الفهرس | Only 14 pages are availabe for public view |
Abstract Abnormal uterine bleeding is a common presenting symptom in the family practice setting. In women of childbearing age, abnormal uterine bleeding includes any change in menstrual-period frequency, duration or amount of flow, as well as bleeding between cycles. In postmenopausal women, abnormal uterine bleeding includes vaginal bleeding 12 months or more after the cessation of menses, or unpredictable bleeding in postmenopausal women who have been receiving hormonal therapy for 12 months or more. The etiology is wide-ranging and includes endometriosis, fibroids, adenomyosis, pelvic congestion syndrome, pelvic inflammatory disease, endometrial hyperplasia, and polyps. Polycystic ovarian syndrome and some congenital uterine anomalies may present with menstrual disturbance.Uterine fibroids, for example, are the most common pelvic tumors in women. They are found in approximately 20% to 40% of women over the age of 35 years. While some of them are asymptomatic, some are associated with significant and disabling symptoms, ranging from prolonged menstrual periods to urinary frequency, low back and pelvic pain. Uterine artery embolization has been used as a promising and minimally invasive new option for patients with symptomatic fibroid disease (leiomyoma). It is indicated after failed medical or surgical uterine sparing surgery in patients who express their desire for uterine preservation or avoidance of further surgery unless they have any of the exclusion criteria. There is marked reduction of bleeding and improvement of the bulk related symptoms after UAE. There is also, reduction of uterine and fibroid size and vascularity on follow up by different imaging techniques UAE has high success rate in comparison with the standard uterine sparing surgery with a shorter post procedural recovery period and lower morbidity and mortality rates. Major complications of UAE are rare compared with other surgical procedures. Minor complications are usually encountered. The most common complication is post embolization syndrome which is transient and usually disappears within one week. Advantages of this method of treatment include; avoidance of surgery and its risks rapid recovery, and a low complication rate UFE has several potential advantages over hysterectomy, myomectomy and hormonal suppression. Unlike myomectomy or hysterectomy, UFE involves virtually no blood loss or risk of blood transfusion. General anesthesia and surgical incisions are avoided. Recovery is weeks shorter than recovery from hysterectomy or open myomectomy. So UAE is a safe and effective method for treating symptomatic fibroid disease with uterine preservation for further fertility.Percutaneous imaging guided ablative therapies using thermal energy sources such as radiofrequency ablation and high intensity focused ultrasound have received much recent attention as minimally invasive strategies for the treatment of tumors. These techniques permit the destruction of tumors without necessitating their removal and in many cases can be used in place of more invasive and expensive surgical techniques. |