Management of single submucosal fibroid in unmarried females with uterine artery embolization
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20200375Keywords:
Dysmenorrhea, Fibroid, Heavy menstrual bleeding, Submucus, Unmarried, Uterine artery embolizationAbstract
Background: Uterine fibroids (leiomyomas) are the most common benign neoplasm of the female pelvis. The location of fibroids, whether submucosal, subserosal, pedunculated subserosal, intramural, or endocavitary, is important because signs and symptoms may be determined by location. Uterine artery embolization (UAE) for many patients is an effective alternative treatment to surgical therapy for fibroid tumors. It is a minimally invasive procedure, which allows for rapid recovery and return to normal activities. Objective of this study was to know the efficacy of minimally invasive technique UAE for reducing symptoms in sub-mucous uterine leiomyoma in unmarried females.
Methods: This retrospective analysis was performed on 9 unmarried females with symptomatic single submucosal fibroid diagnosed on MRI with size range of 3.5 cms to 6.5 cms. They presented at Dayanand Medical College and Hospital, Ludhiana, Punjab in a period of 3 years from January 2016-December 2019. Inclusion criteria were unmarried females, single submucosal fibroid diagnosed on USG/MRI. Exclusion criteria was active infection, more than one fibroid in uterus, prior GnRH analogues treatment during the previous 3 months.
Results: All patients presented with heavy menstrual bleeding (HMB) and dysmenorrhea, lower abdomen pain was encountered in 3 patients and 2 patients had inter-menstrual bleeding. Recurrent, UTI was there in 1 patient and 1 patient had vaginal discharge. All fibroids belonged to stage 1 FIGO classification. UAE was done and patients were followed for 6 months. Symptomatic success was seen in 100% patients and 77.77% patients expelled the fibroid per vaginally.
Conclusions: UAE is alternative method of treatment for submucosal fibroids in unmarried females who do not want to undergo surgery. Proper case selection can give us good results and symptomatic relief.References
Vollenhoven BJ, Lawrence AS, Healy DL. Uterine fibroids: a clinical review. Br J Obstet Gynaecol. 1990;97:285-98.
Buttram VC, Reiter RC. Uterine leiomyomata: etiology, symptomatology and management. Fertil Steril. 1981;36:433-45.
Spies JB, Roth AR, Jha RC, Gomez-Jorge J, Levy EB, Chang TC, et al. Leiomyomata treated with uterine artery embolization: factors associated with successful symptom and imaging outcome. Radiol. 2002;222:45-52.
Salerno S, Belli AM. Percutaneous treatment of uterine fibroleiomyomas: analysis of complications and quality of life after embolization. Radiol Med (Torino). 2001;101:360-4.
Stewart EA. Clinical practice. Uterine fibroids. N Engl J Med. 2015;372(17):1646-55.
Goodwin S, McLucas B, Lee M, Chen G, Perrella R, Vedantham S, et al. Uterine artery embolization for the treatment of uterine leiomyomata: midterm results. J VascInterv Radiol. 1999;10:1159-65.
Ravina JH, Herbreteau D, Ciraru-Vigneron N. Arterial embolisation to treat uterine myomata. Lancet. 1995;346(8976):671-2.
Aziz A, Petrucco O, Makinoda S, Wikholm G, Svendsen P, Brännström M, et al. Trans arterial embolization of the uterine arteries: patient reactions and effects on uterine vasculature. Acta Obstet Gynecol Scand. 1998;77:334-0.
McCluggage WG, Ellis PK, McClure N, Walker WJ, Jackson PA, Manek S. Pathologic features of uterine leiomyomas following uterine artery embolization. Int J Gynecol Pathol. 2000;19:342-7.
Siskin GP, Eaton LA, Stainken BF, Dowling K, Herr A, Schwartz J. Pathologic findings in a uterine leiomyoma after bilateral uterine artery embolization. J Vasc Interv Radiol. 1999;10:891-4.