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Ning FF, Yao TT, Wang XX. Application of dezocine patient-controlled epidural analgesia in postoperative analgesia in patients with total myomectomy. World J Clin Cases 2024; 12:4265-4271. [PMID: 39015894 PMCID: PMC11235541 DOI: 10.12998/wjcc.v12.i20.4265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 05/08/2024] [Accepted: 05/29/2024] [Indexed: 06/30/2024] Open
Abstract
BACKGROUND Uterine fibroids are common benign gynecological conditions. Patients who experience excessive menstruation, anemia, and pressure symptoms should be administered medication, and severe cases require a total hysterectomy. This procedure is invasive and causes severe postoperative pain, which can affect the patient's postoperative sleep quality and, thus, the recovery process. AIM To evaluate use of dezocine in patient-controlled epidural analgesia (PCEA) for postoperative pain management in patients undergoing total myomectomy. METHODS We selected 100 patients undergoing total abdominal hysterectomy for uterine fibroids and randomized them into two groups: A control group receiving 0.2% ropivacaine plus 0.06 mg/mL of morphine and an observation group receiving 0.2% ropivacaine plus 0.3 mg/mL of diazoxide in their PCEA. Outcomes assessed included pain levels, sedation, recovery indices, PCEA usage, stress factors, and sleep quality. RESULTS The observation group showed lower visual analog scale scores, shorter postoperative recovery indices, fewer mean PCEA compressions, lower cortisol and blood glucose levels, and better polysomnographic parameters compared to the control group (P < 0.05). The cumulative incidence of adverse reactions was lower in the observation group than in the control group (P < 0.05). CONCLUSION Dezocine PCEA can effectively control the pain associated with total myomectomy, reduce the negative impact of stress factors, and have less impact on patients' sleep, consequently resulting in fewer adverse effects.
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Affiliation(s)
- Feng-Feng Ning
- Department of Anesthesiology, Gansu Provincial Maternity and Child-care Hospital, Lanzhou 730050, Gansu Province, China
| | - Ting-Ting Yao
- Department of Gynecology, Gansu Provincial Maternity and Child-Care Hospital, Lanzhou 730050, Gansu Province, China
| | - Xiao-Xia Wang
- Department of Gynecology, Gansu Provincial Maternity and Child-Care Hospital, Lanzhou 730050, Gansu Province, China
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2
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Clements W, Chenoweth A, Phipps B, Mozo L, Bolger M, Morphett L, Phan T, Koukounaras J, Lukies MW. A study comparing the cost-effectiveness of conventional and drug-eluting transarterial chemoembolisation (cTACE and DEB-TACE) for the treatment of hepatocellular carcinoma in an Australian public hospital. J Med Imaging Radiat Oncol 2024. [PMID: 38985987 DOI: 10.1111/1754-9485.13731] [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: 02/23/2024] [Accepted: 06/20/2024] [Indexed: 07/12/2024]
Abstract
INTRODUCTION Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality and transarterial chemoembolisation (TACE) is an established technique to treat patients with intermediate-stage HCC. The aim of this study was to generate accurate costing data on cTACE and DEB-TACE in an Australian setting and assess whether one of the procedures offers favourable cost-effectiveness. METHODS Costing study using data from all TACE procedures performed at a single centre between January 2018 and December 2022. Data were included from all direct and indirect costs including operative costs, wages, overheads, ward costs, transfusion, pathology, pharmacy and ward support. Cost-effectiveness was assessed by dividing local costs by existing high-quality data on quality-adjusted life years (QALYs). RESULTS 64 TACE treatments were performed on 44 patients. Mean age was 66.5 years and 91% were male. Overall median total cost per patient for the entire TACE treatment regime was AUD$7380 (range AUD$3719-$20,258). However, 39% of patients received more than one treatment, and the median cost per individual treatment was AUD$5270 (range AUD$3533-$15,818). The difference in median cost between cTACE (AUD$4978) and DEB-TACE (AUD$9202) was significant, P < 0.001. In calculating cost-effectiveness, each cTACE treatment cost AUD$2489 per QALY gained, while each DEB-TACE cost AUD$3834 per QALY gained. The incremental cost-effectiveness ratio (ICER) for DEB-TACE over cTACE was AUD$10,560 per QALY gained. CONCLUSION Both cTACE and DEB-TACE are low-cost treatments in Australia. However, DEB-TACE offers a solution with an ICER of AUD$10,560 per QALY gained which is below the Australian government willingness to pay threshold and thus is a more cost-effective treatment.
