Recovery fast in uterine fibroid embolization: most patients recover within 2 weeks

OB/GYN News, August 15, 2002 by Kate Johnson

WINNIPEG, MAN. -- Most patients undergoing uterine fibroid embolization can return home the next day and fully recover within the expected 2-week period, according to results of a Canadian study.

The investigation, described by its authors as the largest reported series of patients who've undergone the procedure, was presented during the annual meeting of the Society of Obstetricians and Gynaecologists of Canada.

"Recovery time is one of the major factors for these patients, because for them this is an added advantage ...in addition to avoiding a hysterectomy," said Dr. Gaylene Pron, an epidemiologist at the University of Toronto and principal investigator for the multicenter trial.

Uterine fibroid embolization (UFE), also known as uterine artery embolization, is a procedure performed by interventional radiologists to treat uterine fibroids. It uses selective catheterization and occlusion of both uterine arteries to deprive fibroids of their blood supply. Occlusion is accomplished with particles of polyvinyl alcohol or Gelfoam, which remain in place. Patients are sent back to their referring physician for follow-up care.

In the study, 555 patients underwent UFE by 11 interventional radiologists practicing at eight hospitals. The mean length of hospital stay was 1.3 nights, mean recovery time was 13.1 days, and 81% of patients had recovered within 2 weeks.

The main complication that has been reported with UFE is postprocedural pain, which necessitates hospitalization in the majority of published series, Dr. Pron said.

In this study, postprocedural pain was reported by 91% of all patients, who together had a mean pain score rating of 7 on a 10-point scale, with 10 representing the worst pain.

The procedure was performed under conscious sedation with pain management protocols of pre-procedural analgesics, patient-controlled morphine analgesic, and planned overnight admission.

Postprocedural pain was the most common indication for the 20% of patients who spent more than 1 night in the hospital and the 5% of patients who spent more than 2 nights, Dr. Pron said in an interview.

In addition, the 10% of patients who returned to the hospital and the 3% who were readmitted did so primarily because of pain. Intraprocedural pain was reported by 29% of patients, with a mean pain score rating of 6.3.

More than 80% of patients had significant improvement in their bleeding, and their uterine size decreased by an average of 40% within the first 3 months after the procedure.

About 15,000-20,000 UFE procedures have been performed worldwide, at least half of them in the United States, according to the Society of Cardiovascular and Interventional Radiology. A small number of UFE patients have experienced infection. There also is a less than a 1% chance of injury to the uterus, potentially leading to a hysterectomy.