Original Article
Uterine-Artery Embolization versus Surgery for Symptomatic Uterine Fibroids
N Engl J Med 2007; 356:360-370January 25, 2007
- Abstract
Background
The efficacy and safety of uterine-artery embolization, as compared with standard surgical methods, for the treatment of symptomatic uterine fibroids remain uncertain.
Methods
We conducted a randomized trial comparing uterine-artery embolization and surgery in women with symptomatic uterine fibroids. The primary outcome was quality of life at 1 year of follow-up, as measured by the Medical Outcomes Study 36-Item Short-Form General Health Survey (SF-36).
Results
Patients were randomly assigned in a 2:1 ratio to undergo either uterine-artery embolization or surgery, with 106 patients undergoing embolization and 51 undergoing surgery (43 hysterectomies and 8 myomectomies). There were no significant differences between groups in any of the eight components of the SF-36 scores at 1 year. The embolization group had a shorter median duration of hospitalization than the surgical group (1 day vs. 5 days, P<0.001) and a shorter time before returning to work (P<0.001). At 1 year, symptom scores were better in the surgical group (P=0.03). During the first year of follow-up, there were 13 major adverse events in the embolization group (12%) and 10 in the surgical group (20%) (P=0.22), mostly related to the intervention. Ten patients in the embolization group (9%) required repeated embolization or hysterectomy for inadequate symptom control. After the first year of follow-up, 14 women in the embolization group (13%) required hospitalization, 3 of them for major adverse events and 11 for reintervention for treatment failure.
Conclusions
In women with symptomatic fibroids, the faster recovery after embolization must be weighed against the need for further treatment in a minority of patients. (ISRCTN.org number, ISRCTN23023665.)
Media in This Article
Figure 1
Enrollment and Outcomes.Table 1
Baseline Characteristics of the Patients.Article Activity
- Article
Uterine fibroids are the most common type of tumor in the female reproductive system. The presence of these tumors may cause menstrual disorder and can be associated with subfertility, miscarriage, and pressure effects.1 For women who no longer plan to give birth, the established treatment is hysterectomy. In the United Kingdom, approximately 42,500 hysterectomies are performed annually, with approximately 30% indicated for fibroids (the second-most-frequent indication).2 For women wishing to maintain their fertility, myomectomy is the principal option.
Uterine-artery embolization was introduced in 1995 as an alternative technique for treating fibroids.3 Since then it has become increasingly accepted as a minimally invasive, uterine-sparing procedure, and more than 100,000 procedures have been performed during the past decade, mainly in the United States and Western Europe.4 Early analysis of an open, prospective, voluntary U.S. registry including 3160 patients revealed major complications in 5.5% of patients at 30 days, with 0.1% requiring a hysterectomy.5 In the United Kingdom, the National Institute for Health and Clinical Excellence issued guidelines in October 2004, stating that the procedure appeared to be safe for routine use and that the majority of patients have short-term symptomatic relief.6 However, there has been a need for a careful assessment of the effects of the procedure on quality of life, particularly in comparison with standard surgical approaches.7 We designed a randomized trial comparing uterine-artery embolization and surgery to assess quality of life and other outcomes at 1 year of follow-up.
Methods
We conducted the trial in 27 hospitals in the United Kingdom. Each hospital was associated with one of four regional centers. Patients were randomly assigned to study groups from November 2000 through May 2004. The 12-month follow-up was completed in September 2005.
The study was approved by the Multicenter Research Ethics Committee and local ethics committees at each center. All patients provided written informed consent. Potential patients were provided with written information describing the study and possible risks, including the unknown effect of embolization on subsequent pregnancy.
Experienced interventional radiologists performed the embolizations; patients were referred to specialist centers from district units in which embolization was not available. Hysterectomy and myomectomy were performed at each local center.
Patients
Women at least 18 years old were eligible if they had one or more fibroids of more than 2 cm in diameter that could be adequately visualized with the use of magnetic resonance imaging (MRI), caused symptoms (such as menorrhagia or pelvic pain and pressure), and were considered by the patient's physician to justify surgical treatment. Exclusion criteria included a contraindication to MRI, severe allergy to iodinated contrast media, subserosal pedunculated fibroids, recent or ongoing pelvic inflammatory disease, pregnancy, and any contraindication to surgery. There was no upper limit on the size or number of fibroids.
Procedures
Patients were randomly assigned to study groups according to a computer-generated schedule (permuted blocks) held by the trial coordinator. Randomization was stratified by center and was performed in a 2:1 ratio, with twice as many patients allocated to the embolization group as to the surgical group. This design allowed better characterization of the outcomes of the embolization procedure with minimal reduction in statistical power. The method of hysterectomy or myomectomy was not specified; the choice between these options depended on whether the patient wished to retain her uterus for fertility or other reasons. Both operations were included, since virtually all operations for fibroids are performed by the open route, allowing appropriate comparison of outcomes. The technique for embolization was also not specified, but both uterine arteries had to be embolized and the particle size of the embolic agent was standardized (500 to 710 μm).
Outcome Measures
The primary outcome measure was quality of life, as assessed at 12 months on the Medical Outcomes Study 36-Item Short-Form General Health Survey (SF-36), with scores ranging from 0 to 100, with higher scores indicating better function. This assessment has been validated in women with menorrhagia.8 Secondary outcomes included an assessment of findings on the EuroQol-5D questionnaire, an instrument used to measure preferences for certain health outcomes, including hysterectomy,9,10 with a range of scores paralleling that of the SF-36; an 11-point symptom score, ranging from −5 (markedly worse) to +5 (markedly better); the time until the resumption of usual activities; a satisfaction score measuring whether patients would recommend the procedure to a friend; a linear-analogue pain score at 24 hours; the presence or absence of complications; and treatment failure, defined as the need for subsequent intervention for symptom control, including hysterectomy or repeated embolization.
Complications were graded with the use of the classification system of the Society of Interventional Radiology, as recommended in the Standards of Practice11 as follows: no therapy required or no consequence (grade 1); nominal therapy required or no consequence, including overnight admission for observation only (grade 2); therapy required, including minor hospitalization of less than 48 hours (grade 3); major therapy required, including an unplanned increase in the level of care or hospitalization for at least 48 hours (grade 4); and permanent adverse sequelae (grade 5). Grades 1 and 2 were considered to be minor; grades 3 through 5 were considered to be major. Two of the investigators (a gynecologist and a radiologist) independently categorized the grades of complications. In 56% of cases, the investigators were in complete agreement; in 91% of cases, they were in agreement to within one grade of complication. In discordant cases, the worse grade was used. Major adverse events included any major complication, a life-threatening event, initial or prolonged hospitalization, an intervention required to prevent permanent impairment or damage, and death. Treatment failures requiring subsequent intervention were considered separately.
