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“WHAT IS THE ANSWER TO MY UTERINE FIBROID QUESTION?” A PATIENT ASKS HER INTERVENTIONAL RADIOLOGIST AND GYNECOLOGIST
Will
there be any hormonal changes after the UAE, hysterectomy, myomectomy, or
endometrial ablation? If so,
what kind of hormonal changes?
Most women have no interruption in
their menstrual cycle after UAE. About 10% of patients have irregular
periods for 3-6 months after UAE. Rarely women will never have another
period after UAE. The chance of this is below 1% for women under 40 and
about 10% for women over 45. Hormonal changes after hysterectomy appear to
be a bit more common than after UAE.
I understand you were part of a committee
that drafted a standard for the training which physicians should have
before they attempt to provide UAE? All physicians who perform the UAE procedure should have the following training: Fifteen hours of formal Continuing Medical Education (CME) accredited study in the basic principles of the diagnosis and management of fibroid disease. (1) Fellowship in Interventional Radiology involves a full year of training in just IR, which includes the full range of procedures including sophisticated vascular catheterization and embolizations. Training in skills of recognizing pitfalls that can lead to serious complications during UAE procedures and how to manage the problems. (2) Practice experience of 100 arteriograms, of which at least 50 must include placement of the catheter into specific branches of the vessels supplying the bodily organs. Perform at least 25 embolization procedures and show documentation on these procedures.
(3)Proctorship – trained under the guidance of an experienced physician in
UAE procedures completes 100 arteriographic procedures without significant
complications. Catheterize
both uterine arteries in minimum of 25 patients successfully and safely. In addition anyone who wishes to
perform UAE should have a minimum of five hours of CME study in the
specific area of Radiation Protection and Safety. Board Certification: Interventional Radiologists have base training as Diagnostic Radiologists, and should be Board Certified. In addition, both the
American Board of Radiology (for MDs) and the American Osteopathic Board
of Radiology (for DOs) have a subspecialty board certification for
Interventional Radiologists. A fully-trained Interventional Radiologist
should have this subspecialty board certification.
Is there anyone who is not a candidate for UAE and if so why? Some women
have other pelvic disorders in addition to fibroids, and need to have
those addressed first. Some
women with specific patterns of fibroid disease may well be better served
by surgery. Because of
equipment limitations, I am unable to treat a patient who weighs 280 lbs.
or more.
There are no fibroid size limitations in my practice
(Dr. Kirsch).
I have treated women with large fibroid uteri, in a few cases as
large as a term pregnancy.
These women have done just as well as women with smaller uteri, so long as
they do not have unrealistic expectations for size reduction.
Will UAE work on multiple uterine fibroids
that are inside and outside the uterus or in the walls? What is the success rate of
patients who have this situation? UAE is a
global treatment of the uterus. As such it treats all fibroids present,
regardless of where in the uterus they are. UAE is effective regardless of
the size, number, and distribution of fibroids. What is the largest size uterine fibroids can grow? What is the highest number of uterine fibroids in one of your patients that you performed the UAE procedure on?A fibroid uterus can be as large as a full-term pregnancy. I have treated a few women with fibroids this extensive, with good results. |
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