Uterine Fibroid Embolization (UFE)

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Uterine Fibroid Embolization (UFE)

July 15, 2011
12:00 p.m. – 1:00 p.m. (EST)

  • Kevin Stadtlander, MD - Interventional Radiologist

Uterine fibroids are the most common pelvic tumor. As many as 1 in 5 women may have fibroids during their childbearing years. Uterine Fibroid Embolization (UFE) is a minimally invasive procedure which blocks the blood flow to the fibroids in the uterus, which causes them to shrink.

Cleveland_Clinic_Host: Today's Live Web Chat, "Uterine Fibroid Embolization" with Kevin Stadtlander, MD will begin at 12 noon EST. Please submit your questions by typing them below and then clicking 'Ask'.

Cleveland_Clinic_Host: Welcome to our Online Health Chat "Uterine Fibroid Embolization" with Kevin Stadtlander, MD. We are thrilled to have him here today for this chat. Let’s begin with the questions.

Carob: Good morning, can you describe the procedure?

Kevin Stadtlander,_MD: Good afternoon, welcome to the chat. Uterine Artery Embolization (UAE) is a minimally invasive procedure to treat fibroids by decreasing blood flow to the fibroids, thereby making them shrink in size. This will then allow for improvement in symptoms. We perform UAE as a same day procedure with conscious sedation followed by an overnight observation.

Carob: How do you determine if a patient is a good candidate and will benefit from the procedure?

Kevin Stadtlander,_MD: I meet with prospective UAE candidates in consultation to discuss the specific symptoms, and to review an MRI of the pelvis, which can be performed same day. We then make a plan together to determine if the patient is a good candidate.

Meanjean: Is there a difference between uterine fibroid embolization and uterine artery embolization?

Kevin Stadtlander,_MD: No, same thing.

Nanu: Hello, I would like to know if this procedure is possible on people who have tube cut and tied and also if it will work on large fibroids bigger than an orange.

Kevin Stadtlander,_MD: Yes, we can perform procedure for patients with prior tubal ligation. As for the "orange" sized fibroid, this would depend on where in the uterus the fibroid is located. We would individualize your treatment based on your symptoms (pressure, pain, or bleeding), and consider other options as well, such as myomectomy if appropriate. In general though, yes UAE is possible.

Carmicat17: What is an interventional radiologist and why do you guys perform the UFE as opposed to my GYN?

Kevin Stadtlander,_MD: An Interventional Radiologist (IR doctor) is a radiologist (a specialist in imaging), who has additional subspecialty training in minimally invasive image guided procedures such as UAE. For additional information check out www.sirweb.org

Ybcleveland: Do fibroids ever go away on their own without any surgery?

Kevin Stadtlander,_MD: Yes, fibroids can shrink in size after menopause. However, we perform UAE in younger women who are symptomatic and do not want to wait that long.

Nanu: Any preparation the day before? Any lab tests? What if the hemoglobin is around 9.8 will the procedure be performed?

Kevin Stadtlander,_MD: Just nothing to eat or drink after midnight. Hemoglobin is ok to proceed with treatment. I would also look at your other lab values of course.

MissLyss: I had a myomectomy and my fibroids came back. Does embolization keep new fibroids from forming?

Kevin Stadtlander,_MD: No, not necessarily. But UAE performed for larger symptomatic fibroids has the added benefit of simultaneously treating very small fibroids (those that would not otherwise need to be treated yet). Therefore, these would not "grow" larger in future. However, it is possible that entirely new fibroids could potentially grow. We really do not see this too often though.

Carob: What is the success rate of the procedure?

Kevin Stadtlander,_MD: This depends on presenting symptoms. Usually 90-95% of patients have improvement in bleeding symptoms. Usually 85-90% of patients have improvement in "bulk" symptoms, but this depends on how large fibroids were to start.

Kellsbells: I have a follow up appointment with my doctor on Friday to determine if he found uterine fibroids. I just wanted to know if weight gain is a side effect. I’ve noticed in the past year I have had some weight gain, but I have not changed any part of my lifestyle including my diet. If anything I eat a little less and healthier.

Kevin Stadtlander,_MD: I am sure your doctor will address different possibilities for weight gain. Fibroids, if very large, can cause protuberant abdomen. An ultrasound of the pelvis would be a good place to start with imaging.

