An advanced fibroid treatment gains popularity

An advanced fibroid treatment known as Uterine Fibroid Embolization (UFE) provided at Aga Khan University Hospital has gained popularity since the introduction of this procedure five years ago. Dr Nigel Hacking, a UFE specialist based in England working together with the obstetrics and gynaecology faculty at Aga Khan University Hospital have carried out over 200 operations. The availability of this procedure has increased the number of treatment options for patients suffering from fibroids in East Africa.

Fibroids are a non-cancerous growth of the muscle of the uterus which typically occur in women during their reproductive years. Research indicates that one in five women has fibroids and black women are two to three times more likely to have them compared to their white counterparts.

Depending on the size, location and nature of symptoms caused by the fibroids, different treatment options are available at AKUH Fibroid Centre. UFE is recommended as a non-surgical alternative for patients who want to avoid open surgery, or have risks resulting from surgical complications, a history of keloid scars (an overgrowth of scar tissue), blood clots, or medical conditions that may complicate aneasthesia.

Dr Timona Obura the Vice Chair, Department of Obstetrics and Gynaecology at Aga Khan University Hospital and Consultant Hysteroscopic and Laparoscopic Surgeon, explained, “This procedure is also an option for patients who may wish to conceive in the future and is a very effective method of reducing menstrual blood loss in those with anaemia. In addition, the choice of UFE allows for rapid resumption of normal activity and is used as a means of shrinking fibroids to reduce pressure symptoms.”

Gloria Wamalwa who recently underwent this procedure found out that she suffered from fibroids ten years ago when she conceived her second child. The doctors advised her to do nothing about them as they seemed to shrink after her pregnancy.

The fibroids did not bother her again until two years ago during a routine MRI, the doctor suggested that she ought to do something about them. Gloria explained, “I kept postponing the issue. I have never been to theatre and the thought of surgery just freaked me out. Many of the stories I’ve heard and read about were not encouraging either.”

“A few weeks ago I started getting very heavy periods and consulted my doctor. He mentioned that an advanced fibroids treatment that did not involve surgery is being performed at the Aga Khan University Hospital and introduced me to Dr Obura.”

“Dr Obura explained the procedure and gave me some websites to help me understand it better. A special MRI was done to determine whether I was a good candidate for the technique. On the day of the intervention, I was asked to be at the hospital at 8am, I was prepared for the procedure at 9am and by 11am I was through and chatting with my visitors in my room.”

“The best part of it was that I was awake throughout the procedure watching everything on the screen in the Cathlab and the doctors were talking to me so it was not scary. I had no side effects after the procedure, it was less costly and I am very happy because it was non- invasive so I have no scars!”

Gloria feels that every woman has a right to know about all the treatment options and where they are available to enable patients make informed choices. She says many doctors don’t give patients treatment options that don’t benefit them for fear of losing business.

ABOUT UTERINE FIBROID EMBOLISATION (UFE)

What is UFE?

UFE is well established internationally as a proven Interventional Radiology treatment. In the United Kingdom, national guidelines recommend that the procedure should be offered to women with symptomatic uterine fibroids. Fibroids are a non-cancerous growth of the muscle of the uterus which typically occur in women during their reproductive years.

Where is the procedure carried out?

At the Aga Khan University Hospital, the procedure is carried out in the Catheter Laboratory. Patients are admitted before the treatment and are required to spend one night in the ward afterwards and are usually discharged the following morning.

Does the patient require any prior preparation? 

After a full gynaecological review and discussion of the treatment options with the doctor, Magnetic Resonance Imaging (MRI) and ultrasound scans are conducted before the process to define the structure of the fibroid accurately and assess the likely response to treatment.

Explain the procedure

This is a painless operation and therefore a full anaesthetic is unnecessary. After a sedative and a local anaesthetic, a tiny nick in the skin is made to allow a very fine catheter to be passed into a blood vessel. The catheter tip is moved along the blood vessels until the uterine arteries are reached. A substance is then injected to block the uterine arteries. All this is followed on an X-ray screen by a radiologist.

What post-operative care is required?

Following the procedure, the patient rests in the ward overnight. Some painkillers are usually needed for the night in hospital, followed by tablets for two to seven days after being discharged. It is possible to resume normal activity and return to work within the first two weeks.

Can a woman still conceive after this procedure?

It is safe to conceive after a UFE operation. Patients are advised to wait for six months before attempting to conceive. There may be some increase of risk to the pregnancy in the presence of fibroids so plans for future childbearing should be carefully discussed with a doctor before planning treatment.

Apart from UFE what are the other methods of treating fibroids?

The other surgical methods of treatment include abdominal hysterectomy, vaginal hysterectomy, open myomectomy, hysteroscopy fibroid resection, laparoscopic myomectomy and laparoscopic hysterectomy.    

• Abdominal hysterectomy is sometimes recommended for patients who have completed their family and have large fibroids.
• Vaginal hysterectomy may be suggested for patients with ‘medium size’ fibroids and have also completed their family. A laparoscopic component of this procedure is sometimes advised.
• Open myomectomy is a suitable option for large symptomatic fibroids in a patient aiming to preserve the potential for childbearing while laparoscopic myomectomy is useful where the fibroids are mainly located on the outside part of the uterus. This allows quicker recovery than an ‘open myomectomy’.
• A hysteroscopic fibroid resection is a technique which uses a telescope inside the uterus to remove fibroids that are protruding into the cavity of the uterus.
• Laparoscopic myomectomy – fibroids are removed surgically via small incisions of 0.5 cm to 1.5 cm made on the abdominal wall.
• Laparoscopic hysterectomy – the entire uterus is removed via small surgical incisions equivalent to those of laparoscopic myomectomy. 

Given the wide choices available the selection of fibroid treatment decisions should be made on the basis of what is best for the individual patient rather than the cost.