Prof Saim Yılmaz, MD
"In multiple intramural fibroids, the treatment of choice is embolization"
Is embolization appropriate in patients with multiple fibroids?
If a patient has multiple fibroids, the ideal treatment is embolization, not myomectomy. Since embolization can treat all fibroids with a single operation, the number of fibroids is not very important. However, a separate incision and suturing are required for each fibroid in myomectomy. As the number of fibroids removed increases, the surgery is prolonged, blood loss increases and risks such as infection, deformation and adhesions increase. In many patients, it is not possible to remove all of the fibroids, and the fibroids that cannot be removed may grow in a short time and cause symptoms again. As a result, it may be necessary to repeat the myomectomy many times or even to remove the entire uterus.
In many cases unfortunately, patients have multiple fibroids, but they and their gynecologists are unaware of this. Because the patient is evaluated only with ultrasound and no MRI is performed. In such patients, since only 1-2 fibroids are seen on ultrasound, the gynecologist thinks that he/she will easily perform myomectomy. However, during the operation, the doctor sees that the number of fibroids in the uterus is much higher, but now that the patient is on the operation, he/she only takes the fibroids that are easy to remove and finishes the operation. In such patients, the remaining fibroids may enlarge in a short time and may require retreatment. However, if MRI was performed in addition to ultrasound in these patients, it would be understood before the operation that the fibroids are multiple, and the patient will be saved from an unnecessary operation and can be easily treated with embolization. Therefore, MRI should be ordered in all patients before treatment and an experienced interventional radiologist who performs fibroid embolization should be consulted.
Video: Myoma embolization and myomectomy, Prof Dr Saim Yılmaz