your office for a brief chat, or to give a complete presentation for you and your partners and office staff. We will bring breakfast or lunch, if appropriate.
Who is a good candidate?
Our typical patient is a woman in her late 30's to early 50's with documented fibroids and menorrhagia or pelvic pain/pressure, urinary frequency, or painful sex. She wants treatment to end these symptoms but she doesn't want a hysterectomy.
Reasons women cite for not wanting a hysterectomy include wanting to keep her body whole, wanting to avoid major surgery, wanting to preserve her ability to reproduce, or wanting to avoid the convalescence of hysterectomy.
I have heard that UFE causes a lot of pain... is that true?
The procedure itself is virtually painless, limited to a little sting at the groin as I infuse local anesthetic.
During the procedure, I use conscious sedation to help them be comfortable. Most of my patients enjoy chatting with me and watching the procedure progress on our video monitors. I am happy to explain what is happening and am always interested to hear about what she is feeling. Some patients prefer just to drift off to sleep.
In the middle of the procedure I administer a superior hypogastric plexus block with a long acting local anesthetic that will decrease sensation from the pelvic organs for about 18 hours. I started using the block back in 2012 and it has made a tremendous difference in post procedure pain.
Without the nerve block most women will experience significant pain after embolization. Enough that I used to routinely admit my patients for pain control with a PCA. Now almost all of my patients go home a few hours after the procedure.
I am a Family Practitioner. Do I need to refer my patient to a Gynecologist for this procedure?
No. As long as you are comfortable in treating general gynecological disorders and can perform gynecological surgery (D&C, hysterectomy) and are willing to follow her long-term. If you do not treat general gynecological disorders and your patient does not have a gynecologist, we can provide her with the names of some who are interested in following UFE patients, at her request or at your request.
Scheduling
You, your staff, or your patient can call us at our clinic, the Interventional Radiology Clinic (IRC) of South Texas Radiology Imaging Centers in San Antonio's Medical Center. (210) 616-7780.
We will take care of the rest:
We will schedule a formal consult and her pre-procedure MRI. During our encounter at the IRC we will gather her history, ensure she has no contraindication to the procedure, and review her MRI images and perform a physical exam to make sure she is a UFE candidate.
If we decide she is a candidate for UFE and she wishes to proceed we will help her verify her benefits, schedule the procedure, perform the procedure, manage her post-discharge symptoms, and answer her post-procedure questions. If by chance the nerve block is insufficient to control her pain and she needs to stay the night for PCA we will admit her.
We ask our patients to return to the IRC for a follow-up visit 3 months post-UFE. We also stress to them the importance of continuing to be followed by you for continuous long-term gynecological health.
If you have a patient with dysfunctional uterine bleeding, pelvic pain or pressure attributable to leiomyomata, she may be a candidate for UFE. Ask her to call my clinic or review this web site for more information.
If you want more information on the procedure or our clinical service, call my clinic (210) 616-7780 or email me
I would be happy to set up a time to come to your office for a brief chat, or to give a complete presentation for you and your partners and office staff. We will bring breakfast or lunch, if appropriate.
Who is a good candidate?
Our typical patient is a woman in her late 30's to early 50's with documented fibroids and menorrhagia or pelvic pain/pressure, urinary frequency, or painful sex. She wants treatment to end these symptoms but she doesn't want a hysterectomy.
Reasons women cite for not wanting a hysterectomy include wanting to keep her body whole, wanting to avoid major surgery, wanting to preserve her ability to reproduce, or wanting to avoid the convalescence of hysterectomy.
I have heard that UFE causes a lot of pain... is that true?
The procedure itself is virtually painless, limited to a little sting at the groin as I infuse local anesthetic.
During the procedure, I use conscious sedation to help them be comfortable. Most of my patients enjoy chatting with me and watching the procedure progress on our video monitors. I am happy to explain what is happening and am always interested to hear about what she is feeling. Some patients prefer just to drift off to sleep.
In the middle of the procedure I administer a superior hypogastric plexus block with a long acting local anesthetic that will decrease sensation from the pelvic organs for about 18 hours. I started using the block back in 2012 and it has made a tremendous difference in post procedure pain.
Without the nerve block most women will experience significant pain after embolization. Enough that I used to routinely admit my patients for pain control with a PCA. Now almost all of my patients go home a few hours after the procedure.
I am a Family Practitioner. Do I need to refer my patient to a Gynecologist for this procedure?
No. As long as you are comfortable in treating general gynecological disorders and can perform gynecological surgery (D&C, hysterectomy) and are willing to follow her long-term. If you do not treat general gynecological disorders and your patient does not have a gynecologist, we can provide her with the names of some who are interested in following UFE patients, at her request or at your request.
Scheduling
You, your staff, or your patient can call us at our clinic, the Interventional Radiology Clinic (IRC) of South Texas Radiology Imaging Centers in San Antonio's Medical Center. (210) 616-7780.
