The thing that bothers me about the hysteroscopic myomectomy is the sodium fluid used to open the uterus.  I read that if you accidentally get too much of it, you can have some very serious problems.

One of the risks of hysteroscopic surgery is fluid overload.  This can happen with any type of fluid, with or without sodium.  I use an electronic device to monitor the amount of fluid absorbed.   

Fluid overload is a genuine concern, but there are a number of things an experienced hysteroscopic surgeon can do to reduce that risk.  It is unusual for a very experienced hysteroscopic surgeon to have serious fluid overload problems. - Paul Indman, M.D.

Refer to Dr. Paul Indman's web site: www.myomectomy.net/laparoscopic_myomectomy.htm www.myomectomy.net/hysteroscopic_myomectomy.htm  www.myomectomy.net/abdominal_myomectomy.htm  

My doctor is board certified and says she has performed hysteroscopic myomectomy procedures.  But, she doesn't appear to be certified by the Accreditation Council for Gynecologic Endoscopy. What credentials do you think are necessary for a doctor to be proficient at hysteroscopic myomectomy? 

Hard to say.  Some get it with 20-30 procedures, and others never get it down.  Although the AAGL accreditation means someone took the time to apply, it doesn't tell you anything about the skill of the surgeon.  I'm afraid the only way to know is to ask other doctors or nurses who have actually observed that surgeon operate. - Paul Indman, M.D.

Can you explain the endometrial biopsy procedure?  How should a patient prepare for it? 

An endometrial biopsy involves placing a small suction tubing through the cervix, and "vacuuming" a small amount of the endometrium (lining of the uterus).  It is helpful to detect cancer, but doesn't help detect polyps or submucous myomas.  Because of this, I rarely do an endometrial biopsy unless I also do a hysteroscopy at the same time to see the inside of the uterus. 

I always numb the cervix (paracervical block) before doing either procedure, which is painless to do, and greatly decreases the discomfort of the procedure.  I also advise my patients (unless there is some reason why they shouldn't) to take 800 mg of ibuprofen or similar medicine 2 hours before the procedure. – Paul Indman, M.D.   Note:  My Journey - endometrial biopsy

I have had fibroids for many years and I just recently had an ultrasound performed.  The following is the impression that I received; can you please help me understand this?  Impression:  Diffuse myomatous changes of the uterus. The endometrial echo and adnexa are normal. 

It means that there appear to be lots of fibroids.  There is no evidence of thickening of the endometrium - which is seen in some non-fibroid problems, and the ovaries and tubes look normal. -  Robert Worthington-Kirsch, M.D.      

Are there different types of CAT Scan dyes/contrasts used for UAE?

The contrast used is the same as that used for CT scan.  There are a number of different formulations, but they are all pretty similar.  -  Robert Worthington-Kirsch, M.D. 

Can a woman have UAE performed if she had an allergic reaction to CAT Scan dye?

It depends on the severity of the reaction they've had.   If only a mild reaction, we can pre-treat with steroids and do the UAE.   If a patient has had a life-threatening contrast reaction, this shifts the risk/benefit ratio to the extent that UAE may not be a good choice.   This is an individual decision that depends on the specifics of the patient's situation and needs to be discussed in consultation with an experienced IR.  

The incidence of allergic reaction in the general population is about 1:5000. -  Robert Worthington-Kirsch, M.D.

What happens if a woman has a reaction to the CAT Scan dye during her UAE procedure?  What are the signs of a reaction?

If you're going to have a reaction it will be within 5-15 minutes of contrast exposure - while the procedure is in progress. Reactions range from a few hives to severe or even life threatening (the most common are the mildest).   An experienced IR and his/her team are equipped to recognize and manage these issues.

Once the procedure is done there is no need to worry about any kind of 'delayed' reaction to contrast.  -  Robert Worthington-Kirsch, M.D.

Is the CAT Scan dye used during the UAE procedure eventually released out of the body?  How is this done?

It's filtered by your kidneys and excreted in the urine.   Most of the dye is gone within 30 minutes. -  Robert Worthington-Kirsch, M.D.