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PubMed2002

Hospital costs of uterine artery embolization and hysterectomy for uterine fibroid tumors.

RATIONALE AND OBJECTIVES: The purpose of this study was to compare the total actual hospital costs of uterine artery embolization (UAE) and hysterectomy for treatment of uterine fibroid tumors and to evaluate factors that might influence cost. MATERIALS AND METHODS: Total actual hospital costs were collected from the institution's cost accounting system on patients who underwent UAE (n = 57) or hysterectomy (n = 300) for uterine fibroids between 1998 and 2001. Electronic medical records were reviewed to collect clinical information. Standard statistical techniques were used to determine which factors influenced hospital costs. RESULTS: The mean total actual hospital costs of UAE were significantly higher than hysterectomy ($8,223 vs $6,046, P < .0001), but the mean length of stay was shorter (0.95 vs 2.6 days, P < .0001). In linear regression analyses, complications were predictive of increased costs of UAE; length of stay, complications, and laparoscopic hysterectomy were predictive of increased costs of hysterectomy. CONCLUSION: Hospital costs of UAE were higher than hysterectomy for the treatment of uterine fibroids, but the hospital stays were shorter.

Adult↗
PubMed2002

Germline mutations in FH predispose to dominantly inherited uterine fibroids, skin leiomyomata and papillary renal cell cancer.

Uterine leiomyomata (fibroids) are common and clinically important tumors, but little is known about their etiology and pathogenesis. We previously mapped a gene that predisposes to multiple fibroids, cutaneous leiomyomata and renal cell carcinoma to chromosome 1q42.3-q43 (refs 4-6). Here we show, through a combination of mapping critical recombinants, identifying individuals with germline mutations and screening known and predicted transcripts, that this gene encodes fumarate hydratase, an enzyme of the tricarboxylic acid cycle. Leiomyomatosis-associated mutations are predicted to result in absent or truncated protein, or substitutions or deletions of highly conserved amino acids. Activity of fumarate hydratase is reduced in lymphoblastoid cells from individuals with leiomyomatosis. This enzyme acts as a tumor suppressor in familial leiomyomata, and its measured activity is very low or absent in tumors from individuals with leiomyomatosis. Mutations in FH also occur in the recessive condition fumarate hydratase deficiency, and some parents of people with this condition are susceptible to leiomyomata. Thus, heterozygous and homozygous or compound heterozygous mutants have very different clinical phenotypes. Our results provide clues to the pathogenesis of fibroids and emphasize the importance of mutations of housekeeping and mitochondrial proteins in the pathogenesis of common types of tumor.

Alleles↗
PubMed1998

Uterine artery blood flow parameters in women with dysfunctional uterine bleeding and uterine fibroids: the effects of tranexamic acid.

The objective of this study was to investigate the effects of tranexamic acid on uterine vascular resistance in women with dysfunctional uterine bleeding and in women with menorrhagia associated with fibroids. A longitudinal, prospective study was carried out in premenopausal women referred to a gynecological outpatient department with a complaint of menorrhagia. We studied 24 women with dysfunctional uterine bleeding (mean age 38.8 years; normal ultrasound examination, hysteroscopy and endometrial biopsy) and 12 women (mean age 42.8 years) with at least one fibroid greater than 2.0 cm on ultrasound examination. None were on any form of oral contraception or other medication which could influence uterine vascular resistance. All women had normal coagulation and thyroid function tests. Transvaginal scanning was performed using an Aloka SSD 650 machine with a 5-MHz probe and pulsed Doppler. Pulsatility index (PI) and resistance index (RI) were measured from the left and right uterine arteries before and during the second month of treatment with tranexamic acid (1 g orally three times a day). Menstrual blood loss was assessed using a validated pictorial blood chart. In women with dysfunctional uterine bleeding, the mean PI and RI fell significantly with treatment (PI 2.20-1.94, p = 0.0001; RI 0.81-0.77, p = 0.003). There was a reduction of approximately 30% in menstrual blood loss with treatment (210.0-137.6 ml, p = 0.0001). In women with uterine fibroids, there was no significant change in either the PI or the RI with treatment and there was no significant reduction in menstrual blood loss. We conclude that tranexamic acid significantly reduces uterine artery vascular resistance in women with dysfunctional uterine bleeding. This effect is unlikely to be a mechanism for the action of tranexamic acid in reducing menstrual blood loss but may have important implications for women taking this treatment in the long term.

