Outpatient Fibroid Treatment Beats Open Surgery
March 6, 2001 (San Antonio) -- An outpatient procedure not only stops the heavy menstrual bleeding caused by benign fibroid tumors in the uterus, but also does it with less pain and faster recovery than open surgery. It also improves sexual function in some women, according to studies reported here at a meeting of interventional radiologists.
Fibroids are benign, noncancerous growths in the uterus. They are very common -- as many as 40% of women 35 and older get them. When fibroids become large, they can cause pain, heavy and prolonged menstrual bleeding, and a feeling of pressure or fullness in the abdomen.
When weighing what treatment to choose for fibroids, though, one expert says more patients learn about the outpatient technique from the Internet than from their gynecologists. If their gynecologists won't support them in seeking the treatment, many women are finding new doctors.
The technique is called uterine fibroid embolization, or UFE. During UFE, a radiologist guides a small tube through a small cut in the groin up into the artery feeding the uterus. The tube is used to deliver tiny beads that block the enlarged blood vessels feeding the fibroids, causing them to shrink.
"What we found is that in terms of control of bleeding, the embolization group did much better than the [abdominal surgery] group," Mahmood K. Razavi, MD, tells WebMD. "My feeling is it shouldn't be a second alternative, it should be the first alternative for bleeding patients."
The findings come from the first direct comparison of UFE to open surgery to remove fibroids without removing the uterus. The study did not look at patients who underwent a less-invasive form of surgery called laparoscopy.
The comparison of UFE and removal of fibroids via traditional, open surgery -- abdominal myomectomy -- is a collaborative study between Razavi and gynecologist Bertha H. Chen, MD, at Stanford University Medical Center. Over a three-year period, Razavi and Chen compared data from UFEs and abdominal myomectomies they performed.
The 76 UFE patients tended to be older, about age 45 vs. 38, and better informed than the 36 myomectomy patients available for follow-up. There was no significant difference between the two groups in terms of fibroid symptoms.
Myomectomy patients did tend to report better improvement in the sensation of uterine pressure, while UFE patients tended to report less pain after the procedure. Consequently, UFE patients reported using pain medication for only three to four days, compared to a week for myomectomy patients. UFE patients also returned to normal activity in about seven days instead of 35 days for those who underwent open surgery, and about 4% of UFE patients reported complications compared to more than 19% of the myomectomy patients.
"In myomectomy, they can't get all the fibroids, but with embolization, all of the fibroids are treated at the same time," Razavi says. "The key is that for appropriately selected patients, embolization performed better than myomectomy."