Uterine Artery Embolization for Reducing Uterine Size and Alleviating Bladder Compression
Uterine artery embolization (UAE) can achieve an average reduction of >50% in uterine fibroid size at 5 years, which is typically sufficient to relieve bladder compression symptoms in a 14cm uterus. 1
Expected Reduction in Uterine Size
- UAE causes arterial occlusion, ischemic necrosis, and involution of fibroids, leading to significant reduction in both fibroid and overall uterine volume 1
- According to the most recent guidelines, UAE results in an average decrease in uterine fibroid size of >50% at 5 years post-procedure 1
- Studies specifically examining large fibroid burden show mean volume reduction of 44% for dominant fibroids and 43% for overall uterine volume 2
- For patients with significant bulk symptoms (including bladder compression), clinical success rates of 93-97% have been reported 3
Timeline of Size Reduction
- Initial reduction can be observed within 3 months post-procedure 3
- MRI studies show approximately 50% uterine volume reduction and 60% dominant fibroid volume reduction at 6 months 3
- Maximum benefit is typically achieved by 5 years, with sustained reduction in fibroid size 1
Factors Affecting Reduction Percentage
- The presence of multiple fibroids may result in slightly different reduction rates compared to a single dominant fibroid 1
- Fibroid location (subserosal, intramural, or submucosal) can influence the degree of reduction 1
- Large fibroid burden (dominant fibroid >10cm or uterine volume >700cm³) still shows good response to UAE with mean volume reduction of 44% 2
Relief of Bladder Compression Symptoms
- For urinary symptoms specifically (including bladder compression), 97% of women experience at least some improvement, with 50% reporting complete resolution of all urinary symptoms 3
- The reduction in uterine size correlates with improvement in bulk-related symptoms such as bladder compression 1, 3
Potential Complications and Considerations
- Side effects of UAE include pelvic pain, vaginal expulsion of submucosal fibroids, and postembolization syndrome (flu-like symptoms with pain, nausea, fevers) 1
- Major complications are rare, with studies reporting no significant procedure-related acute complications 3
- Reintervention rates are approximately 28% at 5 years and 35% at 10 years according to the EMMY trial 1
Follow-up Recommendations
- Follow-up imaging at 3-6 months post-procedure is recommended to assess treatment efficacy and measure fibroid volume reduction 4
- Clinical follow-up should focus on symptom improvement, particularly relief of bladder compression 4
In conclusion, for a 14cm uterus causing bladder compression, UAE can be expected to provide approximately 40-50% reduction in uterine size, which is typically sufficient to alleviate bladder compression symptoms in the majority of patients.