Adult↗
PubMed1999

Fibroids: pathophysiology and current medical treatment.

Uterine leiomyomas, or fibroids, are a major cause of abnormal uterine bleeding in women. These benign tumours develop during the reproductive years and their growth has been shown to be dependent on the ovarian steroid hormones oestradiol and progesterone. The growth promoting effects of these steroid hormones appear to be mediated through the local production of specific growth factors. Traditional treatment for leiomyomas has been surgical removal through either hysterectomy or myomectomy. Newer surgical techniques, such as hysteroscopic removal of leiomyomas, endometrial ablation, or uterine arterial embolization, are now being tested as effective but less invasive methods of treatment. Non-surgical treatment of leiomyomas has been primarily through the use of gonadotrophin-releasing hormone agonists which suppress circulating oestradiol and progesterone levels by shutting down the pituitary-ovarian axis. The suppression in steroid hormone levels results in significant fibroid shrinkage, but long-term use of these compounds is not recommended because patients suffer significant bone loss. New antisteroidal compounds, such as the antiprogestin RU 486 and the selective oestrogen-receptor modulator raloxifene, are now being tested as possible therapeutic agents for fibroids.

Embolization, Therapeutic↗
PubMed2006

Uterine fibroid embolization.

Uterine fibroid embolization (UFE) is a minimally invasive therapy for the treatment of symptomatic uterine fibroids and offers an alternative to conventional myomectomy and hysterectomy. This review focuses on recent publications evaluating UFE and concludes that it is a safe treatment option, providing substantial improvement in both health-related quality of life and symptom control for most patients, with a very low rate of major complications. The durability of these outcomes appears similar to those obtained with myomectomy; however, a direct comparative long-term study is needed. Recent comparative studies have begun to provide more insight in to UFE outcomes compared with outcomes achieved with myomectomy and hysterectomy. UFE should be considered a first line therapy for women with symptomatic uterine fibroids. Additional research will continue to provide us with information as to the ideal candidates for UFE and may provide us with better tools to predict patient outcomes.

Embolization, Therapeutic↗
PubMed2002

[Uterine fibroid embolization - a new therapeutic option for symptomatic leiomyomata of the uterus].

Uterine fibroid embolization (UFE) is a new minimal-invasive therapy for the treatment of symptomatic leiomyomata of the uterus and a uterine-sparing alternative to surgical procedures. Short-term and mid-term results indicate a high clinical success rate with improvement of fibroid-related bleeding symptoms in 80 - 100 % of cases, improvement of bulk symptoms in 60 - 100 % of cases and reduction in fibroid volume at an average of about 36 - 78 % combined with a low rate of complications and side effects. This review discusses indications and contraindications, technique and pathophysiology, choice of material, results and complications of UFE on the basis of the current literature and our own results.

Angiography↗
PubMed2004

A case of inflammatory fibroid polyp causing small-bowel intussusception in which retrograde double-balloon enteroscopy was useful for the preoperative diagnosis.

We showed a newly developed method, retrograde double-balloon enteroscopy, to be useful for preoperative diagnosis in a case of inflammatory fibroid polyp accompanied by small-bowel intussusception. A 64-year-old woman was admitted to our hospital with small-bowel intussusception. Results of radiographic and ultrasonographic examination were suggestive of a small-bowel mass. Retrograde double-balloon enteroscopy was performed in an attempt to make a preoperative diagnosis. Endoscopic observation, in combination with histological findings derived from endoscopic biopsy, was suggestive of an inflammatory fibroid polyp. The patient then underwent laparotomy with minimal incision, which revealed a polypoid mass leading to a jejunojejunal intussusception, without bowel necrosis, and a partial small-bowel resection was performed. The pathological diagnosis was an inflammatory fibroid polyp.

