Uterine artery embolization (UAE) is an effective and accepted treatment option for symptomatic uterine leiomyoma. Between 2000 and 2005, 91 women were treated using this method, and were prospectively followed at our institution. Twenty of them subsequently underwent surgery. One of these patients was subjected to four surgical procedures. We describe the pathological findings of 23 surgical specimens obtained from these 20 patients. The embolic material used consisted of tris-acryl gelatin microspheres (TGMS) in 15 patients (18 surgical specimens), polyvinyl alcohol particles (PVA) in three patients, and a combination of PVA and TGMS in two patients. Histologically, of the 23 specimens examined, 20 were diagnosed as leiomyomas, and three as adenomyosis. Particles used for embolization were found in all but three specimens. Necrosis was present in 15 of 20 leiomyoma specimens. Hyaline necrosis was found in 12 specimens, coagulative necrosis in one case, and a combination of hyaline and coagulative or suppurative necrosis in two cases. The foci of adenomyosis remained unaltered.

• MeSH
• arterie MeSH
• dospělí MeSH
• endometrióza patologie   terapie   MeSH
• leiomyom patologie   terapie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• nádory dělohy patologie   terapie   MeSH
• nekróza MeSH
• polyvinylalkohol terapeutické užití   MeSH
• prospektivní studie MeSH
• terapeutická embolizace * MeSH
• uterus krevní zásobení   patologie   MeSH
• výsledek terapie MeSH
• želatina terapeutické užití   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• klinické zkoušky MeSH
• práce podpořená grantem MeSH
• Názvy látek
• polyvinylalkohol MeSH
• želatina MeSH

Hysteroscopic examination of the uterine cavity revealed that patients previously treated for intramural myoma(s) by uterine artery embolization had a significantly higher incidence of abnormal findings compared with patients treated by laparoscopic occlusion of uterine arteries (59.5% vs. 2.7%). In particular, there was a higher incidence of necrosis in the uterine cavity of patients subjected to uterine artery embolization (43.2%) compared with patients after surgical uterine artery occlusion (2.7%).

• MeSH
• arteria uterina chirurgie   MeSH
• dospělí MeSH
• embolizace děložní tepny škodlivé účinky   metody   rehabilitace   MeSH
• hysteroskopie * škodlivé účinky   metody   MeSH
• incidence MeSH
• laparoskopie * škodlivé účinky   metody   rehabilitace   MeSH
• leiomyom diagnóza   chirurgie   MeSH
• lidé MeSH
• ligace škodlivé účinky   metody   MeSH
• nádory dělohy diagnóza   chirurgie   MeSH
• nekróza epidemiologie   MeSH
• prognóza MeSH
• uterus patologie   MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• klinické zkoušky MeSH
• práce podpořená grantem MeSH
• srovnávací studie MeSH

OBJECTIVE: Uterine fibroids are the most common benign tumours in women of the reproductive age. Symptoms of heavy menstrual bleeding, abdominal discomfort and infertility may seriously affect a woman's quality of life. Uterine artery embolization is a safe and effective alternative treatment to hysterectomy or myomectomy for symptomatic uterine fibroids. Which treatment provides the highest quality of life, least complications, symptom reduction and least chance intervention, has not been established and might depend on strict patient selection. This study aims to identify which specific subgroups benefit most of each treatment by analyzing individual participant data derived from randomized controlled trials of women undergoing embolization or surgical treatment. This study will primarily assess the effectiveness of both treatment groups by evaluating the effect on quality of life of embolization in comparison to surgery on specific patient and fibroid characteristics and the possible need for re-intervention for fibroid-related symptoms. DATA SOURCES: PubMed/MEDLINE, Embase and The Cochrane Library were searched up to August 2020. STUDY ELIGIBILITY CRITERIA: We will collect individual participant data from randomized controlled trials that studied clinical and procedural outcomes of premenopausal women with symptomatic uterine fibroids, who were randomized between uterine artery embolization and surgery. STUDY APPRAISAL AND SYNTHESIS METHODS: Individual participant data from all eligible trials will be sought and analysed according to intention-to-treat principle. Risk of Bias will be done by using version 2 of the Cochrane tool for Risk of Bias in randomized trials. Subgroup analyses to explore the effect of e.g. age, fibroid characteristics and fibroid complaints will be performed, if data is available. This individual patient data meta-analysis will be analysed according to a one-stage model.

