Intervention Management of Uterine Fibroma (Pages: 0-0)


Akhlaghpour A.A *,

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Leiomyomata uteri are the most frequent myometrial disorders and the most common pelvic tumor in women. Although most women with uterine leiomyomas do not seek therapy 20% to 40% of women in the reproductive age do have significant enough symptoms caused by these fibroids to cause the woman to seek and warrant therapy. Since 1995 uterine fibroid embolization (UFE) or uterine artery embolization (UAE) was originally devised to reduce pelvic bleeding due to postpartum hemorrhage . it has been introduced as a treatment for symptomatic uterine myomas sparing the uterus. Without a good blood supply it has been shown fibroids will decrease in size between 30% and 50% and decrease in symptomatology. Initial studies have shown that UAE can improve menorrhagia in 90% of patients at 1 year after therapy. On average the volume of the fibroids decrease by 30%–60% and the associated symptoms (of mass effect) are successfully treated in 71% of patients. Complications include postprocedure pain and postembolization syndrome possibly related to the release of cytokines and toxins from the ischemic tissue. Vascular anastomotic communications between the uterine and ovarian arteries provide a route by which embolization materials can affect the ovarian blood supply and ovarian function either permanently or temporarily. So Currently UAE is not recommended as the first line of therapy in patients with infertility presumed to be caused by fibroids. Magnetic resonance imaging–guided focused ultrasound surgery (MRIgFUS) is another groundbreaking minimally invasive alternative to surgery for fibroids. Focused ultrasound causes local tissue thermal coagulation ablates the target fibroid and allows preservation of uterine function. It is a feasible and safe outpatient procedure that does not require hospitalization. The procedure begins with the delivery of low-power (50–100 watt) sonication with real-time thermometry acquired simultaneously. We will discuss these two techniques in detail and share our experience.