Endoscopy, Gastrointestinal↗
PubMed2006

Management of uterine fibroids in Enugu, Nigeria.

A 5-year review of management of uterine fibroids at the university of Nigeria Teaching Hospital Enugu revealed that symptomatic uterine fibroids constituted 9.8% of all gynaecological admissions. The peak incidence n = 51 (26.8%) was in the age range of 31 - 35 years and the majority of the women n = 77 (40.5%) were nulliparous. The main clinical features were lower abdominal discomfort, menorrhagia and associated infertility. There was no medical management. The surgical management consisted of myomectomy by laparotomy (60%); total abdominal hysterectomy (24.7%); total abdominal hysterectomy and bilateral salpingo-oophorectomy (12.1%), and polypectomy (3.2%). There was no endoscopic surgery available. Postoperative morbidity was high but there was no mortality. Uterine fibroids mostly managed by myomectomy at laparotomy remains a major public health problem in Enugu Nigeria.

Adult↗
PubMed1998

Features of uterine fibroids treated by abdominal myomectomy at Nnewi, Nigeria.

Seventy-two women with symptomatic uterine fibroids were treated by abdominal myomectomy from January 1994 to December 1996. Important features were a mean age of 32.3 years (range 25-49 years) and parity of 0 to 6; 83% ( n = 60) were nulliparous and 68% ( n = 49) were unmarried. The average estimated blood loss was 480 ml with 1.6 g/dl mean haemoglobin drop and 15.3% required blood transfusion. Complications were mild and infrequent; 7% ( n = 5) had mild wound infection and 16.7% ( n 12) had a febrile complication. The average hospital stay was 8.1 days. There was no mortality. In this study, symptomatic uterine fibroids requiring abdominal myomectomy predominantly affected young women who were mainly unmarried and nulliparous. Although the the operation was safe and well tolerated, preoperative GnRH(a) is recommended to reduce fibroid size and need for blood transfusion.

Journal Article↗
PubMedDate not supplied

The illness experiences of women with fibroids: an exploratory qualitative study.

Previous research suggests that women attending gynaecology clinics experience high rates of psychological distress and psychiatric morbidity. Although the reasons for this are poorly understood, certain conditions appear to cause women particularly high levels of anxiety and depression. This paper reports a qualitative study, using Interpretative Phenomenological Analysis (IPA), to examine the illness experiences of women with the common gynaecological condition of fibroids. The study employs semi-structured interviews, guided by Leventhal's self-regulation model, to explore 18 women's understanding and experiences of having fibroids. Qualitative analysis revealed eight themes drawn into two higher-order themes - 'Managing uncertainty' and 'Struggling between defeat and optimism'. These higher-order themes illustrate the multiplicity of experiences and meanings used by women attempting to understand their condition, treatment options and future health outcomes. The differences in women's illness representations may account for differences in their relative distress levels. The findings indicate the importance of considering an individual's illness representations in order to facilitate the provision of appropriate medical and psychological care to women with fibroids.

Adult↗
PubMed2000

Inflammatory fibroid polyp and Helicobacter pylori. Aetiology or coincidence?

OBJECTIVE: To evaluate our incidence of inflammatory fibroid polyps, compare our experience with that of others, and to analyze the possible pathophysiological and aetiological factors. DESIGN: Retrospective review. SETTING: Teaching hospital. MATERIAL: All histopathological slides of the gastrointestinal tract. MAIN OUTCOME MEASURES: Incidence and treatment in our Medical Center and elsewhere. RESULTS: We could find only one case of inflammatory fibroid polyp, an estimated incidence of 1/4000. Between 1987-1996 only 331 were reported elsewhere, most of which (293, 88.5%), were located in the stomach. CONCLUSION: Primary mucosal damage can expose the stroma to several irritants (chemical, mechanical and biological), that may subsequently cause inflammatory fibroid polyps in certain people.

