The procedure, called uterine fibroid embolization, is as effective as surgery at relieving other fibroid symptoms such as pelvic pain and pressure.

Additionally, fibroids treated with embolization are significantly less likely to recur and patients recover from the treatment much more quickly, said Mahmood Razavi, MD, an associate professor of radiology who conducted the first direct comparison of the two treatments.

"The embolization patients have an overall better quality of life," said Razavi. Results of the retrospective three-year study were presented Tuesday in San Antonio, Tex., at the annual meeting of the Society of Cardiovascular and Interventional Radiology.

Studies indicate that up to 25 percent of all women may have uterine fibroids -- benign tumors that grow in the uterus. Fortunately, most women don't experience symptoms and don't require treatment. For others, however, fibroids can cause excessive bleeding, pelvic pain and pressure, urinary urgency and abdominal swelling.

A uterus can harbor one or several fibroids, which can range in size from a few centimeters to the diameter of a grapefruit or larger. In extreme cases, the swelling uterus can approach the size of a full-term pregnancy.

In uterine fibroid embolization, physicians snake a tiny catheter through the femoral artery in the patient's groin to the arteries that supply the fibroids with blood. They use the catheter to deliver tiny plastic pellets that lodge in the vessels and cut off the fibroids' blood supply.

"Basically, you put the fibroids on a severe diet, so they shrink," said Razavi. The patient is typically sedated lightly during the procedure, and often returns home the same day.

In contrast, the surgical procedure known as an abdominal myomectomy requires general anesthesia and a hospital stay of about three days. The physician makes an incision several inches long in the patient's pubic area and removes as many fibroids as possible.

Because all of the fibroids may not be accessible, between 10 and 30 percent of myomectomy patients experience a recurrence and must have additional treatment, Razavi said. Embolization, however, attacks all of the fibroids at once and reduces the chance of a recurrence.

Razavi found when he compared the two procedures that embolization patients lost significantly less blood during the procedure, spent less time in the hospital and were able to resume normal activities up to five times more quickly than the women who had had their fibroids surgically removed.

In addition, more than 90 percent of the 73 embolization patients in the study experienced a reduction in their previously heavy menstrual bleeding, compared to 61 percent of the 36 women who had an abdominal myomectomy. Statistically equivalent numbers of women undergoing either embolization or myomectomy reported less pelvic pain and pressure after the procedure.

In many parts of the country, the only treatment option offered for uterine fibroids is a hysterectomy, a surgical procedure in which the entire uterus is removed. Published data indicate that roughly 200,000 hysterectomies and tens of thousands of myomectomies are performed in the United States every year because of uterine fibroids.

Stanford Hospital was one of the first sites in Northern California to offer myomectomies, Razavi said. He plans to begin an additional study comparing embolization with laproscopic myomectomy, in which specialized instruments are used to remove fibroids through a small incision in the abdomen.

Razavi's co-authors on the study include Stanford medical student Gloria Hwang and Bertha Chen, MD, assistant professor of gynecology and obstetrics at Stanford. Hwang presented the study findings at the San Antonio conference. She will also present the research at the April 28-May 2 meeting of the American College of Gynecology and Obstetrics in Chicago. - By Krista Conger

[Contact: Krista Conger]

08-Mar-2001