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Affiliation(s)
- Warren Clements
- Department of Radiology, Alfred Health, Melbourne, Victoria, Australia
- Department of Surgery, Monash University Central Clinical School, Melbourne, Victoria, Australia
- National Trauma Research Institute, Melbourne, Victoria, Australia
| | - Abigail Chenoweth
- Department of Radiology, Alfred Health, Melbourne, Victoria, Australia
| | - Benjamin Phipps
- Department of Radiology, Alfred Health, Melbourne, Victoria, Australia
| | - Lowella Mozo
- Department of Radiology, Alfred Health, Melbourne, Victoria, Australia
| | - Mark Bolger
- Department of Radiology, Alfred Health, Melbourne, Victoria, Australia
| | - Laura Morphett
- Department of Finance, Alfred Health, Melbourne, Victoria, Australia
| | - Tuan Phan
- Department of Radiology, Alfred Health, Melbourne, Victoria, Australia
- Department of Surgery, Monash University Central Clinical School, Melbourne, Victoria, Australia
| | - Jim Koukounaras
- Department of Radiology, Alfred Health, Melbourne, Victoria, Australia
- Department of Surgery, Monash University Central Clinical School, Melbourne, Victoria, Australia
| | - Matthew W Lukies
- Department of Radiology, Alfred Health, Melbourne, Victoria, Australia
- Department of Surgery, Monash University Central Clinical School, Melbourne, Victoria, Australia
- Department of Medical Imaging, Monash Health, Melbourne, Victoria, Australia
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3
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Clements W, Chenoweth A, Morphett L, Billington E, Nandurkar R, Phan T, Venn GA, Lukies MW. A cost outcome study of varicocoele embolisation and future pregnancy in an Australian public hospital setting. J Med Imaging Radiat Oncol 2024; 68:282-288. [PMID: 38437182 DOI: 10.1111/1754-9485.13629] [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: 12/28/2023] [Accepted: 02/21/2024] [Indexed: 03/06/2024]
Abstract
INTRODUCTION Varicocoele is commonly encountered in males with infertility. Studies have shown that varicocoele repair (surgery or embolisation) can improve the rate of subsequent pregnancy. In Australia, there have been no studies assessing the cost of varicocoele embolisation and current practice is based on international data. This study aimed to assess the cost of varicocoele embolisation and estimate the treatment cost per pregnancy. METHODS Retrospective cost-outcome study of patients treated by embolisation between January 2018 and 2023. A bottom-up approach was used to calculate procedure costs whereas a top-down approach was used to calculate costs for all other patient services, including direct and indirect costs. To calculate cost per pregnancy, costs were adjusted according to existing published data on the rate of pregnancy after embolisation. RESULTS Costing data from 18 patients were included, of median age 33.5 years (range 26-60) and median varicocoele grade 2.5 (range 1-3). All patients had unilateral treatment, most commonly via right internal jugular (16 patients, 89%) and using a 0.035″ system (17 patients, 94%). The median cost for the entire treatment including procedural, non-procedural, ward and peri-procedural costs was AUD$2208.10 (USD$1405 or EUR€1314), range AUD$1691-7051. The projected cost to the healthcare system per pregnancy was AUD$5387 (USD$3429 or EUR€3207). CONCLUSION Total varicocoele embolisation cost and the cost per-pregnancy were lower than for both embolisation and surgical repair in existing international studies. Patients undergoing varicocoele treatment should have the option to access an interventional radiologist to realise the benefits of this low-cost pinhole procedure.