Amoxicillin↗
PubMed1996

GnRH analogues in the treatment of uterine fibroids.

It is now known that gonadotrophin-releasing hormone analogues (GnRHa) are extremely efficient at reducing uterine fibroid volume and reversing the related symptomatology. However, the fibroids tend to return to their pretreatment size about 6 months after discontinuing treatment. GnRHa treatment cannot be continued indefinitely due to its potential complications and high cost. It is therefore proposed that GnRHa treatment should be phase one of a two-phase treatment plan for uterine fibroids. The initial course of GnRHa should be followed by either menopause or surgery. Experience with presurgical GnRHa use indicates a definite treatment advantage and the use of GnRHa as adjuncts to surgery is well established. The value of GnRHa treatment as a alternative to surgery in pre-menopausal patients, however, remains to be established.

Adult↗
PubMed2002

The effect on IVF outcome of small intramural fibroids not compressing the uterine cavity as determined by a prospective matched control study.

BACKGROUND: Several studies have reported that the presence of intramural fibroids affects conception following IVF. We attempted to corroborate or refute the conclusions relating to IVF and leiomyomas of the aforementioned studies. METHODS: Women with small intramural leiomyomata (< or = 5 cm) discovered on initial pelvic sonographic studies performed in preparation for IVF were prospectively matched by age, with the next patient of the same age undergoing IVF who did not demonstrate fibroids (controls). RESULTS: Though no significant differences were found in outcome when comparing these two groups, there was a distinct trend for lower live delivery rates and higher miscarriage rates. CONCLUSIONS: These data support the conclusions of the only other prospective matched control study evaluating similar factors, i.e. that small intramural fibroids can negatively affect IVF outcome. Nevertheless, we think that a multicentre study should be conducted first before evaluating whether myomectomy improves outcome or not.

Abortion, Spontaneous↗
PubMed2006

Uterine artery embolization for symptomatic fibroids: short-term versus mid-term changes in disease-specific symptoms, quality of life and magnetic resonance imaging results.

BACKGROUND: Prospective study to evaluate changes in symptom severity, health-related quality of life (HRQOL) and uterine and leiomyoma volume after uterine artery embolization (UAE). METHODS: Eighty-two women completed a validated uterine fibroid symptom and quality of life (UFS-QOL) questionnaire and underwent magnetic resonance imaging (MRI) before and 3-20 months after UAE. Primary outcome measures were changes in symptom severity and QOL at short-term follow-up [median 5 (range 3-7) months] and mid-term follow-up [median 14 (8-20) months]. Secondary outcome measures included the frequency of additional procedures to control persistent symptoms and changes in dominant fibroid volume (DFV) and uterine volume (UV). RESULTS: Of 82 patients, 71 (86.6%) patients completed follow-up, 7 (8.5%) patients had a second procedure and 4 (4.9%) were lost to follow-up. Symptom severity scores decreased from a median of 43.75 to 21.88 (P < 0.001) in the short-term follow-up group and from a median of 43.75 to 9.38 (P < 0.001) in the mid-term follow-up group. QOL scores increased from a median of 56.90 to 87.93 (P < 0.001) and 66.81 to 96.12 (P < 0.001), respectively. During short-term follow-up, median UV decreased by 27% (95% CI 20.25-33.81, P < 0.001) and median DFV by 62% (95% CI 47.81-71.55, P < 0.001), whereas UV decreased by 36% (95% CI 23.34-55.02, P < 0.001) and DFV by 66% (95% CI 54.28-71.92, P < 0.001) for the mid-term follow-up group. A decrease in UV correlated with change in symptom severity (P < 0.005). CONCLUSIONS: Women report significant improvements in fibroid-specific symptoms and QOL at short- and mid-term follow-ups after UAE.