We assessed outcome measures (with the exception of the 24-hour pain score) at 1, 6, 12, and 21 months and annually thereafter. In this study, we present the 12-month results, with two exceptions: major adverse events requiring hospitalization and subsequent intervention for treatment failure, which are reported through September 2005 (maximum follow-up, 58 months).
Economic Analysis
We prospectively collected data on the total use of financial resources up to 12 months after treatment. These data included the time in the operating room and recovery room, the total length of stay in the hospital, outpatient visits associated with the procedure, treatment failure, and any associated complications. We obtained unit costs for all resources used from routinely collected data and published literature; we used such data to determine the direct health care costs associated with each patient from the perspective of the National Health Service. Since the trial showed no significant differences between groups in the primary outcome, we considered the appropriate form of economic evaluation to be a cost-minimization analysis.12 We calculated the 95% confidence intervals (CIs) for the differences in costs between groups with the use of the bias-corrected and accelerated bootstrap method.13 We performed one-way sensitivity analysis on key unit cost components by varying one measure at a time.
Statistical Analysis
We analyzed all patients in the group to which they were randomly assigned, regardless of the treatment actually received. Analysis of covariance was used to compare quality-of-life scores (on the basis of results on the SF-36 and EuroQol questionnaires) between groups, adjusting for baseline values. Other comparisons between groups were made with the use of a two-sided Student's t-test and the Mann–Whitney test for continuous data and the chi-square test for categorical data. The original power calculation required the enrollment of 200 patients to give a power of 90% to detect a difference of 10 points in the SF-36 score at 12 months (the primary end point) at the 0.05 significance level. Because of slower-than-expected recruitment, the decision was subsequently made to reduce the power to 80%, which required the enrollment of 150 patients.
An independent data and safety monitoring committee reviewed the results and serious adverse events every 12 months. The panel followed the highly conservative Haybittle–Peto approach of requiring a significance level of less than 0.001 in the comparison between groups before making any recommendation to terminate the trial prematurely.14
The manufacturers of the embolic agents used in the study (William Cook Europe, Cordis, and Biocompatibles) had no role in the design of the study; data collection, analysis, and interpretation; or the writing of the final report. The Writing Committee members assume responsibility for the accuracy and completeness of the data and for the overall content and integrity of the article.
Results
A total of 157 women were randomly assigned to study groups: 106 to undergo uterine-artery embolization and 51 to undergo surgery, including 43 hysterectomies and 8 myomectomies (Figure 1Figure 1
Enrollment and Outcomes.). Eight patients (5%) did not receive their allocated treatments (five in the embolization group and three in the surgery group). In addition, there was one technical failure in the surgical group (a myomectomy converted to hysterectomy owing to technical difficulties) and there were three technical failures in the embolization group (owing to difficulty in the identification or catheterization of one or both uterine arteries). All the hysterectomies and myomectomies were performed through an abdominal incision. The groups were well matched at baseline (Table 1Table 1Baseline Characteristics of the Patients.).Primary Outcome
The primary outcome measure (the SF-36 quality-of-life score at 12 months) was available for 140 of the 157 women (89%). The results on the SF-36 and EuroQol at 1 and 12 months are shown in Table 2Table 2
Effects of Uterine-Artery Embolization and Surgery on Measures of Quality of Life, Symptoms, and Resumption of Usual Activities.. There were no significant differences between groups in any of the eight components of the SF-36 at 12 months, although at 1 month, the embolization group had significantly greater improvement in scores than the surgery group for the physical function, social function, and physical-role components.Secondary Outcomes
Women in the surgical group had a significantly higher pain score at 24 hours (Table 2). Symptom scores at 1 and 12 months after the procedure were significantly better in the surgical group. At 12 months, the percentage of women who reported that they would recommend their treatment to a friend was high in both treatment groups (93% in the surgical group and 88% in the embolization group) (P=0.32).
The median hospital stay after uterine-artery embolization was significantly shorter than that after surgery (1 day vs. 5 days, P<0.001). The median time until patients could resume all recorded usual activities was significantly lower in the embolization group (Table 2).
Minor Complications
Minor complications were reported by 36 women (34%) in the embolization group and 10 (20%) in the surgical group (P=0.06) (Table 3Table 3
Minor Complications within First Year and Major Adverse Events and Interventions for Treatment Failure Occurring during Median Follow-up of 32 Months.). Minor complications were usually related to the postembolization syndrome (52%), which includes pyrexia, pain, and elevated inflammatory markers, in the embolization group and to minor infections (25%) in the surgical group.Major Adverse Events
There were 16 major adverse events (15%) in the embolization group, as compared with 10 (20%) in the surgical group during a median follow-up of 32 months (interquartile range, 23 to 41) (Table 3). When we categorized these events with respect to the timing of their occurrence (i.e., during the hospital stay, during the first year of follow-up, or after the first year), 8 of the 10 major adverse events in the surgical group occurred during the hospital stay, whereas 15 of the 16 events in the embolization group occurred after discharge from the hospital.
Treatment Failures
Twenty-one patients (20%) in the embolization group required an additional invasive procedure (hysterectomy or repeated uterine-artery embolization) for continued or recurrent symptoms, 10 during the first 12 months of follow-up (2 of which were due to technical failures) and 11 subsequently. In the surgical group, there was one conversion of myomectomy to hysterectomy at the time of the primary procedure.
Economic Analysis
Uterine-artery embolization was associated with a lower use of resources than was surgery at the initial hospitalization. However, during the 1-year follow-up period, when compared with surgery, embolization was associated with more imaging studies and a longer mean hospital stay.
Table 4Table 4
Results of Cost-Minimization Analysis and Sensitivity Analysis. shows the results of the cost-minimization analysis and one-way sensitivity analysis.15-18 Uterine-artery embolization was associated with total costs significantly lower than those for surgery (mean difference, £951 [$1,712 at an exchange rate of £1=$1.80]; 95% CI, £329 to £1480 [$592 to $2,664], suggesting that at 1 year, embolization was more cost-effective than surgery for patients with symptomatic uterine fibroids, from the perspective of the National Health Service. Sensitivity analyses showed the result was robust when assumptions were varied around the cost of MRI and the embolization agent. The results were sensitive to the cost per inpatient-day, with no significant difference in costs between the two procedures when the cost per inpatient-day was halved. Threshold analysis indicated that uterine-artery embolization was more cost-effective over a 12-month period only if the cost per inpatient-day exceeded £291 ($524).Other Outcomes
Through September 2005, eight pregnancies had occurred in five women (seven in the embolization group and one in the myomectomy group). Four of the pregnancies resulted in miscarriage, three in successful live births (two by cesarean section, including one patient from each group, and one spontaneous vertex delivery), and one intrauterine death of the fetus at 33 weeks (with no abnormalities found on postmortem examination).
