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Capezzuoli T, Aslan B, Vannuccini S, Orlandi G, La Torre F, Sorbi F, Fambrini M, Petraglia F. Recurrence of Uterine Fibroids After Conservative Surgery or Radiological Procedures: a Narrative Review. Reprod Sci 2024; 31:1171-1178. [PMID: 38110820 DOI: 10.1007/s43032-023-01418-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 11/29/2023] [Indexed: 12/20/2023]
Abstract
The present narrative review aims to discuss the available data on the incidence and the risk factors of uterine fibroids (UFs) recurrence after different types of conservative surgical or radiologic procedures in women wishing to preserve their uterus. UFs are the most common benign tumors in women all over the world. Clinical presentation, including abnormal uterine bleeding (AUB), pelvic pain, bulky symptoms, and infertility affect patients' quality of life, and a large variety of conservative treatments are available especially for those with desire of pregnancy. Fertility sparing surgery, by either laparoscopy, hysteroscopy or laparotomy, or radiological interventions (uterine artery embolization, high-intensity focused ultrasound or magnetic resonance-guided focused ultrasound), are the most common therapeutic approaches. However, the genetic or acquired predisposition to UFs remain despite the treatments, and the recurrences are frequently described in a large percentage of patients. The most relevant risk factors for recurrence of UFs are young age at the first surgery, incomplete fibroid resection, the presence of multiple lesions, an enlarged uterus, and the coexistence with other pelvic diseases. The discussion on the possible medical strategy to reduce the recurrence is an open field of clinical investigation, in particular by using hormonal drugs.
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Affiliation(s)
- Tommaso Capezzuoli
- Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Careggi University Hospital, Viale Morgagni 44, 50134, Florence, Italy
| | - Batuhan Aslan
- Department of Obstetrics and Gynecology, Ankara University School of Medicine, Ankara, Turkey
| | - Silvia Vannuccini
- Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Careggi University Hospital, Viale Morgagni 44, 50134, Florence, Italy
| | - Gretha Orlandi
- Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Careggi University Hospital, Viale Morgagni 44, 50134, Florence, Italy
| | - Francesco La Torre
- Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Careggi University Hospital, Viale Morgagni 44, 50134, Florence, Italy
| | - Flavia Sorbi
- Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Careggi University Hospital, Viale Morgagni 44, 50134, Florence, Italy
| | - Massimiliano Fambrini
- Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Careggi University Hospital, Viale Morgagni 44, 50134, Florence, Italy
| | - Felice Petraglia
- Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Careggi University Hospital, Viale Morgagni 44, 50134, Florence, Italy.
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Yan X, Zhou L, He G, Liu X. Pregnancy rate and outcomes after uterine artery embolization for women: a systematic review and meta-analysis with trial sequential analysis. Front Med (Lausanne) 2023; 10:1283279. [PMID: 38179282 PMCID: PMC10764427 DOI: 10.3389/fmed.2023.1283279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 11/30/2023] [Indexed: 01/06/2024] Open
Abstract
Objective The assessment of the relative impacts of uterine artery embolization (UAE) treatment for female patients is a critical field that informs clinical decisions, yet there is a noticeable scarcity of high-quality, long-term comparative studies. This meta-analysis aimed to focus on the pregnancy rate and outcomes in female patients following UAE and to conduct subgroup analyses based on different patient populations or various control treatments. Methods A systematic literature search was conducted on 2 August 2023 through the Web of Science, PubMed, Embase, and the Cochrane Library of Clinical Trials for all potential studies. Relative risks (RRs) with 95% confidence intervals (CIs) were applied to compare pregnancy rates and outcomes between the UAE group and the control group. Heterogeneity was evaluated statistically by using the chi-square-based Cochran's Q test and Higgins I2 statistics, and 95% prediction interval (PI). Software R 4.3.1 and Stata 12.0 were used for meta-analysis. The trial sequential analysis (TSA) was performed with TSA v0.9.5.10 Beta software. Results A total of 15 eligible studies (11 cohort studies, 3 randomized controlled trials, and 1 non-randomized clinical trial) were included in this meta-analysis. The overall results revealed that UAE significantly decreased postoperative pregnancy rate [RR (95% CI): 0.721 (0.531-0.979), 95% PI: 0.248-2.097] and was associated with an increased risk of postoperative PPH [RR (95% CI): 3.182 (1.319-7.675), 95% PI: 0.474-22.089]. Analysis grouped by population indicated that UAE decreased the risk of preterm delivery [RR (95% CI): 0.326 (0.128-0.831), p = 0.019] and cesarean section [RR (95% CI): 0.693 (0.481-0.999), p = 0.050] and increased the risk of placenta previa [RR (95% CI): 8.739 (1.580-48.341), p = 0.013] in patients with UFs, CSP, and PPH, respectively. When compared with myomectomy, HIFU, and non-use of UAE, UAE treatment was associated with the reduced risks of preterm delivery [RR (95% CI): 0.296 (0.106-0.826)] and cesarean section [(95% CI): 0.693 (0.481-0.999), p = 0.050] and increased placenta previa risk [RR (95% CI): 10.682 (6.859-16.636)], respectively. Conclusion UAE treatment was associated with a lower postoperative pregnancy rate and increased risk of PPH. Subgroup analysis suggested that UAE was shown to decrease the risk of preterm delivery and cesarean section and increase placenta previa risk.Systematic review registration:https://www.crd.york.ac.uk/prospero/, Identifier CRD42023448257.
