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Paper 3
Published in Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw, The Final FRCR, 2020
Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw
Fibroid torsion is uncommon and is associated with pedunculated subserosal fibroids. It can present with pain; however uterine artery embolisation does not predispose to this and the most likely diagnosis in this case remains post-embolisation syndrome.
Secondary Hemorrhage after Myomectomy
Published in Rooma Sinha, Arnold P. Advincula, Kurian Joseph, FIBROID UTERUS Surgical Challenges in Minimal Access Surgery, 2020
A retrospective review from Korea [20] described the efficacy and safety of uterine artery embolization in eight patients who had hemorrhage after myomectomy. The time interval between myomectomy and the embolization was from 0 to 47 days with a median interval of 1.5 days. Two patients who underwent transcervical and hysteroscopic myomectomy had to be embolized on the very same day as surgery because of persistent vaginal bleeding and low hemoglobin levels. Two patients who underwent open myomectomy were embolized on day 1, and another patient had to undergo embolization on day 2 after surgery. Three patients had secondary hemorrhage after open myomectomy on days 22, 28, and 47. Two of them were hemodynamically unstable. Pelvic angiography of the eight patients revealed hypervascular staining without obvious bleeding focus in five patients, active extravasation of contrast from the uterine artery in two patients, and a pseudoaneurysm in one patient. Peritoneal hematoma was noted on CT in one patient. Uterine artery embolization was technically and clinically successful in all eight patients. Gelatin sponge particles were used in all eight patients. All patients resumed normal menstrual cycles after the procedure.
Minimizing Blood Loss
Published in John C. Petrozza, Uterine Fibroids, 2020
Elise Bardawil, Jessica B. Spencer
Uterine artery embolization was previously discussed in the Abdominal Myomectomy section. A small retrospective case-control study compared same-day uterine artery embolization with subsequent laparoscopic myomectomy with laparoscopic myomectomy alone. A non-significant trend was seen in reduced intraoperative blood loss. There are two retrospective studies that show statistically significant decreases in intraoperative blood loss with uterine artery embolization, either the day of laparoscopic myomectomy or within 48 hours of surgery. The mean perioperative blood loss reported in these studies was 90 mL and 147 mL, respectively [3,4]. However, the data for open and laparoscopic myomectomy were combined. Further study is needed to identify which patient population most benefits from UAE prior to laparoscopic or robotic-assisted surgery.
Comparison of efficacies between ultrasound-guided curettage combined with hysteroscopic electro-resection after injection of pituitrin and hysteroscopic electro-resection after methotrexate chemotherapy in the treatment of cesarean scar pregnancy
Published in Journal of Obstetrics and Gynaecology, 2022
Previously, uterine artery embolisation, uterine artery embolisation chemotherapy combined with curettage has been extensively implemented in treating CSP. However, it was found that uterine artery embolisation may affect the ovarian reserve, causing intrauterine adhesion and even affecting the fertility of patients (Qiao et al. 2016; Zhang et al. 2019). As in-depth studies have been extensively performed and minimally invasive technologies have been developed, novel therapeutic options have been constantly explored. A study reveals that the injection of pituitrin at the cervical junction before uterine curettage can significantly reduce the amount of intraoperative haemorrhage (Wang et al. 2019). A study suggests that ultrasound-guided curettage to remove most pregnancy tissues combined with hysteroscopic electro-resection to remove the residual tissues at the site of diverticulum in the area of incision shows more satisfactory effects of uterine curettage compared with hysteroscopic electro-resection alone (Li, Wu, et al. 2020). Additionally, a study shows that hysteroscopic electro-resection after methotrexate chemotherapy is feasible (Leggieri et al. 2016).
Successful mast-cell-targeted treatment of chronic dyspareunia, vaginitis, and dysfunctional uterine bleeding
Published in Journal of Obstetrics and Gynaecology, 2019
Lawrence B. Afrin, Tania T. Dempsey, Lila S. Rosenthal, Shanda R. Dorff
At 30, she began suffering refractory DUB (rDUB) and frequent dysuria, which was consistently diagnosed as urinary tract infections, despite all urine testing failing to reveal infection. Multiple extensive evaluations (including imaging and biopsies) and empiric medication trials were all unrevealing and unhelpful. No coagulopathy was found. Cystoscopy at 32 led to discovery of a uterine fibroid. A trial of leuprolide caused hallucinations and suicidal ideation. An oestrogen patch provided no benefit to her. The fibroid was resected via an exploratory laparotomy, but her healing was poor, requiring multiple medications (each of which worsened her problems), and the rDUB persisted without improvement. Twelve different oral contraceptives were tried, each worsening assorted symptoms; similar results were seen with many other empiric interventions. A uterine artery embolisation was performed, to no effect. The symptom flares responded well, if briefly, to oral and intravenous diphenhydramine.
A retrospective study of ultrasound-guided high intensity focussed ultrasound ablation for multiple uterine fibroids in South Africa
Published in International Journal of Hyperthermia, 2018
Min He, Hayley Jacobson, Cai Zhang, Raymond Setzen, Lian Zhang
The definitive treatment for multiple uterine fibroids is hysterectomy. However, hysterectomy is not suitable for patients who wish to have children. Myomectomy is an option for patients wishing to retain their uterus, but the surgical damage to uterus is dramatic in treating patients with multiple fibroids, and the cumulative recurrence rate of fibroids at 12 and 24 months after myomectomy was 12.4 and 46.0%, respectively, with the risk of further treatment being high [7,8]. As a minimally invasive treatment, uterine artery embolization (UAE) has been used to treat multiple uterine fibroids. Severe side effects and complications including postembolization syndrome, infection of the uterus, ovary damage, temporary amenorrhoea, problems with future pregnancies and possibly infertility have limited its application [9].