NEW YORK (Reuters Health) – Uterine artery embolization (UAE) is a “satisfactory alternative” to hysterectomy or myomectomy for fibroids, according to the long-term results of a randomized comparison trial conducted in Scotland and reported in BJOG online April 12.

The results are in line with findings from a recent Dutch meta-analysis published online March 17th in the American Journal of Obstetrics and Gynecology (see Reuters Health report on March 28, 2011). It showed that health-related quality of life and satisfaction rates did no differ between UAE and surgical groups, despite higher re-intervention rates with UAE.

For the current study, Dr. J. G. Moss, with North Glasgow University Hospitals, and colleagues compared 5-year outcomes in 157 women with symptomatic fibroids who were originally randomized to UAE (n=106) or surgery -- i.e., hysterectomy (n=42) or myomectomy (n=9).

Quality of life assessed by SF-36 scores was virtually identical in the UAE and surgical groups, with each arm showing a gain in quality of life that reached normative levels, the researchers found.

At 5 years, the mean symptom score was +4.5 in the UAE group and +4.8 in the surgical group, with +5 indicating markedly better, according to the report.

Rates of adverse events were similar in both groups (19% with UAE and 25% with surgery), but the 5-year intervention rate for treatment failure or complications was 32% in the UAE arm versus 4% in the surgery arm.

The authors note that, because of the re-intervention rate, the two treatments were cost neutral at 5 years.

“The less invasive nature of UAE needs to be balanced against the need for re-intervention in almost a third of patients,” Dr. Moss and colleagues conclude. “The choice should lie with the informed patient.”

Randomised comparison of uterine artery embolisation (UAE) with surgical treatment in patients with symptomatic uterine fibroids (REST trial): 5-year results
BJOG 2011.