Submucosal myomatous nodules treated by uterine artery embolization

Objective. To study the possibility of using uterine artery embolization (UAE) to treat uterine myoma with submucosal nodules. Subject and methods. A total of 1610 reproductive- and premenopausal-aged patients diagnosed as having uterine myoma who had been treated by UAE were examined. The examinees’ age ranged from 21 to 56 years (mean age 40.8±0.7 years). The examination involved the consultations of a gynecologist and an interventional radiologist, small pelvic ultrasound study determining the Doppler readings of blood flow in the uterine arteries, their branches, and perifibroid plexus vessels, biochemical and clinical blood tests, smears to define purity grade and flora, and a test to detect urogenital infection. To evaluate the endometrium, the investigators performed aspiration and, if indicated, hysteroscopy and separate curettage of the uterine cavity. Results. UAE was carried out in 1003 (62.3%) patients with solitary submucosal or multiple myoma; one of its nodules displayed submucosal growth. Myoma belonged to type 0 in 17 (1.7%) of the patients, type 1 in 361 (36%), and type 2 in 625 (62.3%). 334 (33.3%) women were observed to have either myolysis or expulsion of uterine nodules and their generation or vaginal removal in the period 2 weeks to 1 year after UAE. Spontaneous generation of nodules occurred in 71 (7.1%) patients. Long-standing nodules in the cervical canal were noted in 15 (1.5%) patients. A nodule was surgically removed by the traditional procedure. Bleeding occurred in 5 patients at 2 months postembolization, which required emergency admission and transvaginal myomectomy. None of these cases needed any radical surgical intervention. Postmyomectomy small pelvic ultrasonography demonstrated complete recovery of the topography of the uterine cavity without any additional surgical interventions. Conclusion. UAE alone and as a treatment stage may be used to treat uterine myoma with the submucosal arrangement of a nodule in any size of a myomatous nodule, at any patient age. It may be carried out in patients with submucosal uterine myoma as an alternative to hysterectomy and when transcervical myomectomy is impossible. UAE is the method of choice in the treatment of this pathology in high risk surgical/anesthetic patients.

submucosal uterine myoma, uterine artery embolization