Discussion
In this randomized trial comparing uterine-artery embolization with standard surgical treatment for women with symptomatic fibroids, we found no significant differences between the groups in measures of quality of life at 12 months, although women in both groups had substantial improvements in each component of the SF-36 score relative to baseline. In contrast, the adverse-event profiles were very different. Surgery was associated with the expected acute morbidity, but only one major adverse event was recorded after the initial hospital stay. Uterine-artery embolization was associated with a significantly faster recovery, including the resumption of usual activities.
Rates of minor complications or major adverse events did not differ significantly between the study groups, although the nature and timing of these events varied between groups; major adverse events in the surgical group typically occurred during the hospital stay, whereas in the embolization group, such events more commonly occurred after hospital discharge. Of note, three of the major adverse events in the embolization group were cancers (two breast cancers, both detected within 2 months after the intervention, and one adrenal cancer), which were highly unlikely to be related to treatment.
At 1 year, however, 10 of the 106 women in the embolization group had required a secondary intervention to treat persistent or recurrent symptoms. After the first year of follow-up, 11 additional women were readmitted for the same indication. These findings are consistent with data from uncontrolled case series indicating complications and treatment failures up to 48 months after embolization.19,20
The cost-minimization analysis showed that at 1 year, embolization was more cost-effective than surgery. This finding supports that of one other study addressing the cost-effectiveness of uterine-artery embolization versus surgery.21 Ongoing follow-up will further assess the efficacy and cost-effectiveness of embolization.
We used a “pragmatic trial” design, in that the particular surgical interventions and technical aspects of the procedures were not dictated by protocol. We included women undergoing either hysterectomy or myomectomy in the surgical group, although in fact only eight women underwent myomectomy. Our primary outcome measure, the SF-36 score, did not take specific fibroid-related symptoms into account, although it was sensitive to changes in quality of life that resulted from successful treatment of menstrual symptoms.8 This fact is important, given the cyclical nature of the patients' menstrual problems. We did not collect data on loss of menstrual blood; comparisons of this measure between groups would not be meaningful, given that only eight women in the surgical group underwent myomectomy.
Two other randomized, controlled trials compared uterine-artery embolization with hysterectomy.22,23 The first study used a controversial randomized-consent methodology,24 in which women who were randomly assigned to the hysterectomy group were not informed about the study or about the possibility of an alternative treatment (i.e., uterine-artery embolization). In addition, this study was small (enrolling only 57 women) and used the length of hospital stay as the primary outcome measure; hospital stays were significantly shorter after uterine-artery embolization, with similar complication rates in both groups.22 The second trial comparing embolization and hysterectomy enrolled 177 patients; at 6 weeks after treatment, the embolization group had a significantly shorter mean hospital stay but a higher rate of minor complications and readmission.23
Limitations of our trial must be acknowledged. The original target number of 200 patients was reduced to 150 because of difficulties in recruitment. Thus, the 95% CIs for the differences between groups indicate that plausible results include as much as a 10-point difference between groups in some components of the SF-36. However, there is no suggestion of clinically important differences. The inclusion of only a small number of patients who underwent myomectomy in the surgical group made it difficult to compare such therapy with uterine-artery embolization. It also suggests that a direct comparison of these two treatments would be difficult to perform unless recruitment involved a very large population base. The use of the time until resumption of usual activities as a secondary outcome must be viewed cautiously, since such an interval could be biased by the patient's expectation (or caregivers' guidance) regarding the time to recovery.
The results of our study make clear that the choice between surgery and uterine-artery embolization for symptomatic uterine fibroids involves tradeoffs. The advantages of embolization — including a significant reduction in the length of the hospital stay and 24-hour pain level and a more rapid return to usual activities — need to be weighed against the risk of treatment failure requiring a second intervention and the possibility, although infrequent, of major late adverse events. Longer-term follow-up is necessary, with attention to the need for repeated intervention, to inform future decision making.
Supported by the Chief Scientist Office of the Scottish Executive, Edinburgh. In addition, Dr. Moss reports receiving on behalf of the trial-management group grants from three companies — William Cook Europe, Cordis, and Biocompatibles — that manufacture embolic agents used in the trial. IBM provided three laptop computers for data collection. The University of Glasgow partly funded a research fellow in gynecology.
Drs. Edwards and Moss report receiving grants from Cordis and William Cook Europe to fund the United Kingdom Interventional Radiology Course; and Dr. Lumsden, lecture fees from Biocompatibles. No other potential conflict of interest relevant to this article was reported.
Source Information
The Writing Committee of the Randomized Trial of Embolization versus Surgical Treatment for Fibroids consisted of Richard D. Edwards, M.B., Ch.B., and Jonathan G. Moss, M.B., Ch.B., Gartnavel Hospital; Mary Ann Lumsden, M.D., Olivia Wu, Ph.D., and Lilian S. Murray, Ph.D., University of Glasgow — all in Glasgow, Scotland; and Sara Twaddle, Ph.D., Scottish Intercollegiate Guidelines Network, and Gordon D. Murray, Ph.D., University of Edinburgh Medical School — both in Edinburgh.
Address reprint requests to Dr. Moss at the Department of Radiology, North Glasgow Hospitals, Gartnavel Hospital, 1053 Great Western Rd., Glasgow G12 OYN, United Kingdom, or at jon.moss@northglasgow.scot.nhs.uk.
Investigators in the REST trial are listed in the Appendix.
