PURPOSE: To evaluate retrospectively the sequelae of fibroid expulsion (FE) after uterine artery embolization (UAE). MATERIALS AND METHODS: From a population of 759 UAE procedures performed from July 1999 to June 2009, 37 patients were found to have a uterine fibroid communicating with the endometrial cavity resulting in "bulk" FE with the passage of large fragments or an entire tumor or "sloughing" FE with shedding or "melting" of the tumor. Medical records and magnetic resonance images were evaluated for clinical information and tumor characteristics, respectively. RESULTS: The mean age of patients with FE was 43 years ± 5 (SD), with 12 nulliparous and 25 parous. Expulsion took place a mean of 14.8 weeks ± 17.7 after UAE (range, 1.6-105.9 wk). FE was asymptomatic in 5% of cases (n = 2) and symptomatic in 95% (n = 35). Among symptomatic cases, 89% (n = 31) had bulk expulsion and 11% (n = 4) had sloughing expulsion. Forty-nine percent of patients (n = 18) had tumor expulsion at home or had an office/emergency room transvaginal myomectomy (TVM), 27% (n = 10) underwent operative TVM, and 8% (n = 3) had hysteroscopic resection. Urgent and elective hysterectomies were performed in 11% (n = 4) and 5% of cases (n = 2), respectively. Nulliparous women showed a trend toward undergoing hysterectomy compared with parous women (33% vs 8%; P =.07, Fisher exact test). CONCLUSIONS: Most women tolerate FE well, with approximately half needing no operative intervention, but some may need to undergo hysteroscopy, operative TVM, or even hysterectomy. Nulliparous women are potentially at greater risk to require hysterectomy.
PURPOSE: To evaluate retrospectively the sequelae of fibroid expulsion (FE) after uterine artery embolization (UAE). MATERIALS AND METHODS: From a population of 759 UAE procedures performed from July 1999 to June 2009, 37 patients were found to have a uterine fibroid communicating with the endometrial cavity resulting in "bulk" FE with the passage of large fragments or an entire tumor or "sloughing" FE with shedding or "melting" of the tumor. Medical records and magnetic resonance images were evaluated for clinical information and tumor characteristics, respectively. RESULTS: The mean age of patients with FE was 43 years ± 5 (SD), with 12 nulliparous and 25 parous. Expulsion took place a mean of 14.8 weeks ± 17.7 after UAE (range, 1.6-105.9 wk). FE was asymptomatic in 5% of cases (n = 2) and symptomatic in 95% (n = 35). Among symptomatic cases, 89% (n = 31) had bulk expulsion and 11% (n = 4) had sloughing expulsion. Forty-nine percent of patients (n = 18) had tumor expulsion at home or had an office/emergency room transvaginal myomectomy (TVM), 27% (n = 10) underwent operative TVM, and 8% (n = 3) had hysteroscopic resection. Urgent and elective hysterectomies were performed in 11% (n = 4) and 5% of cases (n = 2), respectively. Nulliparous women showed a trend toward undergoing hysterectomy compared with parous women (33% vs 8%; P =.07, Fisher exact test). CONCLUSIONS: Most women tolerate FE well, with approximately half needing no operative intervention, but some may need to undergo hysteroscopy, operative TVM, or even hysterectomy. Nulliparous women are potentially at greater risk to require hysterectomy.
Authors: Denis Szejnfeld; Rômulo Florêncio Tristão Santos; Antonio Massamitsu Kambara; Marcelo Bueno de Oliveira Colli; Felipe Nasser; Mauricio de Sena Martins; Suzan Menasce Goldman Journal: Radiol Bras Date: 2022 Jul-Aug
Authors: Jeffrey L Roberson; Lauren N Krumeich; Nabil F Darwich; Victor Babatunde; Dorottya Laczko; Andrew Albee; Zhaohai Yang; Amr El Jack; Richard Shlansky-Goldberg; Mary DeAgostino-Kelly; Benjamin M Braslow Journal: J Med Case Rep Date: 2021-07-09