TEALE FENNING

Nick Raine-Fenning · Posted: Sat Dec 02, 2006 6:52 pm Post subject: Fibroid embolisation

Here is the summary of the Royal College of Radiologists Guideline on Uterine Arerty Embolisation in the Management of Fibroids

Summary of recommendations

1 While the early results of uterine artery embolisation (UAE) are encouraging, no long-term data exist.

2 UAE should be considered only for women with symptomatic fibroids who might otherwise be advised surgical treatment.

3 UAE as treatment for fibroids in infertile patients should be within a controlled clinical trial.

4 The procedure is contraindicated in women who have evidence of current or recent infection and women who are unwilling to have a hysterectomy in any circumstances.

5 Infection is the predominant cause of serious morbidity and mortality. Further research on the place of prophylactic antibiotic therapy and the value of pre-treatment screening for infection is needed.

6 Patients should be seen by a gynaecologist in the first instance and accurate pretreatment diagnosis is essential.

7 The procedure should only be undertaken by radiologists with specialised embolisation experience or who have undergone appropriate training.

8 The particular responsibilities of both gynaecologist and radiologist should be established prior to treatment and be set out in a relevant hospital protocol. The patient must be under a named responsible consultant at all times.

9 All cases of UAE must be part of a primary research programme and be registered with the Safety and Efficacy Register of New Interventional Procedures (SERNIP), class C procedure.

10 The collection of data relating to methodology, outcome, complications and pregnancy following UAE is essential; a national register is recommended.

11 These recommendations are intended for both the National Health Service and the private sector[/url]

Nick Raine-Fenning · Posted: Sat Dec 02, 2006 6:55 pm Post subject:

The key points for me include:

- no long term data

- not advised for subfertile women

- infection is the key cause of morbidity

- indicated for symptomatic women

Nick Raine-Fenning · Posted: Sat Dec 02, 2006 6:57 pm Post subject:

... and here is the NICE Guideline

rpwalavalkar · Teale Fenning Administrator Joined: 20 Jul 2006 Posts: 973

Material used

300 to 1200µm microspheres of tris-acryl gelatin or
300 to 700µm polyvinyl alcohol (PVA) plastic particles

Side effects

•Death - from septicemia resulting in multiple organ failure
•Infection - from tissue death of fibroids, leading to endometritis
•Misembolization - microspheres or polyvinyl alcohol (PVA) particles flow or drift into organs or tissues where they were not intended to be
•Ovarian damage, loss of ovarian function, Menopause
•Infertility
•Anorgasm
•Failure of surgery - continued fibroid growth or regrowth within four months
•Post-Embolization Syndrome (PES) - characterized by acute and/or chronic pain, temperatures of up to 102 degrees, malaise, nausea, vomiting and severe night sweats
•Foul vaginal odor and Vaginal discharge - coming from infected, necrotic tissue which remains inside the uterus
•Hysterectomy - due to infection, pain or failure of embolization
•Pain - severe, persistent pain
•Hematoma
•Fibroid expulsion
•Unsuccessful fibroid expulsion - fibroid trapped in the cervix causing infection requiring surgical removal
•allergic reaction to the contrast material
•Uterine adhesions and Asherman's

results –

Variable shrinkage of fibroids that averages 48 to 78 percent in volume.

Total uterine volume decrease of an average of 50 percent

81 to 92 significant improvement or resolution of abnormal uterine bleeding,

79 to 92 percent improvement in bulk symptoms

86 percent patient satisfaction

10 to 27 percent recurrence rate or regrowth of fibroids

Pregnancy reported, needs randomised study

Effect on fertility uncertain
_________________
Dr Miss. Raj Walavalkar MBBS MRCOG
TealeFenning Administrator
SR O&G Wessex Region

Nick Raine-Fenning · Posted: Sun Dec 03, 2006 3:06 pm Post subject: Re: UAE tidbits

rpwalavalkar · Teale Fenning Administrator Joined: 20 Jul 2006 Posts: 973

hi nick,

please don't be Shocked

. i got that from the HERS foundation site.
_________________
Dr Miss. Raj Walavalkar MBBS MRCOG
TealeFenning Administrator
SR O&G Wessex Region

Nick Raine-Fenning · Posted: Mon Dec 04, 2006 11:37 am Post subject:

I don't care where it came from it still makes me feel .... Shocked

Not sure I will tell people about this side effect!