Adult↗
PubMed1992

Peripheral CA 125 levels in patients with uterine fibroids.

CA 125, a marker of ovarian cancer, is also increased in otherwise normal women suffering from, for example, pelvic inflammatory disease, endometriosis and adenomyosis. The tissues suspected of producing CA 125 in normal women include the endometrium, the ovary and the peritoneum. This study was based on the hypothesis that uterine myomata would distend the peritoneum covering the uterus and thereby increase the peripheral levels of CA 125. To verify this hypothesis we measured CA 125 by an immunoradiometric assay in eight normal women every second day throughout the cycle and in 26 women with uterine fibroids before and after hysterectomy and at 8 and 12 weeks during gonadotrophin releasing hormone (GnRH) analogue therapy. In normal women no difference was observed between CA 125 levels in the follicular phase or in the luteal phase of the cycle. Over one-third (10/26) of the patients with uterine fibroids had increased (greater than 90th centile of the controls) levels of CA 125 before GnRH therapy or hysterectomy. Removal of the uterus or administration of GnRH significantly decreased peripheral concentrations of CA 125 to levels below those observed in normal women. Furthermore, a significant positive correlation was observed between the levels of CA 125 and the volume of myomata as assessed by ultrasound. We conclude that in those cases of uterine fibroids where CA 125 is increased, monitoring this parameter during GnRH therapy is a good indirect measurement of regression of myomata.

Adult↗
PubMed2000

Interstitial thermo-ablation under MRI guidance for the treatment of fibroids.

Women with symptomatic uterine fibroids are increasingly seeking alternatives to open surgery. The combination of high resolution magnetic resonance imaging and the application of laser heat permit percutaneous treatment of fibroids under local anaesthetic. This article reviews the technique of interstitial thermo-ablation and other current minimally invasive therapies for symptomatic fibroids.

Adult↗
PubMed2001

Alternative treatment for symptomatic fibroids.

The present review discusses treatment options for symptomatic fibroids. Although the standard treatment of fibroids has been surgical hysterectomy, an increasing number of reports indicate that uterine artery embolization with preservation of the uterus is a promising alternative. Other surgical and medical approaches reported during the past year are also addressed. The review summarizes patient selection, contraindications, results, complications and future considerations. Complications following uterine artery embolization treatment for symptomatic fibroids have been minor in comparison with those following hysterectomy. Although patient satisfaction is good, none of the studies included control individuals and further studies are needed to optimize patient selection and to evaluate long-term results of treatment.

Embolization, Therapeutic↗
PubMed2002

Minimally invasive management of uterine fibroids.

PURPOSE OF REVIEW: Many minimally invasive techniques have recently been introduced for the management of uterine fibroids. The purpose of this review is to analyse recent data for techniques that are used to manage uterine fibroids. RECENT FINDINGS: Laparoscopic myomectomy has provided a minimally invasive alternative to laparotomy for intramural and subserous myomata. However, this technique is still the subject of debate. With good surgical experience, the risk of perioperative complications is comparable with conventional surgery. Laparoscopic myomectomy is associated with faster postoperative recovery, and could potentially reduce the risk of postoperative adhesions compared with laparotomy. Spontaneous uterine rupture, although uncommon after laparoscopic myomectomy, is still a concern. The risk of recurrence seems to be higher after laparoscopic myomectomy than after myomectomy performed by laparotomy. Uterine artery embolization is another new and attractive treatment for patients with symptomatic fibroids. Uterine artery embolization provides excellent relief for abnormal bleeding, pelvic pain, and bulk-related symptoms. Early reports show that uterine artery embolization is associated with normal reproductive and obstetric functions. This technique is associated with a shorter hospital stay and a rapid recovery time. SUMMARY: Laparoscopic myomectomy and uterine artery embolization are being performed more than ever. Current evidence proves the safety, reliability and reproducibility of both procedures. However, prospective randomized controlled trials comparing both procedures with conventional myomectomy are needed.

Clinical Trials as Topic↗