Outcome of Uterine Embolization and Hysterectomy for Leiomyomas: Results of a Multicenter Study

This multicenter prospective study compared uterine embolization with hysterectomy in the treatment of women with symptomatic leiomyomas. One hundred two patients were treated with embolization and 50 underwent hysterectomy. Clinical and demographic data, menstrual flow, menorrhagia, general health, and quality-of-life assessments were recorded for each patient. Follow up consisted of office visits with 1 to 3 weeks of treatment, at 3 months, and 6 months. Patients were mailed a questionnaire for evaluation at 12 months. Participants were between 30 and 50 years of age. Embolization patients were more often black, more likely to have had prior treatment for leiomyomas, and had more leiomyomas. The mean uterine volume for these patients was nearly twice that of hysterectomy patients. Embolization procedures took an average of 60 minutes. The average hospital stay was less than 1 day (mean 0.83 days), and the time to return to work was an average of 11 days after treatment. For hysterectomy patients, the mean operating time was 97 minutes, mean hospital stay was 2.3 days, and mean time to return to work was 33 days (P <0.001 for all 3 comparisons). Patients who had embolization had a 55.6% reduction in blood loss at the 3 months follow-up visit and a 58.1% reduction at 6 months (P <0.001 for change). Menorrhagia scores followed a similar pattern. Three hysterectomy patients had minimal cyclic bleeding after surgery. No other differences in symptoms were seen between the 2 groups at 6 months. At 12 months, 98% of hysterectomy patients had improved pelvic pain compared with 84% of embolization patients. Hysterectomy patients also reported a reduction in pelvic pressure more often than those who had embolization (98% vs. 84%). Urinary symptoms were similar in both groups. No differences were seen between the 2 groups in physical and mental health summaries and patient self-assessments of overall health status, which all showed improvement at 6 months and 12 months. Overall, patients who had the lowest baseline scores for these measures reported the greatest improvement at 6 months. The embolization group experienced a mean decrease in uterine volume of 26% at 3 months and 33.1% at 6 months (P <0.001 for both). Leiomyomata volume decreased by 45.8% and 54%, respectively (P <0.001 for both). At 3 and 6 months, 94% of hysterectomy patients expressed at least moderate satisfaction with symptom improvement; by 12 months, 97% were satisfied. Comparable scores for embolization patients were 89%, 88%, and 90%, respectively. Complications from treatment were more frequent among patients who had hysterectomy. Within the follow-up period, febrile morbidity was seen in 24% of hysterectomy patients and 12.7% of embolization patients (P <0.01). Eight percent and 3%, respectively, were readmitted to the hospital, 8.0% and 2.0% had additional unintended surgery, and 8.0% and 0.0% experienced blood loss requiring 2 or more units of blood (P <0.01). Overall morbidity was 34% in hysterectomy patients and 15% in embolization patients (P <0.01). Seven patients in the embolization group were amenorrheic at 12 months.