Risks of surgery
Whilst the majority of operative procedures are uncomplicated, surgery inherently has some risk. This is in principle least with minimally invasive techniques (particularly hysteroscopic resection) and greatest with open procedures. Clearly there are generic risks associated with all surgery (such as bleeding and infection) and more specific risks associated with particular procedures.
Risks specific to laparoscopic and open myomectomy include post-operative adhesions (internal scarring) that can cause problems in the future, recurrence of fibroids over time, the potential need for Caesarean Section delivery in future pregnancies and the very small risk of hysterectomy. The actual risk will depend on the type of surgery required as well as other features that vary from patient to patient.
Uterine artery embolisation (UAE)
Uterine artery embolisation allows treatment of all fibroids in the womb using minimally invasive techniques without the need for surgical scars. A fine catheter is introduced into the arterial blood supply to the womb via the femoral artery (the main artery in the groin). A dye is passed down the catheter to confirm that it is correctly sited in the uterine artery – the main blood supply to the womb and therefore the fibroids. At this point small PVA particles are passed down the catheter and lodge in the uterine artery and also the smaller vessels that feed the fibroids themselves. Ultimately blood flow within these vessels stops and the oxygen supply to the fibroids is massively reduced. As a result many cells within the fibroids die and this leads to shrinkage in individual fibroid size and the overall volume of the womb. Typically overall shrinkage is between 30-50% which in many patients will lead to significant improvement in symptoms.
Clearly whilst the potential to treat all fibroids within the womb with a single treatment without surgical scars appears to be a very attractive option this treatment is not suitable for all women. Treatment can affect ovarian function (which in some cases may lead to premature menopause or reduced fertility) and there may be other fertility and miscarriage implications. Other risks include post-procedure pain, infection and in 1% of cases hysterectomy.
MRI guided focussed Ultrasound
Sound is a form of energy and as with other energy sources can create heat. By increasing the intensity of the energy and ‘focussing’ the ultrasound to very precise areas the resulting heat production can be used to cause very accurate tissue death within targeted fibroids. As with UAE this results in fibroid shrinkage and potentially symptom improvement. Unfortunately this treatment is not appropriate for multiple fibroids and may not be as effective for pressure symptoms as other treatments. As this technique has been developed relatively recently it is more difficult to be certain about the long-term effect of this treatment although results so far have been reassuring.
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Clinics are three times a week and Gail will help you arrange a time to see Mr Miskry and if necessary a scan on the same day.
If you are pregnant, you can expect to have a number of routine tests and appointments and you can find out more about the schedule of care here.
Appointments can be arranged by phone or email.
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