What are the success rates of uterine artery embolization (UAE) for achieving urinary frequency improvement in patients with multiple fibroids in the myometrium versus a single large fibroid?

Uterine Artery Embolization Success Rates for Urinary Frequency Improvement: Multiple vs. Single Fibroids

UAE demonstrates an 86% success rate for improving urinary frequency symptoms at 3 months post-procedure, with similar effectiveness for both multiple fibroids and single large fibroids. 1

Effectiveness of UAE for Urinary Symptoms

General Success Rates

• The Ontario Uterine Fibroid Embolization Trial, a multicenter prospective registry, demonstrated significant improvement in urinary frequency (86%) at 3 months after UAE 1
• Overall clinical success rates of UAE range from 81% to 100% across numerous studies 1, 2
• At 12 months, 95% of patients report symptomatic alleviation and improved quality-of-life scores 1

Multiple vs. Single Large Fibroids

• A retrospective study showed no difference in outcomes or complications in patients with large fibroid volumes compared with published outcomes for other patients treated with UAE 1
• Patients with multiple fibroids may actually have better outcomes, as multiplicity of nodules has been identified as a predictive factor for success 1
• For patients with a large fibroid burden (dominant fibroid >10 cm and/or uterine volume >700 cm³), long-term clinical results are comparable to those in other UAE patients 3

Factors Affecting UAE Success

Predictors of Success

• Hypervascularity of the nodules and multiplicity of nodules have been identified as preoperative factors predictive of success 1
• However, some studies found no correlation between fibroid characteristics and outcome 1
• The location of fibroids is important for patient selection - cervical fibroids have higher treatment failure and reintervention rates 1

Durability of Results

• There is a 20-25% incidence of symptom recurrence at 5-7 years after UAE 1, 2
• Continued symptom relief was reported in 72% of women at median follow-up of 54 months 1
• Reintervention rates of 14.4% at 3 years have been reported (9.8% repeat UAE, 2.8% myomectomy, and 1.8% hysterectomy) 1, 2

Technical Considerations

Procedure Details

• UAE is performed under conscious sedation using either unilateral or bilateral common femoral artery approach 1
• Both uterine arteries are selectively catheterized and embolized using particulate embolic agents 1
• The goal is occlusion of all distal uterine artery branches feeding the leiomyomas 1

Follow-up Protocol

• Patients are followed closely for the first 24-48 hours after discharge 1
• At 3-6 months after the procedure, patients are reevaluated for treatment efficacy 1
• Follow-up imaging is performed to determine fibroid volume reduction and assess for incomplete fibroid infarction 1

Complications and Considerations

Common Complications

• Major complications occur in <3% of patients 1, 2
• Up to 10% of patients may need readmission for pain control 1, 4
• Amenorrhea risk is age-dependent: <2-3% for women under 45 years, up to 20% for those over 45 years 1

Special Considerations

• Age impacts treatment failure rates, with worse outcomes for patients <40 years of age 1
• Despite relatively high long-term recurrence rates, repeat embolization is effective for most patients 1
• UAE does not preclude other therapies if unsuccessful 1

In conclusion, UAE is highly effective for improving urinary frequency symptoms in patients with uterine fibroids, with similar success rates for both multiple fibroids and single large fibroids. The evidence suggests that multiplicity of fibroids may actually be associated with better outcomes in some cases.