• Klíčová slova
• Fibroid, Hysterectomy, Leiomyoma, Menorrhagia, Myomectomy, Premenopause, Quality of life, Uterine artery embolization,
• MeSH
• embolizace děložní tepny * MeSH
• kvalita života MeSH
• leiomyom * chirurgie   MeSH
• lidé MeSH
• metaanalýza jako téma MeSH
• myomektomie * MeSH
• nádory dělohy * chirurgie   MeSH
• randomizované kontrolované studie jako téma MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• protokol klinické studie MeSH

• MeSH
• arterie chirurgie   MeSH
• dospělí MeSH
• elektrokoagulace škodlivé účinky   metody   MeSH
• laparoskopie MeSH
• leiomyom chirurgie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• nádory dělohy chirurgie   MeSH
• prospektivní studie MeSH
• těhotenství MeSH
• terapeutická embolizace škodlivé účinky   metody   MeSH
• uterus chirurgie   MeSH
• výsledek těhotenství * MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• klinické zkoušky MeSH

PURPOSE: To compare outcomes of two different types of occlusive therapy of uterine fibroids. METHODS: Women with fibroid(s) unsuitable for laparoscopic myomectomy (LM) were treated with uterine artery embolization (UAE) or laparoscopic uterine artery occlusion (LUAO). RESULTS: Before the procedure, patients treated with UAE (n = 100) had a dominant fibroid greater in size (68 vs. 48 mm) and a mean age lower (33.1 vs. 34.9 years) than surgically treated patients (n = 100). After 6 months, mean shrinkage of fibroid volume was 53 % after UAE and 39 % after LUAO (p = 0.063); 82 % of women after UAE, but only 23 % after LUAO, had complete myoma infarction (p = 0.001). Women treated with UAE had more complications (31 vs. 11 cases, p = 0.006) and greater incidence of hysteroscopically verified intrauterine necrosis (31 vs. 3 %, p = 0.001). Both groups were comparable in markers of ovarian functions and number of nonelective reinterventions. The groups did not differ in pregnancy (69 % after UAE vs. 67 % after LUAO), delivery (50 vs. 46 %), or abortion (34 vs. 33 %) rates. The mean birth weight of neonates was greater (3270 vs. 2768 g, p = 0.013) and the incidence of intrauterine growth restriction lower (13 vs. 38 %, p = 0.046) in post-UAE patients. CONCLUSION: Both methods are effective in the treatment of women with future reproductive plans and fibroids not suitable for LM. UAE is more effective in causing complete ischemia of fibroids, but it is associated with greater risk of intrauterine necrosis. Both methods have low rate of serious complications (except for a high abortion rate).

• MeSH
• dospělí MeSH
• embolizace děložní tepny metody   MeSH
• hysteroskopie MeSH
• kontrastní látky MeSH
• laparoskopie metody   MeSH
• leiomyom terapie   MeSH
• lidé MeSH
• magnetická rezonanční tomografie MeSH
• nádory dělohy terapie   MeSH
• neparametrická statistika MeSH
• pooperační komplikace MeSH
• prospektivní studie MeSH
• rozdělení chí kvadrát MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• klinické zkoušky MeSH
• práce podpořená grantem MeSH
• srovnávací studie MeSH
• Názvy látek
• kontrastní látky MeSH

