Treatment of uterine fibroids by embolization--advantages, disadvantages, and pitfalls

Abstract

Uterine fibroids are the most common benign tumors of the female genital tract. Apart from vaginal or abdominal hysterectomy, which has been in use for more than 100 years, the more recently established techniques of laparoscopy and hysteroscopy provide two additional treatment approaches. In cases of symptomatic uterine fibroids, the most widely accepted alternative to surgery is the catheter-supported embolization of uterine arteries (uterine artery embolization, UAE). All patients who wish to be treated by UAE because of symptomatic fibroids should be presented to both gynecologists and radiologists. To the best of our knowledge, there are no interdisciplinary guidelines for UAE. Therefore, it would be very helpful if gynecologists and radiologists could reach an agreement for both indications and treatment strategies. However, there is no defined "gold standard" for fibroid therapy at all. In this respect, the therapeutic approach should be influenced less by the preference of the (potential) surgeon, and more by factors like size, localization, and number of fibroids. In addition, symptoms, ethnicity, and the wish to have children should be considered. Cooperation between radiologists and gynecologists is absolutely necessary, not only for the choice of the optimal treatment and care of patients, but also for the development of useful guidelines and future studies. UAE may be a therapeutic approach for selected patients. In these special cases, embolization is a safe and practical alternative to the established treatment options.