Myomectomy Following UAE
Leiomyomas may be treated with UAE followed by myomectomy in a scheduled or unscheduled manner. UAE may be scheduled immediately prior to myomectomies if the patient has large fibroids or pedunculated or subserosal myomas, or wishes to maintain an intact
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Contents
Abstract
1
Introduction.......................................................................... 135
2 2.1 2.2 2.3
Scheduled Myomectomy ..................................................... Indications.............................................................................. Benefits of UAE Prior........................................................... Surgical Technique ................................................................
136 136 137 138
3 3.1 3.2 3.3
Unscheduled Myomectomy ................................................. Failure to Relieve Symptoms................................................ Prolapse of Submucous Myoma ........................................... Necrotic Fibroid.....................................................................
139 139 139 140
Leiomyomas may be treated with UAE followed by myomectomy in a scheduled or unscheduled manner. UAE may be scheduled immediately prior to myomectomies if the patient has large fibroids or pedunculated or subserosal myomas, or wishes to maintain an intact uterus for the possibility of pregnancy within a short time window. UAE may be beneficial in these instances because it reduces blood loss in removal of large fibroids and prevents fibroid recurrence. Patients who benefit from the combination of these procedures include young patients with a high risk of recurrence and patients wanting to achieve pregnancy immediately after 6 months of the surgery. Unscheduled myomectomies occur if the UAE fails to relieve symptoms, if prolapsed of a submucous myoma occurs, or in the event of fibroid necrosis.
References...................................................................................... 140
1
Introduction
This chapter will discuss myomectomy after uterine artery embolization [UAE]. We will cover two distinct groups of patients. First, patients who knew prior to myomectomy that they would have two procedures. Second, patients who underwent a myomectomy for treatment of a complication or failure after UAE. This distinction will be important. All too often, any surgery following UAE is considered a failure of the procedure. We will discuss the benefits of combination procedures to patients, and identify the patients who might benefit from this approach. Other surgeries may take place after UAE. These include hysterectomy and cesarean section. These surgeries will not be covered in this chapter. B. McLucas (&) Department of Obstetrics and Gynecology, University of California, Los Angeles David Geffen School of Medicine, Los Angeles, CA, USA e-mail: [email protected]
J. Reidy et al. (eds.), Radiological Interventions in Obstetrics and Gynaecology, Medical Radiology. Diagnostic Imaging, DOI: 10.1007/174_2013_933, Springer Berlin Heidelberg 2013 Published Online: 7 November 2013
135
136
B. McLucas
2
Scheduled Myomectomy
2.1
Indications
UAE is suggested for women with symptomatic uterine leiomyomata, including menorrhagia, pelvic pain, and pelvic pressure among other bulk-related symptoms. In addition, m
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