Uterine artery embolization vs hysterectomy in the treatment of symptomatic uterine fibroids: 5-year outcome from the randomized EMMY trial

• Published in: American journal of obstetrics and gynecology 2010-08, Vol.203 (2), p.105.e1-105.e13
• Main Authors: van der Kooij, Sanne M., MD, Hehenkamp, Wouter J.K., MD, PhD, Volkers, Nicole A., MD, PhD, Birnie, Erwin, PhD, Ankum, Willem M., MD, PhD, Reekers, Jim A., MD, PhD
• Format: Article
• Language: English
• Subjects: Adult; Biological and medical sciences; Female; Female genital diseases; fibroid tumor; Follow-Up Studies; Gynecology. Andrology. Obstetrics; Humans; hysterectomy; Hysterectomy - adverse effects; Hysterectomy - methods; Hysterectomy, Vaginal - adverse effects; Hysterectomy, Vaginal - methods; Kaplan-Meier Estimate; Leiomyoma - pathology; Leiomyoma - surgery; Medical sciences; menorrhagia; Middle Aged; Neoplasm Staging; Obstetrics and Gynecology; Pain Measurement; Pain, Postoperative - physiopathology; Patient Satisfaction; Postoperative Complications - epidemiology; Postoperative Complications - physiopathology; Prospective Studies; Quality of Life; Risk Assessment; Statistics, Nonparametric; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the genital tract and mammary gland; Time Factors; Treatment Outcome; Tumors; uterine artery embolization; Uterine Artery Embolization - adverse effects; Uterine Artery Embolization - methods; Uterine Neoplasms - pathology; Uterine Neoplasms - surgery
• ISSN: 0002-9378; 1097-6868
• DOI: 10.1016/j.ajog.2010.01.049

Objective The purpose of this study was to compare clinical outcome and health related quality of life (HRQOL) 5 years after uterine artery embolization (UAE) or hysterectomy in the treatment of menorrhagia caused by uterine fibroids. Study Design Patients with symptomatic uterine fibroids who were eligible for hysterectomy were assigned randomly 1:1 to hysterectomy or UAE. Endpoints after 5 years were reintervention rates, menorrhagia, and HRQOL measures that were assessed by validated questionnaires. Results Patients were assigned randomly to UAE (n = 88) or hysterectomy (n = 89). Five years after treatment 23 of 81 UAE patients (28.4%) had undergone a hysterectomy because of insufficient improvement of complaints (24.7% after successful UAE). HRQOL measures improved significantly and remained stable until the 5-year follow-up evaluation, with no differences between the groups. UAE had a positive effect both on urinary and defecation function. Conclusion UAE is a well-established alternative to hysterectomy about which patients should be counseled.