Appendix
In addition to the Writing Committee, the following investigators participated in the REST trial: Data and Trial Management: L.S. Murray (trial coordinator), H. Dewart, B. Ferrie, M. Khaund, L. Lawrie, D. Lyons, F. McLean. Data Monitoring Committee: I.T. Cameron (chair), H. Critchley, J. Reidy, P. Warner. Trial Management Committee: J.G. Moss (chair), R.D. Edwards, M.A. Lumsden, L.S. Murray (trial coordinator), G.D. Murray, S. Twaddle. Trial Steering Committee: J.G. Moss (chair), R.D. Edwards, M.A. Lumsden, L.S. Murray, G.D. Murray, S. Twaddle, C. West, I. Gillespie, M. Thomson, G. Houston, K. Cooper, P. Thorpe. The following centers and investigators (all in the United Kingdom) participated in the trial: Aberdeen Royal Infirmary, Aberdeen — K. Cooper, P. Thorpe; Bolton Royal Infirmary, Lancashire — J. Tuck; Murrayfield Hospital, Edinburgh — I. Gillespie; Crosshouse Hospital, Kilmarnock — G. Irvine; Eastern General Hospital, Edinburgh — C. Tay; Edinburgh Royal Infirmary — C. West, I. Gillespie; Falkirk Royal Infirmary, Falkirk — O. Prabu; Forth Park, Kirkcaldy — S. Pinion; Glasgow Royal Infirmary, Glasgow — M. Rodger, A. Reid; Hairmyres Hospital, Lanarkshire — K. Spowart; Hull Royal Infirmary, Hull — J. Killick, A. Nicholson; Inverclyde Hospital, Greenock — L. Cassidy; Monklands Hospital, Lanarkshire — V. Harper; Ninewells Hospital, Dundee — M. Thomson, G. Houston; Perth Royal Infirmary, Perth — D. Phillips; Queen Margaret's Hospital, Dunfermline — S. Pinion; Raigmore Hospital, Inverness — L. Caird, D. Nicholls; Ross Hall BMI Hospital, Glasgow — J. Moss; St. John's Hospital, Livingstone — P. Dewart; Southern General Hospital, Glasgow — M. Carty, G. Urqhuart; Stirling Royal Infirmary, Stirling — F. Morrison; Stobhill Hospital, Glasgow — M. Deeney; Vale of Leven Hospital, Alexandria — M. Haxton; and Western Infirmary, Glasgow — M.A. Lumsden, N. McMillan.
- References
References
1
Lumsden MA ,Wallace EM . Clinical presentation of uterine fibroids. Baillieres Clin Obstet Gynaecol 1998;12:177-195
CrossRef | Web of Science | Medline2
Edozien LC . Hysterectomy for benign conditions. BMJ 2005;330:1457-1458
CrossRef | Web of Science | Medline3
Ravina JH ,Herbreteau D ,Ciraru-Vigneron N , et al. Arterial embolisation to treat uterine myomata. Lancet 1995;346:671-672
CrossRef | Web of Science | Medline4
Committee on Gynecologic Practice, American College of Obstetricians and Gynecologists
Medline5
Worthington-Kirsch R ,Spies JB ,Myers ER , et al. The Fibroid Registry for outcomes data (FIBROID) for uterine embolization: short-term outcomes. Obstet Gynecol 2005;106:52-59[Erratum, Obstet Gynecol 2005;106:869.]
CrossRef | Web of Science | Medline6
Uterine artery embolisation for the treatment of fibroids: NICE interventional procedures guidance. Yorkshire, United Kingdom: National Institute for Health and Clinical Excellence, October 2004. (Accessed November 3, 2006, at http://www.nice.org.uk/ip020overview.)
7
Sculpher MJ ,Dwyer N ,Byford S ,Stirrat GM . Randomised trial comparing hysterectomy and transcervical endometrial resection: effect on health related quality of life and costs two years after surgery. Br J Obstet Gynaecol 1996;103:142-149
CrossRef | Medline8
Jenkinson C ,Peto V ,Coulter A . Making sense of ambiguity: evaluation of internal reliability and face validity of the SF 36 questionnaire in women presenting with menorrhagia. Qual Health Care 1996;5:9-12
CrossRef | Medline9
Kind P. The EuroQol Instrument: an index of health related quality of life. In: Spilker B, ed. Quality of life and pharmacoeconomics in clinical trials. 2nd ed. Philadelphia: Lippincott-Raven, 1996:191-202.
10
Garry R ,Fountain J ,Brown J , et al. EVALUATE hysterectomy trial: a multicentre randomised trial comparing abdominal, vaginal and laparoscopic methods of hysterectomy. Health Technol Assess 2004;8:1-154
Web of Science | Medline11
Goodwin SC ,Bonilla SM ,Sacks D , et al. Reporting standards for uterine artery embolization for the treatment of uterine leiomyomata. J Vasc Interv Radiol 2001;12:1011-1020
CrossRef | Web of Science | Medline12
Drummond M, Stoddart G, Torrance G. Methods for the economic evaluation of health care programmes. Oxford, England: Oxford University Press, 1987.
13
Briggs AH ,Wonderling DE ,Mooney CZ . Pulling cost-effectiveness analysis up by its bootstraps: a non-parametric approach to confidence interval estimation. Health Econ 1997;6:327-340
CrossRef | Web of Science | Medline14
Jennison C, Turnbull BW. Group sequential methods with applications to clinical trials. Boca Raton: Chapman & Hall/CRC, 2000.
15
Fletcher J ,Clark MD ,Sutton FA ,Wellings R ,Garas K . The cost of MRI: changes in costs 1989-1996. Br J Radiol 1999;72:432-437
Web of Science | Medline16
Garside R ,Stein K ,Wyatt K ,Round A ,Price A . The effectiveness and cost-effectiveness of microwave and thermal balloon endometrial ablation for heavy menstrual bleeding: a systematic review and economic modelling. Health Technol Assess 2004;8:1-155
Web of Science17
Henderson J ,Bricker L ,Roberts T ,Mugford M ,Garcia J ,Neilson J . British National Health Service's and women's costs of antenatal ultrasound screening and follow-up tests. Ultrasound Obstet Gynecol 2002;20:154-162
CrossRef | Web of Science | Medline18
NHS National Services Scotland. Scottish Health Service costs. Edinburgh: ISD Scotland, Information Services, 2005.
19
Marret H ,Keris Yle B ,Acker O ,Cottier JP ,Herbreteau D . Late leiomyoma expulsion after uterine artery embolisation. J Vasc Interv Radiol 2004;15:1483-1485
CrossRef | Web of Science | Medline20
Marret H ,Cottier JP ,Alonso AM ,Giraudeau B ,Body G ,Herbreteau D . Predictive factors for fibroids recurrence after uterine artery embolisation. BJOG 2005;112:461-465
CrossRef | Web of Science | Medline21
Beinfeld MT ,Bosch JL ,Gazelle GS . Hospital costs of uterine artery embolization and hysterectomy for uterine fibroid tumors. Acad Radiol 2002;9:1300-1304
CrossRef | Web of Science | Medline22
Pinto I ,Chimeno P ,Romo A , et al. Uterine fibroids: uterine artery embolization versus abdominal hysterectomy for treatment -- a prospective, randomized, and controlled clinical trial. Radiology 2003;226:425-431
CrossRef | Web of Science | Medline23
Hehenkamp WJK ,Volkers NA ,Donderwinkel PFJ , et al. Uterine artery embolization versus hysterectomy in the treatment of symptomatic uterine fibroids (EMMY trial): peri- and postprocedural results from a randomized controlled trial. Am J Obstet Gynecol 2005;193:1618-1629
CrossRef | Web of Science | Medline24
Zelen M . A new design for randomized clinical trials. N Engl J Med 1979;300:1242-1245
Full Text | Web of Science | Medline
- Citing Articles (91)
Citing Articles
1
Stewart, Elizabeth A., . (2012) Uterine Fibroids and Evidence-Based Medicine — Not an Oxymoron. New England Journal of Medicine 366:5, 471-473
Full Text2
Aniket N. Tavare, Ali Alsafi, Mohamad S. Hamady. (2012) Analysis of the Quality of Information Obtained About Uterine Artery Embolization From the Internet. CardioVascular and Interventional Radiology
CrossRef3
Andrew W. Horne, Hilary O. D. Critchley. 2012. Menstrual Problems: Heavy Menstrual Bleeding and Primary Dysmenorrhoea. , 534-543.
