Uterine fibroid embolization: Is there a role?

We present a case of uterine fibroid embolization (UFE) in Salmanya Medical Complex, Bahrain as a primary theraputic option for a selected case symptomatic fibroid uterus.Within 6 weeks of UFE, this patient developed life threatening infection due to sloughing of the fibroid through the cervix but she conceived within 11-months of the procedure and delivered normally at term. As this patient developed life threatening infection, the author is left with the predicament whether to try it again or not in the next selected case. Our patient was a 20-year-old, nulliparous girl who had fibroid uterus extending 2 fingers above the umbilicus. Ultrasound and computed tomography confirmed a large intramural posterior wall fibroid uterus measuring 17 x 15 cms Uterine fibroid embolization was carried out by single puncture using 700 polyvinyl alcohol particles lodged permanently inside both the uterine arteries to block or damp the flow of the blood through these vessels. On 6th week, she had vaginal myomectomy for sloughing of submucous fibroid through the cervix. (Figure 1) Postoperatively, she showed immediate improvement. She conceived after 11-months of treatment and pregnancy till normal delivery was uneventful. Patients who have had fibroid embolization have become pregnant as in our patient, after 11-months of embolization. Bradley et al4 described a woman who conceived immediately after the procedure. Ravina et al1 also reported a successful twin pregnancy in his patients. There have been no studies that define the incidence of pregnancy after the procedure and further studies are necessary to delineate the impact of UFE on fertility. Many gynecologists consider UFE as safe, exciting, promising, minimally invasive and highly effective non surgical primary treatment for symptomatic fibroid uterus. In spite of this, patient should me made aware of the limitations of the treatment and she should recognize that complications of the procedure may lead to hysterectomy. As this patient did not want to have surgery at any cost, UFE was tried on the first selected case in our institution as it allowed uterine preservation along with avoiding psychological trauma of surgery. In spite of having fulminating infection due to sloughing of the fibroid through endocervical canal, this patient conceived after 11-months. Accurate pretreatment diagnosis is essential as UFE allows uterine preservation and resumption of usual activities earlier than surgical method. At the moment, some of the gynecologist may not be familiar with it but indication of its use may expand in the future and this may find a permanent place amongst many modalities available for the treatment of symptomatic fibroid uterus. It is also important that radiologist work closely with the gynecologist to follow up patients carefully and also ensure that the technique is performed carefully with particular attention paid to keeping radiation dose to the minimum. Future considerable research is needed along with long term follow up after this procedure