AIM: Uterine artery embolization for fibroids is a controversial issue for women with incomplete reproductive plans. Ovarian failure and uterine infection are the most dreaded complications of this procedure. The purpose of the present study was to assess the types and the frequency of intrauterine abnormalities and the histological features of the endometrium after embolization. METHODS: Uterine artery embolization was performed on 51 women (average age 34.5 years) with intramural fibroid/s larger than 4 cm. Hysteroscopy and endometrial biopsy was performed from 3 to 9 months later in the luteal phase of the cycle. RESULTS: Despite all women having no major symptoms prior to hysteroscopy, only 19 (37%) had completely normal hysteroscopic findings. There was intrauterine protrusion of fibroid/s in 19 cases (37%), yellowish coloration of the endometrium in 14 (28%), intrauterine or cervical adhesions in seven (14%), and communication between the myoma and the uterine cavity in five cases (10%). A normal, functional endometrium was histologically verified in 44 women of 49 (90%) who could be evaluated. Regressive changes (necrosis or hyalinization) of leiomyoma or of indefinite origin were found in 17 patients and embolization particles in five, including one patient with microspheres inside the endometrial vessel. No case of Asherman syndrome or endometrial atrophy was observed. CONCLUSION: The frequency of abnormal hysteroscopic findings after embolization is surprisingly high. The clinical significance, reversibility, and impact on fertility of abnormal hysteroscopic findings after embolization remain unclear. Regardless, hysteroscopy should be strongly recommended to all patients after uterine fibroid embolization, prior to conception.

• MeSH
• dospělí MeSH
• hysteroskopie MeSH
• leiomyom patologie   terapie   MeSH
• lidé MeSH
• nádory dělohy patologie   terapie   MeSH
• prospektivní studie MeSH
• terapeutická embolizace škodlivé účinky   MeSH
• uterus patologie   MeSH
• věkové faktory MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• klinické zkoušky MeSH
• práce podpořená grantem MeSH

PURPOSE: To systematically review published studies on the pregnancy rate and outcomes after uterine artery embolization (UAE) for uterine arteriovenous malformations (UAVMs). MATERIALS AND METHODS: International medical databases were searched for all English-language studies published between 2000 and 2022 on patients with UAVMs who had undergone embolization and had a subsequent pregnancy. Data on the pregnancy rate, pregnancy complications, and physiologic status of newborns were extracted from the articles. Ten case series were included in the meta-analysis, and 18 case reports on pregnancy following UAE were reviewed. RESULTS: In the case series, 44 pregnancies were reported in 189 patients. The pooled estimate of pregnancy rate was 23.3% (95% confidence interval [CI], 17.3%-29.3%). The pregnancy rate was higher in studies of women with a mean age of ≤30 years (50.6% vs 22.2%; P < .05). The pooled estimate of live birth rate was 88.6% (95% CI, 78.6%-98.7%). CONCLUSIONS: All published series report preservation of fertility and successful pregnancies after embolization of UAVMs. The live birth rate in these series does not differ substantially from that of the general population.

• MeSH
• arteriovenózní malformace * diagnostické zobrazování   terapie   MeSH
• dospělí MeSH
• embolizace děložní tepny * škodlivé účinky   MeSH
• fertilita MeSH
• lidé MeSH
• novorozenec MeSH
• těhotenství MeSH
• úhrn těhotenství na počet žen v reprodukčním věku MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• novorozenec MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• metaanalýza MeSH
• přehledy MeSH
• systematický přehled MeSH

OBJECTIVE: To report a case of successful pregnancy outcome after embolization treatment of symptomatic leiomyoma. DESIGN: Case report. SETTING: Department of Gynaecology and Obstetrics of University Hospital, Hradec Králové. SUBJECT AND METHOD: A 41-year old primigravida who had previously undergone uterine artery embolization and myomectomy had successful course of the spontaneously conceived pregnancy terminated per sectionem cesarean. An analysis of the 50 published cases of pregnancy after uterine artery embolization revealed the following complications: spontaneous abortion (22%), malpresentation (17%), hypotrophy (7%), premature delivery (28%), caesarean section (58%) and postpartum hemorrhage (13%). CONCLUSION: Whether this procedure is safe for women desiring future fertility is controversial. There are very few data regarding the outcomes of pregnancies after embolization.

