Midterm clinical and first reproductive results of a randomized controlled trial comparing uterine fibroid embolization and myomectomy

Michal Mara, Jana Maskova, Zuzana Fucikova, David Kuzel, Tomas Belsan, Ondrej Sosna, Michal Mara, Jana Maskova, Zuzana Fucikova, David Kuzel, Tomas Belsan, Ondrej Sosna

Abstract

The purpose of this study was to compare the midterm results of a radiological and surgical approach to uterine fibroids. One hundred twenty-one women with reproductive plans who presented with an intramural fibroid(s) larger than 4 cm were randomly selected for either uterine artery embolization (UAE) or myomectomy. We compared the efficacy and safety of the two procedures and their impact on patient fertility. Fifty-eight embolizations and 63 myomectomies (42 laparoscopic, 21 open) were performed. One hundred eighteen patients have finished at least a 12-month follow-up; the mean follow-up in the entire study population was 24.9 months. Embolized patients underwent a significantly shorter procedure and required a shorter hospital stay and recovery period. They also presented with a lower CRP concentration on the second day after the procedure (p < 0.0001 for all parameters). There were no significant differences between the two groups in the rate of technical success, symptomatic effectiveness, postprocedural follicle stimulating hormone levels, number of reinterventions for fibroid recurrence or regrowth, or complication rates. Forty women after myomectomy and 26 after UAE have tried to conceive, and of these we registered 50 gestations in 45 women. There were more pregnancies (33) and labors (19) and fewer abortions (6) after surgery than after embolization (17 pregnancies, 5 labors, 9 abortions) (p < 0.05). Obstetrical and perinatal results were similar in both groups, possibly due to the low number of labors after UAE to date. We conclude that UAE is less invasive and as symptomatically effective and safe as myomectomy, but myomectomy appears to have superior reproductive outcomes in the first 2 years after treatment.

Figures

Fig. 1
Fig. 1
Reproductive results of 26 women after uterine artery embolization (UAE) and 40 women after myomectomy. Statistical difference between the groups (p value): pregnancy, NSb; delivery, <0.05b; abortion, <0.05b; ectopic gestation, NSc; pregnancy termination, NSc; pregnant now, NSc. Tested by: bchi-square test; cFisher’s test. NS, nonsignificant

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