Wojciech Wrona

Influence of ulipristal acetate therapy compared with uterine artery embolization on fibroid volume and vascularity indices assessed by three‐dimensional ultrasound: prospective observational study

To compare the effects of two alternative treatment options for uterine fibroids, ulipristal acetate (UPA) and uterine artery embolization (UAE), on fibroid volume and vascularity at 3‐month follow‐up.

Predicting the results of uterine artery embolization: correlation between initial intramural fibroid volume and percentage volume decrease

Introduction and objective Uterine artery embolization (UAE) is a minimally invasive treatment option for symptomatic fibroids. Long-term follow-up studies have shown that at five-year follow-up after UAE, up to 30% of patients required a hysterectomy. Therefore, it seems of utmost importance to identify patients, who are unlikely to benefit from UAE. It has been postulated that the percentage volume reduction of fibroids may predict long-term UAE outcome. The results of available studies are equivocal, therefore it seemed of interest to investigate the correlation between the preinterventional intramural fibroid volume and imaging outcome of UAE in premenopausal patients. Material and methods Uterine artery embolization was performed in 65 premenopausal patients with symptomatic, intramural fibroids. Dominant fibroid volume was assessed using an integrated VOCAL (Virtual Organ Computer-aided AnaLysis) imaging program at baseline and 3 months after UAE. The percentage reduction of fibroid volume was calculated. The association between preinterventional fibroid volumes and percentage volume reductions was determined with the Spearman rank correlation test. Results Before UAE, the median dominant fibroid volume was 101 cm3 (range 23.6-610). At three-month follow-up the median dominant leiomyoma volume decreased to 50.4 cm3 (range 6.9-193.9). Median percentage reduction of fibroid volume three months after UAE was calculated at 50.1% (range 2.7-93.5). The Spearman correlation test between the preinterventional dominant fibroid volume and percentage volume reduction showed a statistically significant, positive correlation (R = 0.33; p = 0.006). Conclusions The percentage volume reduction of intramural leiomyomas after UAE seems to be more pronounced in the case of larger tumors.

The influence of uterine artery embolisation on ovarian reserve, fertility, and pregnancy outcomes – a review of literature

Uterine fibroids are considered to be the most frequent female benign tumours. Fibroids affect mainly women of reproductive age. The most frequently reported signs and symptoms of fibroids include disturbances of the menstrual cycle such as heavy bleeding and painful menstruation, pelvic masses associated with pelvic pain, urinary problems or constipation, as well as infertility and recurrent pregnancy loss. The mainstay of fibroid treatment is still surgery. However, many patients seek alternative treatment options for fibroids, to preserve their uterus and fertility. One of the most important alternative treatment options for fibroids is uterine artery embolisation (UAE). However, there are some concerns that UAE may negatively influence ovarian function and even result in premature menopause. Moreover, the use of UAE in patients with future reproductive plans is still controversial, due to the possible pregnancy complications. The purpose of this review is to summarise the current knowledge regarding the possible influence of UAE on fertility, pregnancy outcome, and ovarian reserve.

P45.02: Ultrasound examination of the female utrethra after short‐term intravaginal estrogen treatment

Objective: The depletion of estrogens during the menopause period seems to be the cause of improper metabolism thus influencing the morphological structures of the lower urinary tract (LUT). Transvaginal ultrasound examination provides the serious possibility of the detailed assessment of the female LUT structures. The aim of the study was to evaluate the influence of vaginally administered estrogens on ultrasonographic features of the urethra in menopausal women. Material and methods: The studied group consisted of 25 menopausal women not suffering from any form of urinary incontinence. The urethral wall thickness and urethral funneling were measured before, after 1, and after 3 months of treatment with vaginal estrogens. The selected variables were measured 3 times as a single dimension using a 7.5 MHz transvaginal probe (Medison SONOACE 9900 Prime) in the sagittal plane. Transvaginal power Doppler ultrasonography was used to study the pulsatility index (PI) and resistence index (RI) of arterial vessels in the examined structure. Results: The median values of urethral wall thickness and urethral funneling before, after 1 month and after 3 months of local administration of estrogens were 3.7, 3.8, 3.9 mm (Friedman ANOVA, ÷2 = 6.36, P = 0.042) and 3.7, 3.6, 3.6 mm (Friedman ANOVA, ÷2 = 8.61, P = 0.013) respectively. No significant changes in the PI and RI in the bladder wall arterial vessels were found. Conclusion: Short-term estrogen therapy results in significant thickening of urethral wall and in the decrease in the funneling diameter, although it does not affect the vascularization of the assessed tissues.

Extensive postpartum urinary retention successfully treated with clean intermittent catheterization

We present a case of extensive urine retention after vaginal delivery. Postpartum urinary retention occurs in 0.7 to 0.9% of vaginal deliveries. In the literature, mediolateral episiotomy, epidural analgesia, perineal lacerations, macrosomic birth and prolonged 2nd stage of labor are suggested as risk factors for postpartum urine retention.

Ascites Index — a novel technique to evaluate ascites in ovarian hyperstimulation syndrome: a concept-proof study

OBJECTIVES Controlled ovarian hyperstimulation is an important step in infertility treatment. In some cases, however, ovar-ian hyperstimulation syndrome (OHSS) can occur. In its severe forms, ascites is likely to develop, associated with dyspnea. The aim of this study was to explore the usefulness of Ascites Index (AsI), a new tool for quantitative determination of ascites in patients with OHSS, to obtain data for planning further trials. MATERIAL AND METHODS Twelve patients with OHSS and ascites were included in the study. All patients were admitted to the hospital because of abdominal pain and dyspnea due to increasing ascites. Ultrasound measurements of ascites extent were performed in four external quadrants of the abdomen. Pockets of free fluid were measured. The obtained values were totaled, forming the Ascites Index (AsI), similarly to the amniotic fluid index. Because of dyspnea, paracentesis was performed in all cases. RESULTS Median AsI at which patients reported dyspnea was 29.0 cm (range 21.6-38.6 cm). At AsI values less than 21.6 cm, no dyspnea was observed in any of the 12 studied patients. To avoid complications, 2000 mL of ascitic fluid was collected in each patient. After paracentesis, range of AsI decreased to 12.1-14.5 cm. CONCLUSIONS The proposed AsI seems to be a promising tool for estimating and monitoring the ascites extent in OHSS. It can be estimated using basic ultrasound equipment. AsI requires further studies for standardization and transferability to other causes of ascites.

P14.01: Evaluation of intramural fibroid vascularisation after uterine artery embolisation by 3D power Doppler ultrasound

Objectives: The popularity of minimally invasive techniques for the treatment of symptomatic uterine fibroids as an alternative to surgical procedures is increasing. The most widely used procedure of this type is uterine artery embolisation (UAE). During UAE embolic material is administered into bilateral uterine arteries to reduce the tumour’s blood supply. This results in necrosis, fibroid volume reduction and relief of symptoms. In some cases tumour regrowth and recurrence of clinical symptoms after UAE are observed, due to fibroid revascularisation. In this study uterine fibroid vascularisation changes after UAE were analysed during a 3 months follow-up period. Methods: 64 premenopausal patients with symptomatic intramural fibroids qualified for UAE in the 3rd Chair and Department of Gynecology, Medical University of Lublin, were included in the study. Dominant fibroid vascularisation was evaluated before UAE, 24 hours and 3 months after UAE using the VOCAL technique by calculating the vascular-flow index (VFI). Data were analysed using the repeated measures ANOVA with the post hoc Fisher’s test. P values below 0,05 were considered significant. Results: Mean fibroid VFI before UAE was estimated at 0,85 (±0,11 SE), 24 hours after UAE at 0,03 (±0,01 SE), and after 3 months at 0,08 (±0,02 SE). Analysis of variance showed a significant (p <0.0001) effect of time after UAE on the vascularisation of uterine fibroids. A post hoc analysis showed that the fibroid VFI’s assessed after 24 hours and 3 months after UAE were significantly lower than before UAE (p <0,0001). Fibroid VFI assessed 24 hours after UAE was not significantly different from VFI 3 months after UAE (p = 0.62). Conclusions: Statistically significant fibroid vascular-flow index reduction was observed at 24 hours after UAE. Three months after UAE this effect was maintained, with an insignificant increase of VFI between 24 hours and 3 months post UAE.

The role of levonorgestrel intrauterine systems in the treatment of symptomatic fibroids

Uterine fibroids are considered to be the most frequently occurring tumours in females. The majority of fibroids do not require any treatment. When symptomatic, the major ailments include abnormal uterine bleeding, painful menstruation, pelvic pressure or pain, urinary problems, constipation, infertility, and recurrent pregnancy loss. Surgery remains a mainstay of symptomatic uterine fibroids therapy; however, minimally-invasive techniques and pharmacological management have become more available. The levonorgestrel intrauterine system (LNG-IUS) is a T-shaped device with a vertical stem containing a reservoir of levonorgestrel and is widely known for its contraception effect. Moreover, the non-contraceptive benefits of the LNG-IUS have been previously confirmed by numerous studies. LNG-IUS causes reduction of the duration and the amount of menstrual bleeding, with minimal side effects due to release of hormones at the targeted organ. Currently, results from systematic reviews show that LNG-IUS may be an effective and safe treatment for symptomatic uterine fibroids in premenopausal women. However, further studies are required to consolidate the usage of LNG-IUS in the treatment of symptomatic uterine fibroids.

Amenorrhea after chemoembolization and suction curettage of caesarean scar pregnancy

LEARNING OBJECTIVES To better understand the management of caesarean scar pregnancy (CSP) and to be able to recognize and to manage a potential complication of an intervention used to treat CSP. CSP is a rare location of ectopic pregnancy implanted in the area of the previous caesarean section (CS) scar. CSP is associated with a high risk of haemorrhage and in severe cases even a necessity to perform life saving hysterectomy. Selective uterine artery chemoembolization with intra-arterial methotrexate (MTX) infusion followed by suction curettage is one of the treatment options available for CSP. Literature data on the possible complications of this treatment approach are scarce.