• MeSH
• císařský řez MeSH
• dospělí MeSH
• leiomyom krevní zásobení   terapie   MeSH
• lidé MeSH
• nádory dělohy krevní zásobení   terapie   MeSH
• novorozenec MeSH
• těhotenství * MeSH
• terapeutická embolizace * MeSH
• uterus krevní zásobení   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• novorozenec MeSH
• těhotenství * MeSH
• ženské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• kazuistiky MeSH

AIM: Several atypical hysteroscopy findings have been described in association with uterine artery embolization (UAE). The purpose of this study was to evaluate the types and frequency of these findings in the largest published series of patients. MATERIAL AND METHODS: Premenopausal patients after bilateral UAE for symptomatic intramural fibroid underwent subsequent hysteroscopic examination 3-9 months following UAE. The uterine cavity was examined with focus on specific post-embolization changes. Biopsy of endometrium was obtained and evaluated together with a biopsy of abnormal foci if present. RESULTS: UAE was performed in a total of 127 women with an average size of dominant fibroid 63.1 mm in diameter and an average patient age of 35.1 years. Even though the majority of patients were asymptomatic at the time of hysteroscopy (78.0%), the post-embolization hysteroscopic examination was normal in only 51 patients (40.2%). The most frequent abnormalities included tissue necrosis (52 women, 40.9%), intracavitary myoma protrusion (45 women, 35.4%), endometrium 'spots' (22.1%), intrauterine synechiae (10.2%) and 'fistula' between the uterine cavity and intramural fibroid (6.3%). Histopathological examination showed normal, secretory or proliferative endometrium in 83.5% patients. Necrosis and/or hyalinization prevailed in the results of biopsy of abnormal loci (45 cases, 35.4%). CONCLUSION: Frequency of abnormal hysteroscopic findings several months after UAE for primary intramural myomas is high. Alarmingly high is the percentage of patients with a histopathologically verified necrosis. Performing hysteroscopy in selected patients after UAE is necessary before eventual surgical re-intervention, especially in women with reproductive plans.

• MeSH
• dospělí MeSH
• embolizace děložní tepny * MeSH
• hysteroskopie * MeSH
• leiomyomatóza patologie   chirurgie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• nádory dělohy patologie   chirurgie   MeSH
• uterus krevní zásobení   patologie   chirurgie   MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

Uterine artery embolization (UAE) is a minimally invasive procedure with large symptomatic potential in treatment of women with uterine leiomyomas. Due to specificities of this method and possible complications the appropriate indication is crucial. Patient' symptoms, age, plans for pregnancy, and surgical and reproductive history play a major role in decision-making regarding appropriate subjects for UAE. Close cooperation between the gynecologist and the interventional radiologist is necessary. UAE is usually offered as an alternative to surgical treatment. In patients with no fertility plans, it is a less invasive option than abdominal hysterectomy, with a comparable effect on fibroid-related symptoms and quality of life. The need for reintervention is markedly greater in patients after UAE (up to 35% within 5 years) than after hysterectomy. Women with large symptomatic fibroids wishing to retain the uterus and ineligible for minimally invasive (laparoscopic or vaginal) hysterectomy are good candidates for UAE. However, studies comparing UAE with minimally invasive hysterectomy are lacking. Use of UAE in younger women desiring pregnancy is more controversial, mainly because of the significant risk of miscarriage (as high as 64% in some studies) as well as the increased risk of other complications of pregnancy, such as preterm delivery, abnormal placentation, and post-partum hemorrhage. The risk of infertility or subfertility following UAE is unknown. Even poor candidates for myomectomy should be carefully selected for UAE after counseling about all possible adverse effects on fertility. Good prospective studies focused on fertility comparing UAE with no treatment or with myomectomy are needed but would be ethically questionable. This review summarizes the current knowledge regarding the benefits and potential risks of UAE from the point of view of the gynecologist, who should be responsible for proper indication of this treatment.

• Klíčová slova
• benefits, hysterectomy, myomectomy, risks, uterine artery embolization, uterine fibroid,
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH