Another option for fibroids: For some women, hysterectomy may not be necessary.
- Created: September 14, 2006
- by: admin
Byline: Katie Mcdowell
By the time Michelle Good saw Dr. Patricia Stoltzfus, an interventional radiologist at WVU Hospitals, her uterus resembled that of a woman nearly four months pregnant. The cause? Fibroids — noncancerous growths in the muscular walls of the uterus. Something nearly 30 percent of women aged 35 and older will develop them within their lifetimes.
And many of them will think that a hysterectomy — the surgical removal of the uterus — is the only option.
But there is another.
While fibroids are not in and of themselves dangerous, they can cause serious discomfort. Some of the most typical signs of fibroids are, according to the Society of Interventional Radiology: long, heavy periods, sometimes accompanied by clots pelvic pain and pressure pain in the back and legs bladder pressure, leading to a frequent urge to urinate pressure on the bowel, leading to constipation and bloating abnormally large abdomen Because fibroids feed on estrogen, they can be treated by cutting off the blood supply, said Stoltzfus, which can be achieved by performing a uterine fibroid embolization, or UFE.
The technique has been around for years — since about the mid-’90s — but there are still many women who do not know the option exists.
“It started in Paris,” explained Stoltzfus, “and has been in common use since 1995. To date there have been about 25,000 done worldwide.”
Stoltzfus, who has worked at WVUH for 12 years, said she first began performing UFEs in 2002 — to the tune of about one patient per year for the first couple of years. In the last two to three years that number has increased steadily, and she now performs about 25 per year.
“vSpring is very enthusiastic about the opportunity that Mirabilis represents and believes their unique system offers a much-needed alternative to invasive surgery for a variety of conditions,” said Mike Connolly of vSpring Capital.
“Fibroids are so common,” she said. “Everyone knows someone with fibroids. One-third of all hysterectomies performed in the United States are because of fibroids.” That translates to about 200,000 hysterectomies per year because of fibroids.
A UFE is performed by first administering a local anesthetic and then making a small nick at the top of the leg, close to the hip, and inserting a needle into the incision. A wire is then threaded through that and the needle taken out, Stoltzfus said. According to the Fibroid Medical Center of Northern California, a dye is then injected, which can be seen under fluoroscopy, and a catheter advanced over the branch of the aorta and into the uterine artery on the side opposite the puncture.
A second arterial catheter is then placed from the opposite femoral artery to the other uterine artery. Tiny polyvinyl alcohol particles, about the size of grains of sand, are then released into the blood vessels feeding the fibroid.
“Those PVA particles then go way out to the little arterials,” she said, “and rob the fibroid of its blood supply. And that’s how it works. With no blood supply, the fibroid will soon begin to shrink.” The goal, she said, is a 50 percent shrinkage of the fibroid. Stoltzfus said she schedules her patients for a three-month follow-up, at which time the make sure the fibroid is shrinking properly. “Our goal is to make them asymptomatic,” she said. “(The fibroid) may still be there, but it’s no longer causing the symptoms — the heavy periods, the discomfort.”
The fibroid will continue to shrink for about six months up to a year, she said.
Good underwent a UFE in the beginning of 2005, after fibroids had made her day-to-day life difficult.
“It had grown to where it was pushing against my bowels and it was very uncomfortable,” she explained. “Whenever I would try to lift something heavy or have to move around a lot I would get a stitch — that’s the best way to describe it. I live on a farm and we have livestock and a pretty sizable garden. The garden is about 15 feet away from the house and just walking to it and back became difficult.”
At the time, Good believed a hysterectomy to be the only real solution to her problem. But she “doesn’t do well at all” with surgery, so when she first heard about Secretary of State Condoleeza Rice’s successful UFE procedure, she began doing some research online. The search, she said, led her to Morgantown and to Stoltzfus.
After undergoing an MRI to check on size and status of her fibroids, Good made an appointment for a UFE of her own.
The process took about an hour, she said, and went smoothly.
“The amazing thing is I have a lot of women who tell me they feel something — feel better — immediately, although I have no explanation for that, because that’s not enough time for it to have shrunk,” Stoltzfus said.
Good, in fact, was one of those women, saying she felt relief from bladder and bowel pressure, caused by her fibroids, almost immediately.
“I know they couldn’t have shrunk already, but I did feel better immediately, really,” she said.
While UFE is a viable option for most women suffering from fibroids, there are a few instances in which Stoltzfus said she wouldn’t recommend the procedure: if the fibroid is extremely large; if the fibroid is totally inside the uterine cavity; if the fibroid is malignant (a very rare but possible occurrence); or if the fibroid has formed and is hanging on a stalk outside the uterus.
The ideal candidate, she said, is a premenopausal woman in her 40s who is symptomatic and who doesn’t want the long recovery time of a hysterectomy or who finds the idea of having her uterus removed traumatic or troublesome. Women who may still want the option of becoming pregnant may also want to look into UFE, as pregnancy is still possible after treatment.
Recovery time after a UFE is about a week to 10 days, compared to a possible recovery time of more than a month for those who have undergone a hysterectomy, or a myomectomy, which is the surgical removal of the fibroids themselves.
Uterine fibroid embolization still does have some side effects, however. According to the FMCNC, most patients will experience “several hours of moderate to severe pain” after the procedure, along with nausea and possible fever. Patients are usually hospitalized overnight with a morphine pump (or other pain relief) and experience vast improvement by the following morning. Cramping may continue for about a week, but can be controlled using pain medica- tions.
Good said she did suffer from bad cramping immediately following the procedure, but that with medication and antiinflammatory drugs, she improved daily. And after about 10 days, the pain was gone completely.
“It was really wonderful,” she said. “There were no stitches, no long recovery. It really has changed my life.”
Some complications may occur, but are anticipated in less than 3 percent of cases. Complications could include injury to the uterus from decreased blood supply or infection — though this is very rare and hysterectomy to treat either of these complications occurs in less than 1 percent of patients, according to the FMCNC.
Stoltzfus said she gets a lot of calls from women who have read about the procedure online and who, prior to that, had no idea that UFE was an option.
But because it’s still relatively unknown, she wants her would-be patients to check in with their gyn
“I still want patients to see a gynecologist first,” she said, “and tell their gynecologist that they are thinking about the (UFE) procedure. If they look me up on the Internet, I still ask that they do that before coming to me.”
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