American Journal of Obstetrics & Gynecology
Volume 203, Issue 2 , Pages 105.e1-105.e13 , August 2010

Uterine artery embolization vs hysterectomy in the treatment of symptomatic uterine fibroids: 5-year outcome from the randomized EMMY trial

  • Sanne M. van der Kooij, MD

      Affiliations

    • Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands
    • Department of Gynecology, Academic Medical Center, Amsterdam, The Netherlands
    • Corresponding Author InformationReprints: Sanne M. van der Kooij, MD, Academic Medical Center, Department of Gynecology, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
  • ,
  • Wouter J.K. Hehenkamp, MD, PhD

      Affiliations

    • Department of Gynecology, Academic Medical Center, Amsterdam, The Netherlands
  • ,
  • Nicole A. Volkers, MD, PhD

      Affiliations

    • Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands
  • ,
  • Erwin Birnie, PhD

      Affiliations

    • Institute of Health Policy and Management, Erasmus Medical Center, Rotterdam, The Netherlands
  • ,
  • Willem M. Ankum, MD, PhD

      Affiliations

    • Department of Gynecology, Academic Medical Center, Amsterdam, The Netherlands
  • ,
  • Jim A. Reekers, MD, PhD

      Affiliations

    • Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands

Received 8 July 2009 ,Revised 22 October 2009 ,Accepted 19 January 2010.