CrossRef4
Siân Jones, Peter O'Donovan, David Toub. (2012) Radiofrequency Ablation for Treatment of Symptomatic Uterine Fibroids. Obstetrics and Gynecology International 2012, 1-7
CrossRef5
Hidenori Sasa, Tatsumi Kaji, Kenichi Furuya. (2012) Indications and Outcomes of Uterine Artery Embolization in Patients with Uterine Leiomyomas. Obstetrics and Gynecology International 2012, 1-3
CrossRef6
Maria Memtsa, Hayden Homer. (2012) Complications Associated with Uterine Artery Embolisation for Fibroids. Obstetrics and Gynecology International 2012, 1-5
CrossRef7
Eisen Liang, Bevan Brown, Rodney Kirsop, Paul Stewart, Andrew Stuart. (2012) Efficacy of uterine artery embolisation for treatment of symptomatic fibroids and adenomyosis - An interim report on an Australian experience. Australian and New Zealand Journal of Obstetrics and Gynaecologyn/a-n/a
CrossRef8
V. Kahn, A. Fohlen, J.-P. Pelage. (2011) Place de l’embolisation dans le traitement des fibromes. Journal de Gynécologie Obstétrique et Biologie de la Reproduction 40:8, 918-927
CrossRef9
Feng Jun, Liu Yamin, Xiao Xinli, Liu Zhe, Zhang Min, Zhang Bo, Gou Wenli. (2011) Uterine artery embolization versus surgery for symptomatic uterine fibroids: a randomized controlled trial and a meta-analysis of the literature. Archives of Gynecology and Obstetrics
CrossRef10
BENTE POULSEN, TORBEN MUNK, PERNILLE RAVN. (2011) Long-term follow up after uterine artery embolization for symptomatic uterine leiomyomas. Acta Obstetricia et Gynecologica Scandinavica 90:11, 1281-1283
CrossRef11
Sanne M. van der Kooij, Shandra Bipat, Wouter J.K. Hehenkamp, Willem M. Ankum, Jim A. Reekers. (2011) Uterine artery embolization versus surgery in the treatment of symptomatic fibroids: a systematic review and metaanalysis. American Journal of Obstetrics and Gynecology 205:4, 317.e1-317.e18
CrossRef12
Young-sun Kim, Duk-Soo Bae, Byoung-Gie Kim, Jeong-Won Lee, Tae-Joong Kim. (2011) A faster nonsurgical solution. American Journal of Obstetrics and Gynecology 205:3, 292.e1-292.e5
CrossRef13
Esther H. Chen, Alexander Nemeth. (2011) Complications of percutaneous procedures. The American Journal of Emergency Medicine 29:7, 802-810
CrossRef14
Simon C.H. Yu, Ingrid Lok, Stella S.Y. Ho, Mabel M.B. Tong, Joyce W.Y. Hui. (2011) Comparison of Clinical Outcomes of Tris-acryl Microspheres Versus Polyvinyl Alcohol Microspheres for Uterine Artery Embolization for Leiomyomas: Results of a Randomized Trial. Journal of Vascular and Interventional Radiology 22:9, 1229-1235
CrossRef15
Esther V.A. Bouwsma, Gina K. Hesley, David A. Woodrum, Amy L. Weaver, Phyllis C. Leppert, Lisa G. Peterson, Elizabeth A. Stewart. (2011) Comparing focused ultrasound and uterine artery embolization for uterine fibroids—rationale and design of the Fibroid Interventions: Reducing Symptoms Today and Tomorrow (FIRSTT) trial. Fertility and Sterility 96:3, 704-710
CrossRef16
Takeshi Maruo, Noriyuki Ohara, Shigeki Yoshida, Koji Nakabayashi, Hiroko Sasaki, Qin Xu, Hiroya Matsuo, Regine Sitruk-Ware, Hideto Yamada. (2011) Lessons learned from the preclinical drug discovery of asoprisnil and ulipristal for non-surgical treatment of uterine leiomyomas. Expert Opinion on Drug Discovery 6:9, 897-911
CrossRef17
Marianne J. Voogt, Mark J. Arntz, Paul N. M. Lohle, Willem P. Th. M. Mali, Leo E. H. Lampmann. (2011) Uterine Fibroid Embolisation for Symptomatic Uterine Fibroids: A Survey of Clinical Practice in Europe. CardioVascular and Interventional Radiology 34:4, 765-773
CrossRef18
Isaac T. Manyonda, Mark Bratby, Jessica S. Horst, Nassera Banu, Maha Gorti, Anna-Maria Belli. (2011) Uterine Artery Embolization versus Myomectomy: Impact on Quality of Life—Results of the FUME (Fibroids of the Uterus: Myomectomy versus Embolization) Trial. CardioVascular and Interventional Radiology
CrossRef19
JG Moss, KG Cooper, A Khaund, LS Murray, GD Murray, O Wu, LE Craig, MA Lumsden. (2011) Randomised comparison of uterine artery embolisation (UAE) with surgical treatment in patients with symptomatic uterine fibroids (REST trial): 5-year results. BJOG: An International Journal of Obstetrics & Gynaecology 118:8, 936-944
CrossRef20
H. Marret, L. Ouldamer. (2011) Contre le traitement chirurgical des fibromes sous-séreux. Gynécologie Obstétrique & Fertilité 39:7-8, 454-457
CrossRef21
Daniel Alyeshmerni, Filip Banovac, Marieta Pehlivanova, Michael McCullough, Barry Hansford, James Spies. (2011) Resolution of Hydronephrosis after Uterine Artery Embolization for Fibroids. Journal of Vascular and Interventional Radiology 22:6, 865-869
CrossRef22
Tetsuya Katsumori, Toshiyuki Kasahara, Minori Oda, Tomoya Kotani. (2011) Initial Experience of Uterine Fibroid Embolization Using Porous Gelatin Sponge Particles. CardioVascular and Interventional Radiology 34:3, 513-521
CrossRef23
J. Julie Kim, Elizabeth C. Sefton. (2011) The role of progesterone signaling in the pathogenesis of uterine leiomyoma. Molecular and Cellular Endocrinology
CrossRef24
Kensaku Mori, Tsukasa Saida, Yoko Shibuya, Nobuyuki Takahashi, Masanari Shiigai, Kayo Osada, Nami Tanaka, Manabu Minami. (2011) Unenhanced MR Angiography of Uterine and Ovarian Arteries after Uterine Artery Embolization: Differences between Patients with Incomplete and Complete Fibroid Infarction. CardioVascular and Interventional Radiology
