Clinical outcome after myomectomy versus uterine artery embolization for uterine fibroids

Background: Although total hysterectomy has been considered as gold standard in treatment of symptomatic uterine fibroids in women with completed childbearing, an increasing number of patients are asking for alternatives. Myomectomy and uterine artery embolization, as reported recently, may yield high success rates as well. To date, only few studies have directly compared treatment outcomes of fibroid enucleation vs. embolization of symptomatic uterine fibroids. Methods: During the last 5 years, symptomatic uterine fibroids were removed by organ-preserving surgery (surgical population, n = 120) or by embolization of the uterine artery (embolization population, n = 140) in our unit. Follow-up was conducted using standardized questionnaires mailed to each patient and was completed by 60 patients from the surgical population and 80 patients from the embolization population. In this retrospective single-center study, we looked at pregnancy outcomes as well as improvements in clinical symptoms after the treatment. Results: Both myomectomy and embolization lead to a significant improvement of clinical symptoms. The patients in the surgical and in the interventional population groups displayed reduction of hypermenorrhoea in 68 vs. 77% of cases, reduction of metrorrhagia in 78 vs. 77% and reduction of dysmenorrhoea in 39 vs. 56% of cases, respectively. A tendency for increased improvement of hypermenorrhoea and dysmenorrhoea was noted after embolization compared to surgery. Conclusion: The success rates with myomectomy and uterine artery embolization elucidate the various methods of treating uterine fibroids to every patient. In addition, in patients with completed family planning we now tend to perform a uterus-preserving therapy for symptomatic uterine fibroids. © Georg Thieme Verlag KG Stuttgart.