Uterine Fibroid Embolization  

Oleh:

Goodwin, Scott C. ; Spies, James B.

Jenis: Article from Journal - ilmiah internasional
Dalam koleksi: The New England Journal of Medicine (keterangan: ada di Proquest) vol. 361 no. 07 (Aug. 2009), page 690-697.
Topik: Uterine fibroid; embolization

Ketersediaan

Perpustakaan FK Nomor Panggil: N08.K.2009.04 Non-tandon: 1 (dapat dipinjam: 0) Tandon: tidak ada

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A 45-year-old, premenopausal black woman (gravida 3, para 2, with a history of one spontaneous abortion) presents with menorrhagia and dysmenorrhea that has worsened progressively over a period of 10 years. She does not wish to have any more children. On physical examination, she has a firm, nontender, enlarged uterus. The ovaries are not palpable. Laboratory tests in the past had revealed intermittent mild anemia that was correctable with iron supplementation, but more severe anemia has been noted recently, and she has had increasing difficulty managing her menstrual bleeding. In-office ultrasound examinations have shown several intramural uterine masses consistent with uterine fibroids that have been slowly increasing in size; the largest measures 6.5 cm at the point of its greatest dimension. The adnexa are normal. The patient's gynecologist has recommended a hysterectomy. However, the patient does not want to undergo a hysterectomy, and her gynecologist suggests uterine fibroid embolization as an alternative. She is referred to an interventional radiologist who orders a magnetic resonance imaging (MRI) scan. The results of the MRI confirm the ultrasound findings and rule out adenomyosis. The interventional radiologist discusses with the patient uterine fibroid embolization as an alternative to hysterectomy. What treatment should be recommended for this patient? Uterine fibroids are among the most common tumors of the female reproductive tract that occur in premenopausal women. In one study of women 17 to 44 years of age undergoing tubal sterilization, fibroids were found in 9% of whites and 16% of blacks, although the prevalence is much higher on pathological examination after hysterectomy. The overall incidence has been reported to be 29.7 per 1000 patient-years, with considerable variation according to age; in most studies, the peak incidence has been shown to occur among women who are in their early to mid-40s. The risk of having fibroids is higher by a factor of three among blacks than among whites. Although uterine fibroids are benign, they can cause considerable symptoms. The most frequent symptom is menorrhagia, with iron-deficiency anemia often occurring as a result. Dysmenorrhea, pelvic pain and pressure, dyspareunia, urinary frequency and urgency, and other pelvic symptoms may occur. Symptoms are often of sufficient severity to necessitate surgical intervention. Fibroids are the most common indication for hysterectomy in the United States; a total of 300,000 hysterectomies to remove fibroids are performed each year. The overall cost of treating fibroids was estimated at $2.1 billion in 2000. More than 70% of those costs were directly related to hysterectomy.

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