Fibroid Expulsion after Uterine Artery Embolization

Uterine artery embolization (UAE) is a ubiquitous procedure, and a broadly recognized alternative to surgical interventions for symptomatic leiomyomata when uterine preservation is desired. Aside from postembolization syndrome (typically considered an expected feature of recovery), the most frequently described complications are temporary or permanent amenorrhea and lingering vaginal discharge. Less frequently described complications include fibroid expulsion (FE), protracted or refractory pain, infection, urinary retention, and access-related injuries. Reported rates of transcervical FE vary in the literature from 3 to 50% but are most often quoted to be around 5 to 15%. Certain features predispose a patient to FE, including size and location of the tumor, with pedunculated submucosal, submucosal, and transmural lesions considered to be high risk. While the optimal management of FE has not been definitively determined, high rates of nonoperative management of FE are noted in the literature. This article describes a case in which a fibroid was expulsed following UAE, as well as the management of the complication. A literature review and recommendations for the management of FE is also given.