CrossRef25
Luke Stall, Justin Lee, Michael McCullough, Hala Nsrouli-Maktabi, James B. Spies. (2011) Effectiveness of Elective Unilateral Uterine Artery Embolization: A Case-control Study. Journal of Vascular and Interventional Radiology 22:5, 716-722
CrossRef26
Charles T. Burke, Brian S. Funaki, Charles E. Ray, Thomas B. Kinney, Jon K. Kostelic, Andrew Loesberg, Jonathan M. Lorenz, Steven F. Millward, Albert A. Nemcek, Charles A. Owens, Howard Shaw, James E. Silberzweig, George Vatakencherry. (2011) ACR Appropriateness Criteria ® on Treatment of Uterine Leiomyomas. Journal of the American College of Radiology 8:4, 228-234
CrossRef27
Dale W. Stovall. (2011) Alternatives to hysterectomy. Menopause 18:4, 443-450
CrossRef28
Ulrike Stampfl, Boris Radeleff, Christof Sommer, Sibylle Stampfl, Angelika Dahlke, Nadine Bellemann, Hans-Ulrich Kauczor, Goetz M. Richter. (2011) Midterm Results of Uterine Artery Embolization Using Narrow-Size Calibrated Embozene Microspheres. CardioVascular and Interventional Radiology 34:2, 295-305
CrossRef29
Desireé M McCarthy-Keith, Alicia Y Armstrong. (2011) Innovations in uterine fibroid therapy. Therapy 8:2, 189-200
CrossRef30
Shannon K. Laughlin, Elizabeth A. Stewart. (2011) Uterine Leiomyomas. Obstetrics & Gynecology 117:2, Part 1, 396-403
CrossRef31
Wen-Ling Lee, Wei-Min Liu, Jong-Ling Fuh, Ying-Chieh Tsai, Chun Che Shih, Peng-Hui Wang. (2010) Use of uterine vessel occlusion in the management of uterine myomas: two different approaches. Fertility and Sterility 94:5, 1875-1881
CrossRef32
Anu Ruuskanen, Maritta Hippeläinen, Petri Sipola, Hannu Manninen. (2010) Uterine artery embolisation versus hysterectomy for leiomyomas: primary and 2-year follow-up results of a randomised prospective clinical trial. European Radiology 20:10, 2524-2532
CrossRef33
H. A. M. Brölmann, A. J. BijdeVaate, A. Vonk Noordegraaf, P. F. Janssen, J. A. F. Huirne. (2010) Hysterectomy or a minimal invasive alternative? A systematic review on quality of life and satisfaction. Gynecological Surgery 7:3, 205-210
CrossRef34
James B. Spies, Linda D. Bradley, Richard Guido, G. Larry Maxwell, Betty A. Levine, Karin Coyne. (2010) Outcomes From Leiomyoma Therapies. Obstetrics & Gynecology 116:3, 641-652
CrossRef35
LeAnn S. Stokes, Michael J. Wallace, Robbie B. Godwin, Sanjoy Kundu, John F. Cardella. (2010) Quality Improvement Guidelines for Uterine Artery Embolization for Symptomatic Leiomyomas. Journal of Vascular and Interventional Radiology 21:8, 1153-1163
CrossRef36
Sanne M. van der Kooij, Wouter J.K. Hehenkamp, Nicole A. Volkers, Erwin Birnie, Willem M. Ankum, Jim A. Reekers. (2010) Uterine artery embolization vs hysterectomy in the treatment of symptomatic uterine fibroids: 5-year outcome from the randomized EMMY trial. American Journal of Obstetrics and Gynecology 203:2, 105.e1-105.e13
CrossRef37
Richard E. J. Forster, Frank Thürmer, Christine Wallrapp, Andrew W. Lloyd, Wendy Macfarlane, Gary J. Phillips, Jean-Pierre Boutrand, Andrew L. Lewis. (2010) Characterisation of physico-mechanical properties and degradation potential of calcium alginate beads for use in embolisation. Journal of Materials Science: Materials in Medicine 21:7, 2243-2251
CrossRef38
Jerry L. Lowder, Sallie S. Oliphant, Chiara Ghetti, Lara J. Burrows, Leslie A. Meyn, Judith Balk. (2010) Prophylactic bilateral oophorectomy or removal of remaining ovary at the time of hysterectomy in the United States, 1979-2004. American Journal of Obstetrics and Gynecology 202:6, 538.e1-538.e9
CrossRef39
Mary Costantino, Justin Lee, Michael McCullough, Hala Nsrouli-Maktabi, James B. Spies. (2010) Bilateral Versus Unilateral Femoral Access for Uterine Artery Embolization: Results of a Randomized Comparative Trial. Journal of Vascular and Interventional Radiology 21:6, 829-835
CrossRef40
F. A. Taran, A. L. Weaver, C. C. Coddington, E. A. Stewart. (2010) Characteristics indicating adenomyosis coexisting with leiomyomas: a case-control study. Human Reproduction 25:5, 1177-1182
CrossRef41
Á. Santalla, J.C. Presa, M.S. López-Criado, J. Gómez-Fernández, I. Vico, J.L. Gallo. (2010) Embolización selectiva de las arterias uterinas en el tratamiento de miomas sintomáticos: dos años de seguimiento. Clínica e Investigación en Ginecología y Obstetricia 37:2, 48-52
CrossRef42
Arul Ganeshan, Sarfraz Ahmed Nazir, Lye Quen Hon, Sara S. Upponi, Peter Foley, Dinuke R. Warakaulle, Raman Uberoi. (2010) The role of interventional radiology in obstetric and gynaecology practice. European Journal of Radiology 73:2, 404-411
CrossRef43
Peter C. Austin, Andrea Manca, Merrick Zwarenstein, David N. Juurlink, Matthew B. Stanbrook. (2010) A substantial and confusing variation exists in handling of baseline covariates in randomized controlled trials: a review of trials published in leading medical journals. Journal of Clinical Epidemiology 63:2, 142-153
CrossRef44
Yan Zhang, Weina Peng, Jane Clarke, Liu Zhishun, Yan Zhang. 2010. Acupuncture for uterine fibroids. .
