Wednesday, May 19, 1999
Uterine fibroids procedure offers hysterectomy option
BY SUE MacDONALD
The Cincinnati Enquirer
A new procedure is giving Tristate women an option other than hysterectomy for uterine fibroids that cause excessive menstrual bleeding.
It's one of two new high-technology methods recently adopted at Health Alliance hospitals. The other is radioactive plaque therapy for patients who have melanoma.
The procedure to shrink fibroids inside a woman's uterus is called embolization, and it involves the insertion of tiny synthetic particles into the artery that supplies the uterus — and the fibroids attached to the uterine lining — with blood.
Those tiny particles travel to the uterus and clump together, cutting off the blood flow and eventually shrinking the fibroids. As the fibroids shrink, bleeding slows to normal. Some women with troublesome fibroids typically bleed three out of four weeks every month, often becoming fatigued and anemic.
“Anybody who's comfortable doing embolization can be comfortable with this,” says Dr. Joseph Bernstein, interventional radiologist at Christ Hospital. Doctors have been using similar particle-blocking techniques for years to control bleeding during an ectopic pregnancy, for pelvic trauma or to treat diseased livers and kidneys, he says.
“Since you're sparing the uterus — that's the main goal — the women who are good candidates for this are women who are afraid of having surgery, don't want to lose an organ and maybe who are younger, someone who potentially still wants to have children,” Dr. Bernstein says.
Developed about three years ago in California, the procedure seems to work best on fibroids that are not excessively large, he says. Women typically undergo treatment and are hospitalized overnight because of intense cramping for 3-6 hours (compared to labor pains) and next-day menstrual bleeding.
He performed the first embolization several months ago when a patient of Christ Hospital obstetrician-gynecologist Dr. Elbert Nelson asked about it after reading about the alternative in an out-of-town newspaper.
About 600,000 women have a hysterectomy each year, making it one of the most common surgeries. About one-third of women opt for surgery because fibroids — masses that grow inside the uterus — cause uncontrolled, heavy and frequent bleeding, often leading to anemia.
“Embolization is basically going to control that bleeding,” Dr. Bernstein says. In time, a woman's menstrual cycle returns to normal, and blood flow to the uterus isn't completely blocked because it has so many vessels supply it with blood.
At University Hospital, Dr. James Augsburger, recently named director of ophthalmology, is performing radioactive plaque therapy for patients who have melanoma — the most serious form of skin cancer — in the pigmented layers of the eye.
A device that's similar to a large, thick contact lens is fitted onto the eye, directly above the tumor, and stitched in place for four days. Attached to the gold device are radioactive seeds that deliver killing radiation to the tumor; the gold blocks radiation from affecting healthy tissue.
The one-time treatment usually stops the tumor from growing and keeps it from spreading elsewhere in the body, says Dr. Augsburger. Exposure to radiation can damage or destroy a person's vision in that eye, especially if the tumor is large or located close to the optic nerve. But many people prefer the radiation treatment to the alternative — removal of the eye.
“Most of the patients retain functional vision,” he says. “If they closed the other eye, they could walk around the room and not bump into things. They may not be able to see things sharply or will lose some vision off to the left or up above. The payoff is you don't lose the eye.”
Until Dr. Augsburger joined the UC staff, patients opting for this treatment had to travel to Philadelphia, Boston or New York.
WHO'S ELIGIBLE?
Women interested in embolization need to undergo a complete examination and series of tests with their gynecologist before being evaluated for the technique.
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