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Affiliation(s)
- Xiaoli Yan
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China
- Department of Gynecology and Obstetrics, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Le Zhou
- Laboratory of the Key Perinatal Diseases, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Guolin He
- Laboratory of the Key Perinatal Diseases, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Xinghui Liu
- Laboratory of the Key Perinatal Diseases, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
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Embolización de arterias uterinas para el manejo de miomas sintomáticos. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2023. [DOI: 10.1016/j.gine.2022.100830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Huang Q, Zhou Y, Li K, Pan L, Liu Y, Bai J, Ji X. Parameter effects on arterial vessel sonicated by high-intensity focused ultrasound: an ex vivo vascular phantom study. Phys Med Biol 2022; 67. [DOI: 10.1088/1361-6560/ac910c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 09/09/2022] [Indexed: 11/11/2022]
Abstract
Abstract
Objective. This study is aimed to explore the effects of vascular and sonication parameters on ex vivo vessel sonicated by high-intensity focused ultrasound. Approach. The vascular phantom embedding the polyolefin tube or ex vivo vessel was sonicated. The vascular phantom with 1.6 and 3.2 mm tubes was sonicated at three acoustic powers (2.0, 3.5, 5.3 W). The occlusion level of post-sonication tubes was evaluated using ultrasound imaging. The vascular phantom with the ex vivo abdominal aorta of rabbit for three flow rates (0, 5, 10 cm s−1) was sonicated at two acoustic powers (3.5 and 5.3 W). Different distances between focus and posterior wall (2, 4, 6 mm) and cooling times (0 and 10 s) were also evaluated. The diameter of the sonicated vessel was measured by B-mode imaging and microscopic photography. Histological examination was performed for the sonicated vessels. Main results. For the 5 cm s−1 flow rate, the contraction index of vascular diameter (Dc) with 5.3 W and 10 s cooling time at 2 mm distance was 39 ± 9% (n = 9). With the same parameters except for 0 cm s−1 flow rate, the Dc was increased to 45 ± 7% (n = 4). At 3.5 W, the Dc with 5 cm s−1 flow rate was 23 ± 15% (n = 4). The distance and cooling time influenced the lesion along the vessel wall. Significance. This study has demonstrated the flow rate and acoustic power have the great impact on the vessel contraction. Besides, the larger lesion covering the vessel wall would promote the vessel contraction. And the in vivo validation is required in the future study.
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Brandão P, Ceschin N, Bellver J, Ferro J. Embolic microspheres observed during metroplasty. Gynecol Minim Invasive Ther 2022; 11:131-133. [PMID: 35746915 PMCID: PMC9212177 DOI: 10.4103/gmit.gmit_58_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 10/05/2021] [Accepted: 11/09/2021] [Indexed: 11/21/2022] Open
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The effect of prophylactic uterine artery embolization on reproductive outcomes in patients with cesarean scar pregnancy: a propensity score-matched study. Arch Gynecol Obstet 2021; 305:651-659. [DOI: 10.1007/s00404-021-06347-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 11/22/2021] [Indexed: 02/06/2023]
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Wattamwar K, Arabkhazaeli M, Shin J, Korff R, Cynamon J, Golowa Y. Efficacy of Uterine Artery Embolization for Treatment of Anticoagulant-Associated Abnormal Uterine Bleeding. J Minim Invasive Gynecol 2021; 29:128-134.e1. [PMID: 34280566 DOI: 10.1016/j.jmig.2021.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/30/2021] [Accepted: 07/11/2021] [Indexed: 10/20/2022]
Abstract
STUDY OBJECTIVE Data regarding uterine artery embolization (UAE) to specifically treat anticoagulant-associated iatrogenic abnormal uterine bleeding (AUB-I) are sparse. This manuscript aimed to quantify the effectiveness of UAE in treating this subset of patients. DESIGN Retrospective case series. SETTING Academic hospital serving a large minority-majority population. PATIENTS Twenty-four patients with AUB-I that was provoked or aggravated by the initiation of anticoagulation therapy. INTERVENTIONS Treatment of anticoagulant-associated AUB-I that failed medical management or was acute with UAE rather than inferior vena cava filter placement and hysterectomy. MEASUREMENTS AND MAIN RESULTS An imaging database search was performed to identify patients who underwent UAE for anticoagulant-associated AUB-I from May 2011 to July 2020. Medical and radiologic records were reviewed. Short- and long-term outcomes were obtained to date, ranging from 10 months to 10 years after the procedure. In total, 24 patients were identified, ranging in age from 35 to 54 (mean 44.9) years. Venous thromboembolic disease was the most common (92%) indication for anticoagulation. At presentation, 14 patients (58%) were anticipated to require lifelong anticoagulation. Most UAE procedures (54%) occurred within 10 days of anticoagulation initiation. Before UAE, 17 patients (71%) attempted and failed medical management, myomectomy, or endometrial ablation to control bleeding. After UAE, 21 patients (88%) experienced substantial improvement or resolution of AUB and continued anticoagulation therapy. Three patients (14%) did not experience improvement and were treated with hysterectomy. Amenorrhea immediately after UAE occurred in 1 patient at age 45. CONCLUSION UAE was an effective tool in the management of anticoagulant associated AUB-I in this cohort, resulting in decreased bleeding while allowing the continuation of anticoagulation therapy, with high rates of uterine preservation and preserved menses.