Cleveland_Clinic_Host: We are receiving many great questions so far! Please remember that this chat is for general questions regarding UFE. If you have a medical question not related to this condition, or that is diagnostic in nature, please follow-up with your personal health care provider or use our contact link clevelandclinic.org/webcontact to submit your questions.

Kcw2002: What happens to the fibroids during UFE?

Kevin Stadtlander,_MD: The fibroids within the uterus lose their individual blood supply and shrink over time. The normal uterus keeps its normal blood supply and functions as normal.

Carmicat17: Does embolization hurt?

Kevin Stadtlander,_MD: Yes, there can be some pelvic pain after procedure. We keep patients overnight after procedure to manage any discomfort or pain. Most patients tolerate very well.

Meanjean: What are the risks and benefits of UFE? Are there any side effects?

Kevin Stadtlander,_MD: Benefits are improvement in symptoms. UAE is a very safe procedure. However, there are some associated risks, as there are with any medical procedure. These include very small risk of infection, which can be treated with antibiotics, a very small risk of bleeding at operative site (tiny skin nick at groin is all that is required), and a very small < 1% chance of needing a hysterectomy based on injury to uterus. We discuss all of this at length at the time of initial consultation.

Cleveland_Clinic_Host: We have approximately 15 minutes left in the chat. We received a large amount of questions and we will continue to answer as many as possible. We apologize if we did not get to your question. If you have additional questions after the chat, please use our contact link clevelandclinic.org/webcontact to submit your questions.

Remygirl: When it comes to uterine fibroids, what is the best treatment to ensure I can still have children? I am not concerned with scars etc… I just want to conceive a child.

Kevin Stadtlander,_MD: There have been numerous reports of pregnancies following uterine fibroid embolization, however prospective studies are needed to determine the effects of UFE on the ability of a woman to have children. One study comparing the fertility of women who had UFE with those who had myomectomy showed similar numbers of successful pregnancies. Bottom line is it all depends on size and location of fibroid(s) whether UAE or myomectomy would be better. I have had patients get pregnant, and carry to term, after UAE. But it is difficult to guarantee this as there are so many contributing factors when it comes to pregnancy.

Hdecker: Is it safe to wait to have the procedure when I have not gone into my changes yet? Do I have to worry that it will turn into Cancer cells?

Kevin Stadtlander,_MD: By "changes" I will assume you mean menopause. We perform UAE in patients who are not yet in menopause and, in fact, we will not perform UAE in post-menopausal patients with bleeding as this requires a work-up by your gynecologist. As for cancer, fibroids themselves are benign. Regular visits to your gynecologist are recommended to look for any "cancer cells."

Kcw2002: Can UFE be used to treat other conditions (like endometriosis or adenomyosis)?

Kevin Stadtlander,_MD: Yes for adenomyosis, but results have not been as encouraging as results have been for treating symptomatic fibroids. However, when only other option may be hysterectomy, it is worth considering a minimally invasive procedure. Fortunately, there is a lot of ongoing investigation into your exact question in the medical community.

KellyAnn: A few women in my family have been diagnosed with fibroids. How likely am I to get them? Is there anything I can do to avoid getting them? How often should I get checked if I don’t see any of the symptoms?

Kevin Stadtlander,_MD: Twenty to 40 percent of women ages 35 and older have uterine fibroids of a significant size. African-American women are at a higher risk for fibroids: as many as 50 percent have fibroids of a significant size. If you were asymptomatic we would not treat anyway. So, any method to check (usually pelvic ultrasound to start) should be determined by your gynecologist.

Cleveland_Clinic_Host: I am sorry to say that our time with Dr. Stadtlander is now over. Thank you again, Dr. Stadtlander, for taking the time to answer our questions today about UFE. To make an appointment with any of the specialists in our Radiology Department at Cleveland Clinic Florida, please call 877.463.2010. You can also visit us online at vanity clevelandclinicflorida.org.

Kevin Stadtlander,_MD: Thank you for your participation and great questions! Each patient is an individual and we can answer all personal questions in a one on one consult.

Cleveland_Clinic_Host: You can reach Dr. Stadtlander's office directly at 954.689.5123.

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