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Affiliation(s)
- Warren Clements
- Department of Radiology, Alfred Health, Melbourne, Victoria, Australia
- Department of Surgery, Monash University Central Clinical School, Melbourne, Victoria, Australia
- National Trauma Research Institute, Melbourne, Victoria, Australia
| | - Abigail Chenoweth
- Department of Radiology, Alfred Health, Melbourne, Victoria, Australia
| | - Laura Morphett
- Department of Finance, Alfred Health, Melbourne, Victoria, Australia
| | - Eliza Billington
- Department of Radiology, Alfred Health, Melbourne, Victoria, Australia
| | - Rohan Nandurkar
- Department of Radiology, Alfred Health, Melbourne, Victoria, Australia
| | - Tuan Phan
- Department of Radiology, Alfred Health, Melbourne, Victoria, Australia
- Department of Surgery, Monash University Central Clinical School, Melbourne, Victoria, Australia
| | - Georgina A Venn
- Department of Radiology, Alfred Health, Melbourne, Victoria, Australia
| | - Matthew W Lukies
- Department of Radiology, Alfred Health, Melbourne, Victoria, Australia
- Department of Medical Imaging, Monash Health, Melbourne, Victoria, Australia
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4
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Clements W. How Important is Low-Cost to the Overall Value of Interventional Radiology? Cardiovasc Intervent Radiol 2024; 47:158-160. [PMID: 38147154 DOI: 10.1007/s00270-023-03637-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 11/24/2023] [Indexed: 12/27/2023]
Affiliation(s)
- Warren Clements
- Department of Radiology, Alfred Health, 55 Commercial Road, Melbourne, VIC, 3004, Australia.
- Department of Surgery, Monash University Central Clinical School, Melbourne, Australia.
- National Trauma Research Institute, Melbourne, Australia.
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Clements W, Brown N, Buckley B, Rogan C, Kok HK, Liang E. Quality care guidelines for uterine artery embolisation in women with symptomatic uterine fibroids in Australia and New Zealand: According to the AGREE-II checklist and endorsed by the Interventional Radiology Society of Australasia. J Med Imaging Radiat Oncol 2022; 66:819-825. [PMID: 35785440 PMCID: PMC9545349 DOI: 10.1111/1754-9485.13455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 06/21/2022] [Indexed: 12/03/2022]
Affiliation(s)
- Warren Clements
- Department of Radiology, Alfred Hospital, Melbourne, Victoria, Australia.,Department of Surgery, Monash University Central Clinical School, Melbourne, Victoria, Australia.,National Trauma Research Institute, Melbourne, Victoria, Australia
| | - Nicholas Brown
- The University of Queensland, St Lucia, Queensland, Australia.,Wesley Hospital, Auchenflower, Queensland, Australia
| | - Brendan Buckley
- Department of Radiology, Auckland City Hospital, Auckland, New Zealand
| | - Chris Rogan
- Royal Prince Alfred Hospital, Camperdown, Sydney, New South Wales, Australia.,Chris O'Brien Lifehouse, Camperdown, Sydney, New South Wales, Australia.,Sydney Adventist Hospital, Wahroonga, Sydney, New South Wales, Australia
| | - Hong Kuan Kok
- Department of Radiology, Northern Health, Melbourne, Victoria, Australia
| | - Eisen Liang
- Sydney Fibroid Clinic, Sydney, New South Wales, Australia
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6
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Rigsby RK, Peters EM. Resident-attending discrepancy rates for two consecutive versus nonconsecutive weeks of overnight shifts. Emerg Radiol 2022; 29:819-823. [PMID: 35616766 DOI: 10.1007/s10140-022-02056-y] [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: 03/14/2022] [Accepted: 05/06/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE Recent Accreditation Council for Graduate Medical Education policy changes no longer limit the number of consecutive night shifts allowed for trainees. Few studies have examined radiology resident overnight performance over time. This study aimed to compare significant resident-attending discrepancy rates for residents working 2 nonconsecutive versus consecutive weeks of overnight shifts. The authors hypothesized significantly increased week-two discrepancies in the consecutive group. METHODS For 2020, a retrospective analysis of significant overnight resident-attending discrepancy rates over a 24-week period using database searches was performed for residents self-selecting 2 nonconsecutive versus consecutive weeks. The nonconsecutive group typically had a 7-day mix of days off and day shifts between their night shift weeks. Paired and unpaired t tests were performed with p < 0.05 considered significant. RESULTS For the 24 sets of 2 weeks covered by two residents at a time, eight were nonconsecutive and 16 were consecutive. The nonconsecutive group had 75.0% R4 coverage compared to 37.5% for the consecutive group. There were no significant study volume differences between the groups. A total of 27,906 studies (35.3% cross-sectional [CT and MR], 54.9% radiograph plus fluoroscopy, 9.8% US) were performed with 223 discrepancies (0.80%). Overall discrepancies for the nonconsecutive versus consecutive groups were 39/4505 (0.87%) versus 59/9462 (0.62%; p = 0.32) for week one and 46/4732 (1.0%) versus 79/9207 (0.86%; p = 0.60) for week two with no significant differences between the groups by modality. CONCLUSION Residents self-selecting 2 consecutive weeks of overnight shifts do not have increased resident-attending discrepancy rates compared to 2 nonconsecutive weeks.