References 

  1. Buttram VC, Reiter RC. Uterine leiomyomata: etiology, symptomatology and management. Fertil Steril. 1981;36:4433–4445
  2. Fraser IS, Critchley HO, Munro MG, Broder M. Can we achieve international agreement on terminologies and definitions used to describe abnormalities of menstrual bleeding?. Hum Reprod. 2007;22:635–643
  3. Edwards RD, Moss JG, Lumsden MA, et al. Uterine artery embolization versus surgery for symptomatic uterine fibroids. N Engl J Med. 2007;356:360–370
  4. Hehenkamp WJ, Volkers NA, Donderwinkel PF, 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
  5. Mara M, Fucikova Z, Maskova J, Kuzel D, Haakova L. Uterine fibroid embolization versus myomectomy in women wishing to preserve fertility: preliminary results of a randomized controlled trial. Eur J Obstet Gynecol Reprod Biol. 2006;126:226–233
  6. 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
  7. Volkers NA, Hehenkamp WJ, Birnie E, Ankum WM, Reekers JA. Uterine artery embolization versus hysterectomy in the treatment of symptomatic uterine fibroids: 2 years' outcome from the randomized EMMY trial. Am J Obstet Gynecol. 2007;196:519.e1–519.e11
  8. Hehenkamp WJ, Volkers NA, Birnie E, Reekers JA, Ankum WM. Symptomatic uterine fibroids: treatment with uterine artery embolization or hysterectomy: results from the randomized clinical embolisation versus hysterectomy (EMMY) trial. Radiology. 2008;246:823–832
  9. Hehenkamp WJ, Volkers NA, Broekmans FJ, et al. Loss of ovarian reserve after uterine artery embolization: a randomized comparison with hysterectomy. Hum Reprod. 2007;22:1996–2005
  10. Higham JM, O'Brien PM, Shaw RW. Assessment of menstrual blood loss using a pictorial chart. BJOG. 1990;97:734–739
  11. Brooks R. EuroQol: the current state of play. Health Policy. 1996;37:53–72
  12. Rabin R, de Charro F. EQ-5D: a measure of health status from the EuroQol group. Ann Med. 2001;33:337–343
  13. Feeny D, Furlong W, Torrance GW. Multiattribute and single-attribute utility functions for the health utilities index mark 3 system. Med Care. 2002;40:113–128
  14. Stead ML, Crocombe WD, Fallowfield LJ. Sexual activity questionnaires in clinical trials: acceptability to patients with gynaecological disorders. BJOG. 1999;106:50–54
  15. Stead ML, Fountain J, Napp V. Psychometric properties of the body image scale in women with benign gynaecological conditions. Eur J Obstet Gynecol Reprod Biol. 2004;114:215–220
  16. Wiklund I, Holst J, Karlberg J, et al. A new methodological approach to the evaluation of quality of life in postmenopausal women. Maturitas. 1992;14:211–224
  17. Kupperman M, Varner RE, Summit RL, Learman LA, Ireland C, Vittinghof E. Effect of hysterectomy versus medical treatment on health-related quality of life and sexual functioning: the medicine or surgery (Ms) randomized trial. JAMA. 2004;291:1447–1455
  18. Hurskainen R, Teperi J, Rissanen P, Aalto AM, Grenman S, Kivela A. Quality of life and cost-effectiveness of levonorgestrel-releasing intrauterine system versus hysterectomy for treatment of menorrhagia: a randomised trial. Lancet. 2001;357:273–277
  19. Ware JE. SF-36 health survey update. Spine. 2000;25:3130–3139
  20. Shumaker SA, Wyman JF, Uebersax JS, McClish D, Fantl JA. Health-related quality of life measures for women with urinary incontinence: the Incontinence Impact Questionnaire and the Urogenital Distress Inventory: Continence Program in Women (CPW) research group. Qual Life Res. 1994;3:291–306
  21. Uebersax JS, Wyman JF, Shumaker SA, McClish DK, Fantl JA. Short forms to assess life quality and symptom distress for urinary incontinence in women: the Incontinence Impact Questionnaire and the Urogenital Distress Inventory: Continence Program in Women (CPW) research group. Neurourol Urodyn. 1995;14:131–139
  22. Roovers JP, van den Bom JG, Huub van der Vaart C, Fousert DM, Heintz AP. Does mode of hysterectomy influence micturition and defecation?. Acta Obstet Gynecol Scand. 2001;80:945–951
  23. Spies JB, Bruno J, Czeyda-Pommersheim F, Magee ST, Ascher SA, Jha RC. Long-term outcome of uterine artery embolization of leiomyomata. Obstet Gynecol. 2005;106:933–939
  24. Lohle PN, Voogt MJ, de Vries J, et al. Long-term outcome of uterine artery embolization for symptomatic uterine leiomyomas. J Vasc Interv Radiol. 2008;19:319–326
  25. Gabriel-Cox K, Jacobsen GF, Armstrong MA, Hung YY, Learman LA. Predictors of hysterectomy after uterine artery embolization for leiomyoma. Am J Obstet Gynecol. 2007;196:588.e1–588.e6
  26. Muller-Hulsbeck S. Long-term results after fibroid embolization. Radiologe. 2008;48:660–665
  27. Hirst A, Dutton S, Wu O, et al. A multi-centre retrospective cohort study comparing the efficacy, safety and cost-effectiveness of hysterectomy and uterine artery embolisation for the treatment of symptomatic uterine fibroids: the HOPEFUL study. Health Technol Assess. 2008;12:1–248
  28. Park AJ, Bohrer JC, Bradley LD, et al. Incidence and risk factors for surgical intervention after uterine artery embolization. Am J Obstet Gynecol. 2008;199:671.e1–671.e6
  29. Blandon RE, Bharucha AE, Melton LJ, et al. Incidence of pelvic floor repair after hysterectomy: a population-based cohort study. Am J Obstet Gynecol. 2007;197:664.e1–664.e7
  30. Istre O. Management of symptomatic fibroids: conservative surgical treatment modalities other than abdominal or laparoscopic myomectomy. Best Pract Res Clin Obstet Gynaecol. 2008;22:735–747
  31. Tulandi T, Sammour A, Valenti D, Child TJ, Seti L, Tan SL. Ovarian reserve after uterine artery embolization for leiomyomata. Fertil Steril. 2002;78:197–198
  32. Narushima M, Otani T, Itoh Y, Kai S, Kondo A, Hayashi H. Clinical effect of transabdominal simple hysterectomy on micturition function. Hinyokika Kiyo. 1993;39:797–800
  33. Chen GD. Pelvic floor dysfunction in aging women. Taiwan J Obstet Gynecol. 2007;46:374–378
  34. Agdi M, Valenti D, Tulandi T, et al. Intraabdominal adhesions after uterine artery embolization. Am J Obstet Gynecol. 2008;199:482.e1–482.e3
  35. Walker WJ, Barton-Smith P. Long-term follow up of uterine artery embolisation: an effective alternative in the treatment of fibroids. BJOG. 2006;113:464–468

 The EMMY trial participants and hospitals are listed with the full-length article at www.AJOG.org.

 Supported by ZonMw “Netherlands Organization for Health Research and Development” (Grant application no: 945-01-017) and by Boston Scientific Corporation, The Netherlands.

 Cite this article as: van der Kooij SM, Hehenkamp WJK, Volkers NA, et al. Uterine artery embolization vs hysterectomy in the treatment of symptomatic uterine fibroids: 5-year outcome from the randomized EMMY trial. Am J Obstet Gynecol 2010;203:105.e1-13.

PII: S0002-9378(10)00079-7

doi: 10.1016/j.ajog.2010.01.049

American Journal of Obstetrics & Gynecology
Volume 203, Issue 2 , Pages 105.e1-105.e13 , August 2010