Uterine Artery Embolization (UAE)
UAE is a nonsurgical alternative to hysterectomy or other surgical alternatives in the treatment of uterine fibroids.
What to expect?
The patient feels absolutely no pain during this one hour procedure. Intravenous sedation (fentanyl and versed)is used. After the procedure patients experience a crampy pain like heavy menstrual cramps. This usually lasts from several to 6-8 hours and is significantly improved by the following morning. Most patients leave the hospital the same day of the procedure, while approximately 10-15% will stay overnight due to some continued pain and/or nausea. All patients have been discharged by the following morning. Patients are given two medications upon discharge.
1. Anti-inflammatory (Anaprox) to be taken three times a day with food for 5 days.
2. Analgesic (Vicodin) which only needs to be taken if needed.
The recovery period is usually 3-4 days, although I suggest patients take 1 week off from work if possible. The only restrictions after the procedure are:
1. No bathing for 2 weeks (you can shower).
2. No tampons for one cycle (use pads then can switch back).
3. No intercourse for 2 weeks.
4. No heavy lifting for 2 weeks.
The patient is encouraged to be well hydrated (drink lots of fluids) the day before the procedure. Nothing is to be taken by mouth after midnight the night before the procedure. One exception to this is if you take medicine in the morning, this can be taken with small sips of water. Prepare your bedside table the night before (tissues, heating pad, thermometer, loose-fitting nightgown, important phone numbers of doctors, pharmacy). You will need someone to drive you home either the evening of the procedure or in the morning the day after the procedure.
If you are tolerating taking food by mouth, are having no leaking from the band-aid in the groin, and the oral pain medicine is adequate in controlling the discomfort you can go home. You will be discharged on an anti-inflammatory (like motrin) which you need to take for 5 days and a pain pill which is taken only as needed. The pain pill will tend to constipate so use a laxative if this occurs as the discomfort of constipation will add to the expected procedural discomfort. You should resume your normal activities as you feel able which should be within 48-72 hours after the procedure. Don't overdo it, and use pain/discomfort as your guide. Eat healthy foods and drink plenty of fluids. Boxer shorts are recommended over briefs (less irritating). Heating pads can be helpful for the discomfort. No aspirin or aspirin-like products should be used during the 5 days on the prescribed medications. Should you have any questions, day or night there is always a physician (Interventional Radiologist) on call to help you.
MRI-guided Focused Ultrasound (MRI-gFUS)
Immediately prior to the procedure, the woman has a catheter inserted in an arm vein and a bladder catheter placed. She lies prone (i.e. on her stomach) for the duration of the procedure. The procedure can take up to 3-4 hours to complete. Intravenous sedation and pain medication are given to the patient to provide comfort and relaxation. There is a nurse with the patient in the scanner along with the treating physician outside of the scanner throughout the entire procedure.
Individual pulses of focused ultrasound energy are deposited to the fibroid. These last for ~20 seconds each and are given until the fibroid is completely treated. Afterwards, MR images are obtained to evaluate the effectiveness of the treatment session.