CrossRef45
RN Subramaniam, A Vijayananthan, SZ Omar, MA Noor Azmi, O Nawawi, BJJ Abdullah. (2010) Uterine artery embolisation for symptomatic fibroids: the University of Malaya Medical Centre experience. Biomedical Imaging and Intervention Journal 6:3,
CrossRef46
Jun Min Seok, Myoung Jin Moon, Sung Woon Chang, Yu Mi Lee, Ji Hyon Jang, Min Jung Baek. (2010) Successful management of cesarean scar pregnancy at 13 weeks of gestation by uterine artery embolization: A case report. Korean Journal of Obstetrics and Gynecology 53:10, 934
CrossRef47
Karen Stein, Charles Ascher-Walsh. (2009) A Comprehensive Approach to the Treatment of Uterine Leiomyomata. Mount Sinai Journal of Medicine: A Journal of Translational and Personalized Medicine 76:6, 546-556
CrossRef48
W. M. W. Gedroyc. (2009) MRgFUS: a sound approach to fibroid therapy. Ultrasound in Obstetrics and Gynecology 34:5, 494-496
CrossRef49
F. A. Taran, C. M. C. Tempany, L. Regan, Y. Inbar, A. Revel, E. A. Stewart, . (2009) Magnetic resonance-guided focused ultrasound (MRgFUS) compared with abdominal hysterectomy for treatment of uterine leiomyomas. Ultrasound in Obstetrics and Gynecology 34:5, 572-578
CrossRef50
Steve H. Eisinger, Julietta Fiscella, Thomas Bonfiglio, Sean Meldrum, Kevin Fiscella. (2009) Open-label study of ultra low-dose mifepristone for the treatment of uterine leiomyomata. European Journal of Obstetrics & Gynecology and Reproductive Biology 146:2, 215-218
CrossRef51
Hayden Homer, Ertan Saridogan. (2009) Pregnancy outcomes after uterine artery embolisation for fibroids. The Obstetrician & Gynaecologist 11:4, 265-270
CrossRef52
Wen-Ling Lee, Wei-Min Liu, Ming-Huei Cheng, Hsiang-Tai Chao, Jong-Ling Fuh, Peng-Hui Wang. (2009) Uterine Vascular Occlusion in Management of Leiomyomas: Laparoscopy vs Laparotomy. Journal of Minimally Invasive Gynecology 16:5, 562-568
CrossRef53
Goodwin, Scott C., Spies, James B., . (2009) Uterine Fibroid Embolization. New England Journal of Medicine 361:7, 690-697
Full Text54
Peng-Hui Wang, Wei-Min Liu, Jong-Ling Fuh, Hsiang-Tai Chao, Chiou-Chung Yuan, Kuan-Chong Chao. (2009) Symptomatic myoma treated with laparoscopic uterine vessel occlusion and subsequent immediate myomectomy: which is the optimal surgical approach?. Fertility and Sterility 92:2, 762-769
CrossRef55
Linda D. Bradley. (2009) Uterine fibroid embolization: a viable alternative to hysterectomy. American Journal of Obstetrics and Gynecology 201:2, 127-135
CrossRef56
James B. Spies. (2009) What Evidence Should We Demand before Accepting a New Embolic Material for Uterine Artery Embolization?. Journal of Vascular and Interventional Radiology 20:5, 567-570
CrossRef57
M.J. Bratby, W.J. Walker. (2009) Uterine artery embolisation for symptomatic adenomyosis—Mid-term results. European Journal of Radiology 70:1, 128-132
CrossRef58
Joyce H.S. You, Daljit Singh Sahota, Pong Mo Yuen. (2009) Uterine artery embolization, hysterectomy, or myomectomy for symptomatic uterine fibroids: a cost-utility analysis. Fertility and Sterility 91:2, 580-588
CrossRef59
David W. Lee, Teresa B. Gibson, Ginger S. Carls, Ronald J. Ozminkowski, Shaohung Wang, Elizabeth A. Stewart. (2009) Uterine fibroid treatment patterns in a population of insured women. Fertility and Sterility 91:2, 566-574
CrossRef60
Elizabeth A. Stewart. 2009. Benign Uterine Disorders. , 597-613.
CrossRef61
S. D. Peddada, S. K. Laughlin, K. Miner, J.-P. Guyon, K. Haneke, H. L. Vahdat, R. C. Semelka, A. Kowalik, D. Armao, B. Davis, D. D. Baird. (2008) Growth of uterine leiomyomata among premenopausal black and white women. Proceedings of the National Academy of Sciences 105:50, 19887-19892
CrossRef62
Amy J. Park, Justin C. Bohrer, Linda D. Bradley, Gouri B. Diwadkar, Eunice Moon, James S. Newman, J. Eric Jelovsek. (2008) Incidence and risk factors for surgical intervention after uterine artery embolization. American Journal of Obstetrics and Gynecology 199:6, 671.e1-671.e6
CrossRef63
Peng-Hui Wang, Wei-Min Liu, Jong-Ling Fuh, Hsiang-Tai Chao, Kuan-Chong Chao, Chiou-Chong Yuan. (2008) Laparoscopic Uterine Vessel Occlusion in the Treatment of Women with Symptomatic Uterine Myomas with and without Adding Laparoscopic Myomectomy: 4-Year Results. Journal of Minimally Invasive Gynecology 15:6, 712-718
CrossRef64
Mohammed Agdi, David Valenti, Togas Tulandi. (2008) Intraabdominal adhesions after uterine artery embolization. American Journal of Obstetrics and Gynecology 199:5, 482.e1-482.e3
CrossRef65
Saeed Mirsadraee, David Tuite, Anthony Nicholson. (2008) Uterine Artery Embolization for Ureteric Obstruction Secondary to Fibroids. CardioVascular and Interventional Radiology 31:6, 1094-1099
CrossRef66
Kevin Fiscella, Steve Eisinger. (2008) CDB-2914 for Uterine Leiomyomata Treatment: A Randomized Controlled Trial. Obstetrics & Gynecology 112:3, 707
CrossRef67
Aradhana Khaund, Mary Ann Lumsden. (2008) Impact of fibroids on reproductive function. Best Practice & Research Clinical Obstetrics & Gynaecology 22:4, 749-760
CrossRef68
M.J. Bratby, A.-M. Belli. (2008) Radiological treatment of symptomatic uterine fibroids. Best Practice & Research Clinical Obstetrics & Gynaecology 22:4, 717-734
CrossRef69
Martha HICKEY, Ian HAMMOND. (2008) What is the place of uterine artery embolisation in the management of symptomatic uterine fibroids?. Australian and New Zealand Journal of Obstetrics and Gynaecology 48:4, 360-368
CrossRef70
Yan Zhang, Jane Clarke, Haiyan Feng, Zhishun Liu, Peng Weina, Yan Zhang. 2008. Acupuncture for uterine fibroids. .