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Affiliation(s)
- Kapil Wattamwar
- Division of Vascular and Interventional Radiology, Department of Radiology (Drs. Wattamwar, Cynamon, and Golowa).
| | - Moona Arabkhazaeli
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology (Dr. Arabkhazaeli), Montefiore Medical Center, Bronx, New York
| | - JaHyun Shin
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Weill Cornell Medical Center/New York Presbyterian Hospital (Dr. Shin)
| | - Ricki Korff
- Division of Interventional Radiology, Department of Radiology, Icahn School of Medicine at Mount Sinai (Dr. Korff), New York, New York
| | - Jacob Cynamon
- Division of Vascular and Interventional Radiology, Department of Radiology (Drs. Wattamwar, Cynamon, and Golowa)
| | - Yosef Golowa
- Division of Vascular and Interventional Radiology, Department of Radiology (Drs. Wattamwar, Cynamon, and Golowa)
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Liu L, Wang T, Lei B. Uterine Artery Embolization Compared with High-intensity Focused Ultrasound Ablation for the Treatment of Symptomatic Uterine Myomas: A Systematic Review and Meta-analysis. J Minim Invasive Gynecol 2020; 28:218-227. [PMID: 33197612 DOI: 10.1016/j.jmig.2020.11.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 11/07/2020] [Accepted: 11/10/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE This study aimed to compare the clinical effects of uterine artery embolization (UAE) with those of high-intensity focused ultrasound (HIFU) ablation for the treatment of symptomatic uterine myomas. DATA SOURCES We searched PubMed, EMBASE, Web of Science, Cochrane Library, Google Scholar, and ClinicalTrials.gov for studies from January 2000 to August 2020. Related articles and relevant references of the included studies were also searched. METHODS OF STUDY SELECTION Two researchers independently performed the data selection. We included comparative studies that compared the clinical outcomes of UAE with those of HIFU ablation in women with myomas. TABULATION, INTEGRATION, AND RESULTS We assessed the study quality using the Cochrane Handbook for Systematic Reviews of Interventions for evaluating the risk of bias. Two independent researchers performed the article selection according to the screening criteria and rated the quality of evidence for each article. We calculated pooled mean difference with 95% confidence interval (CI) for continuous data and relative risk (RR) with 95% CI for dichotomous data. The systematic review registration number is CRD42020199630 on the International Prospective Register of Systematic Reviews. A total of 7 articles (5 trials), involving 4592 women with symptomatic uterine myomas, were included in the meta-analysis. Compared with the HIFU ablation group, the decrease in "uterine fibroid symptom" scores as well as the increase in quality-of-life scores at the time of follow-up were higher in the UAE group, with overall mean difference 19.54 (95% CI, 15.21-23.87; p <.001) and 15.72 (95% CI, 8.30-23.13; p <.001), respectively. The women in the UAE group had a significantly lower reintervention rate (RR 0.25; 95% CI, 0.15-0.42; p <.001). The women undergoing UAE had a significantly lower pregnancy rate than those undergoing HIFU ablation (RR 0.06; 95% CI, 0.01-0.45; p = .006). The difference in the incidence of adverse events between the 2 groups was not statistically significant (p = .53). CONCLUSION Compared with HIFU ablation, UAE provided more significant alleviation of symptoms and improvement in quality of life, lower postoperative reintervention rate, and lower pregnancy rate for women with uterine myomas. However, we cannot conclude that HIFU ablation is more favorable for desired pregnancy than UAE because of the confounding factors.
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Affiliation(s)
- Lu Liu
- National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, Guangdong, China (all authors)
| | - Tianfu Wang
- National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, Guangdong, China (all authors)
| | - Baiying Lei
- National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, Guangdong, China (all authors)..
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