We will take care of the rest:
We will schedule a formal consult and her pre-procedure MRI. During our encounter at the IRC we will gather her history, ensure she has no contraindication to the procedure, and review her MRI images and perform a physical exam to make sure she is a UFE candidate.
If we decide she is a candidate for UFE and she wishes to proceed we will help her verify her benefits, schedule the procedure, perform the procedure, manage her post-discharge symptoms, and answer her post-procedure questions. If by chance the nerve block is insufficient to control her pain and she needs to stay the night for PCA we will admit her.
We ask our patients to return to the IRC for a follow-up visit 3 months post-UFE. We also stress to them the importance of continuing to be followed by you for continuous long-term gynecological health.
Expected results
Symptoms resolve in 85-95% of patients. Menorrhagia and dysmenorrhea often resolve by the first menses post-procedure. Once infarcted, the fibroids undergo fibrinoid necrosis that results in dramatic volume decrease over time. The fibroids do not immediately shrink, but women feel relief from bulk symptoms faster than a measurable drop in volume; often just a few weeks after her UFE. The fibroids and uterus decrease in volume by approximately 30% at three months. The fibroids will continue to shrink, often by 60-70% by the end of the first year. Symptoms due to mass effect continue to improve over this time.
Out of town patients?
No problem, we have treated patients from La Grange to Laredo to El Paso. We have also had several out of state and international patients. We will ask that out of town patients make arrangements to stay in San Antonio the night of the UFE.
Pre-procedure imaging
We request that the patient have an MRI of the pelvis (T1 axial, T2 axial coronal and sagital, and a gadolinium enhanced set of images) to document fibroid number, position, size, and viability. The MRI will also help exclude coexisting pathology, such as adnexal disease or adenomyosis.
We do not accept a pelvic ultrasound as a substitute as it is woefully inferior to MRI.
We will arrange for her imaging, but also gladly accept outside imaging.
What about her cancer risk?
True, by keeping the uterus and ovaries a woman remains at risk for developing neoplasia of those organs. When taken together, the lifetime risk of ovarian cancer, endometrial cancer, cervical cancer, and uterine leiomyosarcoma is less than 5%. If that risk is unacceptable to your patient, she may wish to proceed to TAH&BSO. To keep things in perspective, the lifetime risk of developing breast cancer is 12.7%, and few women (other than those with mutations that make their risk much higher than 12.7%) elect to have prophylactic bilateral mastectomy.
The incidence of a fibroid undergoing malignant degeneration is considered negligible, perhaps impossible.
The incidence of leiomyosarcoma in women undergoing hysterectomy for abnormal uterine bleeding from presumed leiomyoma is between 0.23%-0.49%. We expect the same incidence in UFE patients. If the patient's symptoms do not respond appropriately to UFE we would recommend repeat MRI. The follow-up imaging studies should be able to pick up any tumor that is growing, a flag that would suggest the possibility of a sarcoma.
Symptoms resolve in 85-95% of patients. Menorrhagia and dysmenorrhea often resolve by the first menses post-procedure. Once infarcted, the fibroids undergo fibrinoid necrosis that results in dramatic volume decrease over time. The fibroids do not immediately shrink, but women feel relief from bulk symptoms faster than a measurable drop in volume; often just a few weeks after her UFE. The fibroids and uterus decrease in volume by approximately 30% at three months. The fibroids will continue to shrink, often by 60-70% by the end of the first year. Symptoms due to mass effect continue to improve over this time.
Out of town patients?
No problem, we have treated patients from La Grange to Laredo to El Paso. We have also had several out of state and international patients. We will ask that out of town patients make arrangements to stay in San Antonio the night of the UFE.
Pre-procedure imaging
We request that the patient have an MRI of the pelvis (T1 axial, T2 axial coronal and sagital, and a gadolinium enhanced set of images) to document fibroid number, position, size, and viability. The MRI will also help exclude coexisting pathology, such as adnexal disease or adenomyosis.
We do not accept a pelvic ultrasound as a substitute as it is woefully inferior to MRI.
We will arrange for her imaging, but also gladly accept outside imaging.
What about her cancer risk?
True, by keeping the uterus and ovaries a woman remains at risk for developing neoplasia of those organs. When taken together, the lifetime risk of ovarian cancer, endometrial cancer, cervical cancer, and uterine leiomyosarcoma is less than 5%. If that risk is unacceptable to your patient, she may wish to proceed to TAH&BSO. To keep things in perspective, the lifetime risk of developing breast cancer is 12.7%, and few women (other than those with mutations that make their risk much higher than 12.7%) elect to have prophylactic bilateral mastectomy.
The incidence of a fibroid undergoing malignant degeneration is considered negligible, perhaps impossible.
The incidence of leiomyosarcoma in women undergoing hysterectomy for abnormal uterine bleeding from presumed leiomyoma is between 0.23%-0.49%. We expect the same incidence in UFE patients. If the patient's symptoms do not respond appropriately to UFE we would recommend repeat MRI. The follow-up imaging studies should be able to pick up any tumor that is growing, a flag that would suggest the possibility of a sarcoma.
