title: Evaluation of the effect of uterine artery embolisation on symptomatic uterine leiomyomata and analysis of the vasculature associated with these benign tumours
Creators: name: Khaund, Aradhana
Publisher: name: University of Glasgow
Year: 2007
Subjects: subject: Surgery, uterine fibroids.

description: Uterine leiomyomata (fibroids) are the most common tumours found in the female reproductive system. Whilst many women affected by these benign tumours are asymptomatic, those who do have symptoms may experience a considerable reduction in quality of life and impose a significant burden on the National Health Service. The mechanisms by which fibroids develop and grow is still unclear to us and thus, examination of the uterine vascular network in greater detail may assist further in our understanding of the biology of these benign tumours. Chapter one provides an introduction to all work in the thesis and initially discusses the histology, incidence and epidemiology of uterine leiomyomata. The pathophysiology of fibroids is also explored, with particular reference to genetic, hormonal, vascular and growth factor influences. Myometrial and fibroid vasculature is discussed in this chapter as well as fibroid symptomatology and the aetiology of menorrhagia. Finally, therapeutic options for fibroids including uterine artery embolisation (UAE) are explored as well as the relevance of quality of life assessments in the evaluation of UAE and an overview of the currently available comparative data on embolisation versus surgery in the treatment of symptomatic fibroids. Chapter 2 presents data from a prospective study evaluating the effect of UAE on menstnial blood loss (MBL) and uterine volume. Main outcome measures were post-embolisation MBL (objectively measured using the alkaline haematin technique) and uterine volume changes. This study concluded that UAE is associated with a statistically significant reduction in objectively measured MBL which is maintained up to 48 months after treatment and a statistically significant reduction in uterine volume at six months. Chapter 3 describes subjects and methods used to evaluate the effects of UAE on health-related quality of life (HRQoL). Chapter 4 sets out to investigate the evolution of inflammatory markers after UAE in order to monitor the normal course following the procedure. It was anticipated that the results would provide further insight into the aetiology of the post-embolisation syndrome, a syndrome which occurs approximately 7-21 days after UAE and is associated with pelvic pain and flu-like symptoms. Chapter 5 aims to evaluate and compare the safety and efficacy of UAE to standard surgical treatments for symptomatic fibroids. This is addressed in the setting of a multicentre randomised controlled trial. The primary outcome measure was health related quality of life at one year as assessed by the SF 36. The study demonstrated there were no significant differences between the embolisation and surgical aims of the trial, in all components of the SF 36 at one year. Embolisation, however, was associated with a shorter duration of hospitalization and a shorter period of time until resumption of normal activities whilst surgery was associated with better symptom scores at one year. Chapter 6 highlights a late complication after uterine artery embolisation and presents the data in the form of a case report. Chapter 7A aims to compare human myometrial and fibroid vasculature using stereological and moiphometric analysis. Finally, Chapter 7B describes experimental work involving vascular perfusion techniques and magnetic resonance imaging (MRI) of fresh human uterus ex-vivo. It was anticipated that this study would demonstrate better resolution of the microvascular network of the uterus, but we did not find this to be the case. (Abstract shortened by ProQuest.).