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Affiliation(s)
- Ryan K Rigsby
- Department of Radiology, Loma Linda University Health, 11234 Anderson St, Loma Linda, CA, 92354, USA
| | - Eric M Peters
- Department of Radiology, Loma Linda University Health, 11234 Anderson St, Loma Linda, CA, 92354, USA.
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Chong CCW, Chennapragada SM, Schick C, McAuliffe W, Schlaphoff G, Lodh S, Whitley J, Cheung A. The 'Sic Vos non Vobis' of Interventional Radiology - Rebranding and modernising the Interventional Specialities of Radiology in Australia and New Zealand. J Med Imaging Radiat Oncol 2022; 66:423-427. [PMID: 35107218 PMCID: PMC9303623 DOI: 10.1111/1754-9485.13380] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 01/04/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Colin Chun Wai Chong
- Department of Radiology, Macquarie University Hospital, Sydney, New South Wales, Australia.,Department of Medical Imaging, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia
| | - Satyanarayana Murthy Chennapragada
- Department of Medical Imaging, SCHN-Westmead, Sydney, New South Wales, Australia.,Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Christoph Schick
- Department of Radiology, Northland District Health Board, Whangarei, New Zealand
| | - William McAuliffe
- Neurological Intervention & Imaging Service of Western Australia, Nedlands, Western Australia, Australia
| | - Glen Schlaphoff
- Department of Interventional Radiology, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Suhrid Lodh
- Department of Radiology, St George Hospital, Sydney, New South Wales, Australia.,St George & Sutherland Clinical School, UNSW Sydney, Sydney, New South Wales, Australia
| | - Justin Whitley
- Department of Interventional Radiology, Liverpool Hospital, Sydney, New South Wales, Australia.,Department of Radiology, St George Hospital, Sydney, New South Wales, Australia.,Neurointervention, Institute of Neurological Sciences, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Andrew Cheung
- Department of Interventional Radiology, Liverpool Hospital, Sydney, New South Wales, Australia.,Neurointervention, Institute of Neurological Sciences, Prince of Wales Hospital, Sydney, New South Wales, Australia.,Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia.,South West Sydney Clinical Campuses, UNSW Sydney, Sydney, New South Wales, Australia
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8
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Clements W. Uterine fibroid embolisation: advocating women's choice for uterine salvage. CVIR Endovasc 2020; 3:78. [PMID: 33079295 PMCID: PMC7575661 DOI: 10.1186/s42155-020-00161-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 09/11/2020] [Indexed: 11/24/2022] Open
Affiliation(s)
- Warren Clements
- Department of Radiology, Alfred Health, Alfred Hospital, 55 Commercial Road, Melbourne, VIC, 3004, Australia. .,Department of Surgery, Monash University, Melbourne, Australia. .,National Trauma Research institute, Monash University, Melbourne, Australia.
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9
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Clements W, Barrett R, Roberts SK, Majeed A, Kemp W, Moriarty HK. Balloon-occluded retrograde transvenous obliteration (BRTO) of gastric varices using foam sclerosant and a reduced balloon inflation time: Feasibility and efficacy. J Med Imaging Radiat Oncol 2020; 64:490-495. [PMID: 32441461 DOI: 10.1111/1754-9485.13049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 04/23/2020] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Balloon-occluded retrograde transvenous obliteration (BRTO) is recommended for secondary prevention of gastric variceal bleeding in the American Association for the Study of Liver Disease (AASLD) guidelines, as an alternative to Transjugular intrahepatic portosystemic shunt (TIPS). However, there is significant heterogeneity in how BRTO is performed, including how and how long to occlude the outflow venous shunt amongst other variables such as variceal size, flow rate, agent used, and preparation technique. We propose a method using foam sclerotherapy and reducing balloon occlusion to as little as 30 min, with assessment of the efficacy of this shorter balloon inflation time. METHODS Retrospective single-centre analysis of BRTO procedures between July 2015 and February 2019 for isolated gastric varices in a non-acute setting, where inflation time was 2 h or less. RESULTS Six patients underwent BRTO with a short inflation time, with a mean age of 66 years. The median balloon inflation and thus 3% athoxysclerol foam contact time was 30 min (range 30-60 min). Four of the 6 patients showed complete resolution of varices, while 2 of the 6 showed a partial response. Mean follow-up was 27 months. There were no patients who did not show a response to treatment and no episodes of clinically significant upper gastrointestinal bleeding. CONCLUSIONS This technique using a shortened balloon occlusion time resulted in complete or partial clinical and technical success in all patients and suggests that the threshold for initiation of gastric variceal thrombosis may be below 30 min. This timepoint may provide a balance between adequate balloon inflation, angiography room efficiency and hospital resource allocation with resultant procedural cost implications.
