Hysterectomy Is Mostly Unnecessary
As a radiologist who has been performing uterine artery embolizations for more than 10 years I have been receiving inquiries from women with asymptomatic fibroids for exactly the same period of time. The women want to know whether the hysterectomy their gynecologist in private practice recommended—for which they usually already have an inpatient appointment—might be avoidable if they underwent uterine artery embolization for their fibroids. As a rule, these women obviously require neither a hysterectomy nor other surgery nor uterine artery embolization nor any other treatment.
The number of unnecessary hysterectomies in Germany, which are performed without any indication, is likely to be shockingly large. Women only find out about the uterine artery embolization option through their own internet searches.
The mention of interventional radiological procedures, such as uterine artery embolization and high intensity focused ultrasound (HIFUS; MRI-guided focused ultrasonographic ablation, to use the authors’ term), in the article is therefore particularly welcome.
Whether uterine artery embolization negatively affects fertility is still the subject of controversial discussion. The study reported by Mara (1), which is usually cited in this context, favors myomectomy over uterine artery embolization in this regard, while pointing out limitations and weaknesses. The results of other studies (unfortunately of a lower evidence level) point into the opposite direction (2) or remain to be evaluated (3).
Quite apart from all these facts, whether uterine artery embolization has a questionable negative effect on fertility should not be used as an argument against the procedure in an article about hysterectomy, after which fertility is not an issue anyway.
Dr. med. Gernot Rott
Klinik für diagnostische und interventionelle Radiologie
Conflict of interest statement
Dr Rott has received conference delegate fees, travel expenses, and hotel expenses from Terumo.
|1.||Mara M, Maskova J, Fucikova Z, Kuzel D, Belsan T: Midterm clinical and first reproductive results of a randomized controlled trial comparing uterine fibroid embolization and myomectomy. Cardiovasc Intervent Radiol 2008; 31: 73–85. CrossRef MEDLINE PubMed Central|
|2.||Pisco JM, Duarte M, Bilhim T, Cirurgiao F, Olveira A: Pregnancy after uterine fibroid embolization. Fertility and Sterility 2011; 95: 1121.e5–8. MEDLINE|
|3.||www.ClinicalTrials.gov Identifier: NCT00839722: Fertility after UAE for the Treatment of Leiomyomas. Last accessed: 21 September 2009|
|4.||Stang A, Merrill RM, Kuss O: Hysterectomy in Germany: a DRG-based nationwide analysis, 2005–2006. Dtsch Arztebl Int 2011; 108(30): 508–14.|