By Judith Groch, Senior Writer, MedPage Today
AMSTERDAM, Feb. 26 -- Although uterine artery embolization and
hysterectomy are both effective approaches to symptomatic fibroids,
each has certain advantages, a study here found.
Action Points
explain to patients who ask that for embolization, recovery time is
faster and more importantly the uterus is preserved, whereas
hysterectomy patients need not worry that fibroids will return.
Fibroid tumors are benign (non-cancerous) growths. They appear on
the muscular wall of the uterus. They range in size from microscopic to
masses that fill the entire abdominal cavity. Fibroids consist of
dense, fibrous tissue, which are nourished and sustained by a series of
blood vessels.
For patients who want absolute certainty, hysterectomy may be the
better choice, reported Wouter J.K. Hehenkamp, M.D., of the Academic
Medical Center, and colleagues in the March issue of Radiology.
But for women who wish to retain their uterus and want a shorter
hospital stay and a faster recovery, embolization may be the better way
to go, the researchers added.
"On the basis of these results, we determined that uterine artery
embolization is a good alternative to hysterectomy," the researchers
said.
The Dutch multicenter randomized Embolization versus Hysterectomy
Trial included 177 women with uterine fibroids and heavy menstrual
bleeding who were scheduled for a hysterectomy. After informed consent,
88 women were randomized to embolization and 89 to hysterectomy.
The researchers measured outcomes up to 24 months, using
health-related quality-of-life questionnaires. Outcomes included mental
and physical health, urinary and defecatory functions, and overall
patient satisfaction.
At two years, the trial showed that 90% of the patients in both
groups reported that they were at least moderately satisfied with their
treatment Yet the hysterectomy patients reported a higher level of
satisfaction (P=0.02), possibly because they no longer experienced
menstrual cycles or worried that their symptoms would recur, the
researchers said.
In the U.S. most of the 600,000 hysterectomies each year are done to
treat bleeding or enlarged uterine fibroids, the researchers wrote. But
even though uterine artery embolization has been used in practice for
more than a decade, the researchers said the risks and benefits of the
procedure had been largely unknown.
Health-related quality of life was measured six times during a
24-month follow-up with the Medical Outcome Study Short Form 36 (SF-36)
mental component summary and physical component summary.
Also used were the Health Utilities Index Mark 3, EuroQol 5D,
urogenital distress inventory, incontinence impact questionnaire, and
defecation distress inventory.
Satisfaction with the treatments was assessed with a seven-point Likert scale.
At six weeks of follow-up, there were no differences between the
groups, with the exception of the physical component summary, which was
higher for the embolization patients (P<0.001).
All the scores were improved significantly in both groups at six
months and afterward (P<0.05), with the exception of the
defecation-distress inventory, which improved significantly in the
embolization patients, but not the hysterectomy group.
Use of laxatives decreased from 10% at baseline to 1% at 24 months,
but only in the embolization group. This was the only significant
difference between the groups, the researches said.
Improvement in the physical component summary at the 24-month
follow-up was significantly higher for patients who were employed at
baseline (P=0.035).
Although these findings suggest an enduring improvement in quality
of life after both treatments, if new fibroids develop, as they might,
especially in younger patients, the quality-of-life assessment might
decrease for embolization patients. Future research is needed to
explore this possibility, the researchers said.
Patients who had embolization and subsequently required hysterectomy
(25%) had lower physical component scores at repeated measurements
(P=0.021), although not for their mental component scores. At 24 months
there was no significant difference between the groups.
Study limitations include the fact that sample size was based on the
primary endpoint (fewer than 25% of patients had a secondary
hysterectomy and embolization) and not the quality-of-life score.
Also validated disease-specific quality-of-life measures, such as
for fibroids, are needed. Actually, the researchers said, a
fibroid-specific questionnaire has been developed, but it was not
available when this trial was designed.
Both uterine artery embolization and hysterectomy improved the
women's health-related quality of life, and no differences were
observed between groups at the 24-month follow-up.
This study was funded by the Netherlands Organization for Health
Research and Development. Boston Scientific (Heek, The Netherlands)
partly sponsored the embolic agent used in this trial and provided a
small unconditional financial grant for study purposes. None of the
authors is employed by or has a commercial interest in the Netherlands
Organization for Health Research and Development or Boston Scientific.
Dr. Hehenkamp reported no financial disclosures.