Uterine Artery Embolization for Symptomatic Adenomyosis Long-Term Results
Uterine Artery Embolization for Symptomatic Adenomyosis Long-Term Results
Objective: Controversy exists regarding the effectiveness of uterine artery embolization (UAE) in the management of symptomatic adenomyosis. The aim our study was to determine the long-term clinical efficacy of UAE in the management of symptomatic adenomyosis without fibroids.
Materials and Methods: The cases of all patients who underwent UAE for adenomyosis without fibroids between 1998 and 2000 were analyzed. This study was a retrospective review of a prospectively collected database. Of the 66 patients, 54 patients with a follow-up period of 3 years or longer were enrolled in the study. Twelve patients were lost to follow-up. The patients' ages ranged from 29 to 49 years (mean, 40.2 years). The mean follow-up period was 4.9 years (range, 3.5-5.8 years). The primary embolic agent was polyvinyl alcohol particles (250-710 µm). All patients underwent MRI before UAE. Long-term follow-up MRI was performed on 29 patients; 22 of these patients had undergone short-term (3.5 months) follow-up MRI. Uterine volume was calculated with MR images. Symptom status in terms of menorrhagia and dysmenorrhea was scored on a scale of 0-10, 0 being no symptoms and 10 being the baseline, or initial symptoms.
Results: Thirty-one (57.4%) of the 54 women who underwent follow-up had long-term success. Four had immediate treatment failure, and 19 had relapses. Changes in mean menorrhagia and dysmenorrhea scores at long-term follow-up were -5.3 and -5.1, respectively (p < 0.001), representing significant relief of symptoms. The time between UAE and recurrence of symptoms ranged from 4 to 48 months (mean, 17.3 months). Five patients underwent hysterectomy because of symptom recurrence. Mean reduction in volume of the uterus was 26.3% at short-term follow-up and 27.4% at long-term follow-up.
Conclusion: We found that UAE is effective in the management of symptomatic adenomyosis and has an acceptable long-term success rate. UAE should be considered a primary treatment method for patients with symptomatic adenomyosis. However, all patients should be given an explanation of the possibility of treatment failure, recurrence, and the need for hysterectomy.
Adenomyosis is characterized by the presence of heterotopic endometrial glands and stroma deep within the myometrium with adjacent myometrial hyperplasia. The frequency of adenomyosis reported in the literature ranges widely, from 8.8% to 31%. Although adenomyosis can be asymptomatic, patients frequently present with symptoms of menorrhagia, dysmenorrhea, and bulk-related symptoms due to uterine enlargement. Hysterectomy is considered definitive management of adenomyosis, but uterine artery embolization (UAE) has been suggested as an alternative treatment. Despite reports of positive short-term outcome, uncertainty remains about the long-term effectiveness of UAE for symptomatic adenomyosis. Some authors have described adenomyosis as a cause of failure of embolization of fibroids. The aim of this study was to determine the long-term clinical efficacy of UAE for symptomatic adenomyosis without fibroids.
Abstract and Introduction
Abstract
Objective: Controversy exists regarding the effectiveness of uterine artery embolization (UAE) in the management of symptomatic adenomyosis. The aim our study was to determine the long-term clinical efficacy of UAE in the management of symptomatic adenomyosis without fibroids.
Materials and Methods: The cases of all patients who underwent UAE for adenomyosis without fibroids between 1998 and 2000 were analyzed. This study was a retrospective review of a prospectively collected database. Of the 66 patients, 54 patients with a follow-up period of 3 years or longer were enrolled in the study. Twelve patients were lost to follow-up. The patients' ages ranged from 29 to 49 years (mean, 40.2 years). The mean follow-up period was 4.9 years (range, 3.5-5.8 years). The primary embolic agent was polyvinyl alcohol particles (250-710 µm). All patients underwent MRI before UAE. Long-term follow-up MRI was performed on 29 patients; 22 of these patients had undergone short-term (3.5 months) follow-up MRI. Uterine volume was calculated with MR images. Symptom status in terms of menorrhagia and dysmenorrhea was scored on a scale of 0-10, 0 being no symptoms and 10 being the baseline, or initial symptoms.
Results: Thirty-one (57.4%) of the 54 women who underwent follow-up had long-term success. Four had immediate treatment failure, and 19 had relapses. Changes in mean menorrhagia and dysmenorrhea scores at long-term follow-up were -5.3 and -5.1, respectively (p < 0.001), representing significant relief of symptoms. The time between UAE and recurrence of symptoms ranged from 4 to 48 months (mean, 17.3 months). Five patients underwent hysterectomy because of symptom recurrence. Mean reduction in volume of the uterus was 26.3% at short-term follow-up and 27.4% at long-term follow-up.
Conclusion: We found that UAE is effective in the management of symptomatic adenomyosis and has an acceptable long-term success rate. UAE should be considered a primary treatment method for patients with symptomatic adenomyosis. However, all patients should be given an explanation of the possibility of treatment failure, recurrence, and the need for hysterectomy.
Introduction
Adenomyosis is characterized by the presence of heterotopic endometrial glands and stroma deep within the myometrium with adjacent myometrial hyperplasia. The frequency of adenomyosis reported in the literature ranges widely, from 8.8% to 31%. Although adenomyosis can be asymptomatic, patients frequently present with symptoms of menorrhagia, dysmenorrhea, and bulk-related symptoms due to uterine enlargement. Hysterectomy is considered definitive management of adenomyosis, but uterine artery embolization (UAE) has been suggested as an alternative treatment. Despite reports of positive short-term outcome, uncertainty remains about the long-term effectiveness of UAE for symptomatic adenomyosis. Some authors have described adenomyosis as a cause of failure of embolization of fibroids. The aim of this study was to determine the long-term clinical efficacy of UAE for symptomatic adenomyosis without fibroids.
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