Endovascular treatment for patients with symptomatic adenomyosis - preliminary study

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Purpose :
Adenomyosis describes a benign uterine disorder in which endometrial glandular tissue is located within the uterine myometrium. The most common clinical presentation of adenomyosis includes cyclical uterine pain, abnormal menstrual bleeding and infertility. Treatment modalities include surgical, pharmacological and minimally-invasive methods. Hysterectomy which is the definitive cure is not an option for women willing to preserve their fertility. The aim of this study is to present our experience with UAE as a treatment of symptomatic adenomyosis or adenomyosis with fibroids and to assess the long-term clinical outcome.
Materials & Methods :
This retrospective cohort study was conducted in a clinical hospital in Poland. It evaluated 12 patients with symptomatic adenomyosis or adenomyosis with fibroids who presented between 2015 and 2020. All patients with adenomyosis were assessed for treatment by an experienced gynecologist and interventional radiologist. Medical history, baseline symptoms and laboratory results were obtained. Afterwards, each patient underwent physical examination and TVUS followed by an MRI study (junctional zone >12 mm). Embolization was performed in local anesthesia with microspheres (500-900 µm) until complete stasis of contrast media in the distal ascending segment of the uterine artery on both sides. Clinical results were obtained.
Results :
Mean age on admission was 48 years (from 39 to 56). Four patients (33%) were diagnosed with pure adenomyosis and eight (67%) with adenomyosis with fibroids. Reported symptoms included: dysmenorrhea (92%) with the mean VAS score of 7.8, menorrhagia with menstrual clots (58%), menorrhagia without menstrual clots (33%) and problems with urination (8%). Successful embolization was achieved in all patients (100%). There were no major procedure-related complications. On average patients spent 2 days in the hospital. A reduction in pelvic pain intensity assessed using VAS was observed in 11/12 (92%) of the patients - pain decreased by 6.2 points on average (from 7.8 to 1.6 pts) in the follow-up period (from 4 to 58 months, mean 39 months). In one patient (8%) the recurrence of pain was observed 2 months after the embolization. This patient underwent hysterectomy. Thus, avoidance of hysterectomy was noted in 92% of the women. All patients reported decrease of menstrual bleeding and consequently improvement of everyday life quality. Five patients experience absence of menstrual periods for at least 12 months after the embolization resulting in menopause rate of 42%. The majority of patients (11/12, 92%) reported to be satisfied very or fairly satisfied with the results and would recommend this treatment to a friend.
Conclusions :
Uterine artery embolization is safe and effective therapeutic option for patients with symptomatic adenomyosis willing to avoid hysterectomy.
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Medical University of Lublin
Medical University of Lublin
Medical University of Lublin
Medical University of Lublin

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