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Affiliation(s)
- Warren Clements
- Department of Radiology, Alfred Health, Melbourne, Victoria, Australia.,Department of Surgery, Monash University Central Clinical School, Melbourne, Victoria, Australia
| | - Rebecca Barrett
- Department of Radiology, Alfred Health, Melbourne, Victoria, Australia
| | - Stuart K Roberts
- Department of Gastroenterology, Alfred Health, Melbourne, Victoria, Australia.,Department of Gastroenterology, Monash University Central Clinical School, Melbourne, Victoria, Australia
| | - Ammar Majeed
- Department of Gastroenterology, Alfred Health, Melbourne, Victoria, Australia.,Department of Gastroenterology, Monash University Central Clinical School, Melbourne, Victoria, Australia
| | - William Kemp
- Department of Gastroenterology, Alfred Health, Melbourne, Victoria, Australia.,Department of Gastroenterology, Monash University Central Clinical School, Melbourne, Victoria, Australia
| | - Heather K Moriarty
- Department of Radiology, Alfred Health, Melbourne, Victoria, Australia.,Department of Surgery, Monash University Central Clinical School, Melbourne, Victoria, Australia
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10
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Clements W. The evolution of interventional radiology literature in Australia and New Zealand. J Med Imaging Radiat Oncol 2020; 64:366-367. [PMID: 32216039 DOI: 10.1111/1754-9485.13026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 03/05/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Warren Clements
- Department of Radiology, Alfred Hospital, Melbourne, Victoria, Australia.,Department of Surgery, Monash University, Melbourne, Victoria, Australia
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11
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Clements W, Ang WC, Law M, Goh GS. Treatment of symptomatic fibroid disease using uterine fibroid embolisation: An Australian perspective. Aust N Z J Obstet Gynaecol 2020; 60:324-329. [PMID: 31956995 DOI: 10.1111/ajo.13120] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 12/16/2019] [Indexed: 12/21/2022]
Abstract
Uterine leiomyomata (fibroids) are symptomatic in up to 35% of women and treatment can be a costly burden to the individual and society. Options for treatment range from non-hormonal, hormonal, minimally invasive, to surgery. While symptoms from smaller fibroids may respond to simple treatment, those with larger fibroids or with a large volume of disease require a more definitive option. Surgery (hysterectomy or myomectomy) are both well-established treatment modalities with good clinical outcomes. Since the 1990s, uterine fibroid embolisation has emerged as a less invasive option for women than for surgical techniques, while level 1 evidence shows that in the short to mid-term, there is a similar improvement in symptom-related quality of life outcomes to surgery, but with reduced hospital stay and reduced cost. However, in the longer term there may be a need for further treatment or retreatment in some patients compared with surgery. Since its introduction, uptake of this procedure in Australia has been low relative to surgical options. This manuscript reviews the current literature surrounding treatment, along with the trends in uptake of embolisation by Australian women, places this in context of current guidelines from major societies, and encourages gynaecologists and interventional radiologists to be aware of the advantages and limitations of embolisation.
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Affiliation(s)
- Warren Clements
- Department of Radiology, Alfred Health, Melbourne, Victoria, Australia.,Department of Surgery, Monash University, Melbourne, Victoria, Australia
| | - W Catarina Ang
- Department of Obstetrics and Gynaecology, Royal Women's Hospital, Melbourne, Victoria, Australia.,Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Meng Law
- Department of Radiology, Alfred Health, Melbourne, Victoria, Australia.,Department of Electrical and Computer Systems Engineering, Monash University, Melbourne, Victoria, Australia.,Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
| | - Gerard S Goh
- Department of Radiology, Alfred Health, Melbourne, Victoria, Australia.,Department of Surgery, Monash University, Melbourne, Victoria, Australia
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