UFE vs Hysterectomy: How does UFE (Uterine Fibroid Embolisation) compare with Hysterectomy?
Dr Eisen Liang, MBBS, FRANZCR
Interventional Radiologist | Founder and Director, Sydney Fibroid Clinic
Introduction:
When it comes to treating uterine fibroids, two popular options are Uterine Fibroid Embolization (UFE) and hysterectomy. This article compares these procedures to help you make an informed decision about your fibroid treatment.
Nature of the procedure:
UFE is a minimally invasive procedure that blocks blood flow to fibroids, causing them to shrink and die. It’s performed under local anaesthesia with light sedation. Hysterectomy, on the other hand, is a major surgical procedure that removes the entire uterus, performed under general anaesthesia.
Effectiveness:
Both procedures are effective in treating fibroid symptoms. UFE has been shown to be comparable to hysterectomy in terms of symptom relief and improving quality of life. Fibroid recurrence (growing back) is very rare following UFE, but common after myomectomy (surgical removal of fibroids).
Patient satisfaction:
Studies have shown high satisfaction rates for both procedures. UFE patients often appreciate the uterus-preserving nature of the treatment, its lower risk, and quicker recovery.
Recovery:
UFE typically has a shorter recovery time, requiring only one night stay in hospital, and most women returning to normal activities in about a week. Hysterectomy recovery can take 4-8 weeks, depending on the type of surgery and size of uterus / fibroids.
Cost:
UFE is generally less expensive than hysterectomy, though costs can vary depending on insurance coverage and specific circumstances.
Risks and complications:
UFE has lower risks of major complications compared to hysterectomy. Risks for UFE include bruise in the groin, bladder infection, injuries to the arteries, allergic reactions to contrast dye.
Hysterectomy risks include infection, bleeding, injury to nearby organs such as ureter, bladder and bowel, blood clots in legs and lungs.
Long-term side effects:
Some fibroids near the cavity might give sloughing issues like vaginal discharge and passage of fibroid tissue; larger fibroid tissue might need to be removed by a curette procedure.
Hysterectomy might increase the risk of prolapse, incontinence, sexual dysfunction, earlier menopause and increased coronary disease risk.
| UFE compared with hysterectomy | ||
| Feature | Uterine fibroid embolisation (UFE) | Hysterectomy |
| Type of procedure | Minimally invasive, image-guided procedure | Surgery to remove the uterus |
| How it works | Blocks the fibroids’ blood supply so they become inactive and shrink | Removes the uterus and therefore removes the fibroids permanently |
| Anaesthesia | Usually local anaesthesia with sedation | Usually general anaesthesia |
| Incision | Small arterial puncture, usually at the wrist or groin | May be vaginal, laparoscopic, robotic or through an abdominal incision |
| Uterus preserved | Yes | No |
| Future pregnancy | Pregnancy remains possible, but fertility and pregnancy outcomes are less certain than after myomectomy | Pregnancy is no longer possible |
| Hospital stay | Commonly one night | Varies with the surgical approach and clinical circumstances |
| Typical recovery | Approximately one to two weeks, although recovery varies | Approximately two to eight weeks, depending on the surgical approach |
| Fibroid symptom relief | High | High |
| Further fibroid treatment | Some women require another procedure | No further treatment for uterine fibroids is required |
| Major complications | Generally less frequent than with hysterectomy in comparative studies | Risks include bleeding, infection, blood clots and injury to the bladder, bowel or ureters |
| Procedure-specific considerations | Post-embolisation pain; rarely, infection or passage of fibroid tissue | Permanent loss of the uterus; possible pelvic-floor, urinary, sexual or ovarian effects |
| Best suited to | Women seeking effective treatment while avoiding major surgery and retaining their uterus | Women who want traditional treatment or have another reason the uterus should be removed |
2014 Cochrane Review assessed randomised trials comparing UFE with surgery, principally hysterectomy and myomectomy.
Its main conclusions were:
- Patient satisfaction and quality-of-life outcomes were broadly similar after UFE and surgery.
- UFE resulted in a shorter hospital stay and faster return to normal activities.
- UFE had fewer major complications than surgery.
- UFE had more minor complications and a higher likelihood of requiring another procedure within two to five years.
- The authors considered UFE a safe and effective alternative to surgery for appropriately selected women.
More about Hysterectomy Risks and Long Term Side effects:
Why should women try to avoid hysterectomies? Risks and Side Effects
Choosing Between UFE and Hysterectomy for Fibroid Treatment
When deciding between UFE and hysterectomy for fibroid treatment, consider factors such as:
- Desire for future fertility
- Severity of fibroid symptoms
- Overall health and surgical risks
- Recovery time preferences
- Long-term health implications
Consult with a fibroid specialist to determine the best treatment option for your specific case.
Conclusion:
Both UFE and hysterectomy offer effective treatments for uterine fibroids. UFE provides a less invasive option with quicker recovery and uterus preservation, while hysterectomy offers a permanent solution but with longer recovery and potential long-term effects. Understanding the differences between these procedures can help you make the best choice for your fibroid treatment.
Reference:
Gupta JK, Sinha A, Lumsden MA, Hickey M. Uterine artery embolization for symptomatic uterine fibroids. Cochrane Database Syst Rev. 2014;(12):CD005073. doi: 10.1002/14651858.CD005073.pub4. PMID: 25541260.
How does UFE work:
Shrinking Fibroids to avoid Hysterectomy – How does UFE work?
UFE FAQs:
https://sydneyfibroidclinic.com.au/fibroids/fibroids-faqs/
About the author: Dr Eisen Liang, MBBS, FRANZCR, is a specialist interventional radiologist and Founder and Director of Sydney Fibroid Clinic. He has extensive clinical experience in uterine artery embolisation and has published several peer-reviewed research on the diagnosis and minimally invasive treatment of fibroids and adenomyosis. He collaborates closely with gynaecologists to provide all appropriate treatment options to treat fibroids and adenomyosis.
Dr Liang’s Publication list can be found: https://sydneyfibroidclinic.com.au/dr-eisen-liangs-research-and-publications/