CrossRef71
D. Vorwerk. (2008) Nachsorge bei Myomembolisation. Der Radiologe 48:7, 649-653
CrossRef72
M. David. (2008) Interdisziplinäre Stratifizierung von Patientinnen mit myombedingten Beschwerden. Der Radiologe 48:7, 654-659
CrossRef73
T.J. Kröncke. (2008) Bildgebende Diagnostik vor und nach Uterusmyomembolisation. Der Radiologe 48:7, 639-648
CrossRef74
Nicole A. Volkers, Wouter J.K. Hehenkamp, Patrick Smit, Willem M. Ankum, Jim A. Reekers, Erwin Birnie. (2008) Economic Evaluation of Uterine Artery Embolization versus Hysterectomy in the Treatment of Symptomatic Uterine Fibroids: Results from the Randomized EMMY Trial. Journal of Vascular and Interventional Radiology 19:7, 1007-1016
CrossRef75
Sundeep S. Toor, Kongteng T. Tan, Martin E. Simons, Dheeraj K. Rajan, J. Robert Beecroft, Eran Hayeems, Kenneth W. Sniderman. (2008) Clinical Failure after Uterine Artery Embolization: Evaluation of Patient and MR Imaging Characteristics. Journal of Vascular and Interventional Radiology 19:5, 662-667
CrossRef76
Eve Cunningham, Lorena Barreda, Michael Ngo, Keith Terasaki, Malcolm G. Munro. (2008) Uterine Artery Embolization Versus Occlusion for Uterine Leiomyomas: A Pilot Randomized Clinical Trial. Journal of Minimally Invasive Gynecology 15:3, 301-307
CrossRef77
Eric D. Levens, Clariss Potlog-Nahari, Alicia Y. Armstrong, Robert Wesley, Ahalya Premkumar, Diana L. Blithe, Wendy Blocker, Lynnette K. Nieman. (2008) CDB-2914 for Uterine Leiomyomata Treatment. Obstetrics & Gynecology 111:5, 1129-1136
CrossRef78
H Zowall, JA Cairns, C Brewer, DL Lamping, WMW Gedroyc, L Regan. (2008) Cost-effectiveness of magnetic resonance-guided focused ultrasound surgery for treatment of uterine fibroids. BJOG: An International Journal of Obstetrics & Gynaecology 115:5, 653-662
CrossRef79
Christian Scheurig, Tina Islam, Elke Zimmermann, Bernd Hamm, Thomas J. Kroencke. (2008) Uterine Artery Embolization in Patients with Symptomatic Diffuse Leiomyomatosis of the Uterus. Journal of Vascular and Interventional Radiology 19:2, 279-284
CrossRef80
Scott C. Goodwin, James B. Spies, Robert Worthington-Kirsch, Eric Peterson, Gaylene Pron, Shuang Li, Evan R. Myers. (2008) Uterine Artery Embolization for Treatment of Leiomyomata. Obstetrics & Gynecology 111:1, 22-33
CrossRef81
Richard J. Epstein. (2007) VEGF signaling inhibitors: More pro-apoptotic than anti-angiogenic. Cancer and Metastasis Reviews 26:3-4, 443-452
CrossRef82
O Wu, A Briggs, S Dutton, A Hirst, M Maresh, A Nicholson, K McPherson. (2007) Uterine artery embolisation or hysterectomy for the treatment of symptomatic uterine fibroids: a cost-utility analysis of the HOPEFUL study. BJOG: An International Journal of Obstetrics & Gynaecology 114:11, 1352-1362
CrossRef83
S Dutton, A Hirst, K McPherson, T Nicholson, M Maresh. (2007) A UK multicentre retrospective cohort study comparing hysterectomy and uterine artery embolisation for the treatment of symptomatic uterine fibroids (HOPEFUL study): main results on medium-term safety and efficacy. BJOG: An International Journal of Obstetrics and Gynaecology 114:11, 1340-1351
CrossRef84
Carole J. Dembek, Elise M. Pelletier, Keith B. Isaacson, James B. Spies. (2007) Payer Costs in Patients Undergoing Uterine Artery Embolization, Hysterectomy, or Myomectomy for Treatment of Uterine Fibroids. Journal of Vascular and Interventional Radiology 18:10, 1207-1213
CrossRef85
Wouter J. K. Hehenkamp, Nicole A. Volkers, Wouter Bartholomeus, Sjoerd Blok, Erwin Birnie, Jim A. Reekers, Willem M. Ankum. (2007) Sexuality and Body Image After Uterine Artery Embolization and Hysterectomy in the Treatment of Uterine Fibroids: A Randomized Comparison. CardioVascular and Interventional Radiology 30:5, 866-875
CrossRef86
Jay Goldberg. (2007) Current thinking on the role of interventional radiology in women’s health. Expert Review of Obstetrics & Gynecology 2:5, 621-629
CrossRef87
Miriam Kuppermann, Lee A. Learman, Michael Schembri, Steven Gregorich, Alison Jacoby, Rebecca A. Jackson, Elena Gates, Christina Wassel-Fyr, James Lewis, A Eugene Washington. (2007) Effect of Noncancerous Pelvic Problems on Health-Related Quality of Life and Sexual Functioning. Obstetrics & Gynecology 110:3, 633-642
CrossRef88
Kee Jiet Ong, Mostafa Metwally, William L Ledger. (2007) Uterine artery embolization and future fertility potential. Women's Health 3:4, 449-453
CrossRef89
(2007) Treatment of Symptomatic Uterine Fibroids. New England Journal of Medicine 356:21, 2218-2219
Full Text90
Andrea Kayyali. (2007) UTERINE FIBROID TREATMENT. AJN, American Journal of Nursing 107:5, 39
CrossRef91
Tulandi, Togas, . (2007) Treatment of Uterine Fibroids — Is Surgery Obsolete?. New England Journal of Medicine 356:4, 411-413
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