What are Fibroids?
The three common types of uterine fibroids
Fibroid tumours are benign (non-cancerous) growths that develop in the wall of the uterus. They occur in 30-70% of women and are particularly common in Afro-Caribbeans. Whilst fibroids do not always cause trouble, abdominal swelling, heavy or prolonged bleeding and pressure symptoms on the bladder and bowel are common. They typically shrink after menopause when the level of oestrogen, the female hormone that circulates in the blood, decreases dramatically. However, menopausal women who are taking hormone replacement therapy may not experience relief of symptoms. Fibroids range in size from that of a pea to the size of a melon. In some cases they can grow so big that the woman can look pregnant.
Treatment: Uterine Fibroid Embolisation (UFE)
This minimally invasive procedure, previously known as Uterine Artery Embolization (UAE), is carried out while the patient is conscious but sedated, drowsy and feeling no pain. A tiny skin puncture is made in the groin and a sheath and then catheter inserted into the artery. The catheter is guided through the arterial tree to the uterus while the Radiologist watches the progress of the procedure using a moving x-ray (fluoroscope). Tiny plastic or gelatin particles the size of grains of sand are injected into the artery that is supplying blood to the fibroids, cutting off the flow. Both left- and right-sided arteries are treated, usually requiring a single micro-incision. Local Anaesthetic is injected directly into the uterine artery midway through the embolisation. This has radically changed the pain following embolisation and many women can now be treated as day cases or with only one night in hospital. Once home women can resume work and normal activities as soon as they feel able
Average volume reduction of individual fibroids is around 50% but some fibroids disappear entirely.
Relief of symptoms occurs in weeks and is seen in over 90% of women
• Excellent pain management
What is Interventional Radiology
An Interventional Radiologist is a physician who is specially trained to diagnose and treat many conditions using tiny, miniaturised tools, while monitoring their progress on X-ray or other imaging equipment. Typically, the Interventional radiologist performs procedures through a very small skin puncture via the groin. Because this treatment does not use a surgical incision the patient benefits from a much shorter stay in hospital and recovery time is reduced to 1-2 weeks. The Interventional Radiologist will work closely with the primary care doctor and Gynaecologist to ensure the highest standards of care.
Other treatment options
Medical Management
Hormonal manipulation, Non Steroidal Anti-inflammatory medication and drugs to shrink fibroids in the short time are often used.
If medical therapy fails to control symptoms an interventional treatment. Fibroid Embolisation or Traditional surgery is often required.
Surgical Management
Hysterectomy
Over 60,000 hysterectomies are performed each year in the UK. over 600,000 are performed in the USA. The majority are for benign disease with fibroids being the commonest diagnosis. Whilst hysterectomy will give a permanent cure for fibroid disease it carries a significantly higher complication rate than Fibroid Embolisation.
Recovery times after abdominal hysterectomy varies but typically women return to work after 6-12 weeks. If work is demanding or physical this can take longer.
Laparoscopically assisted hysterectomy can lead to faster recovery times.
Myomectomy
This is usually reserved for women wanting to preserve fertility.
Abdominal myomectomy is most commonly performed if fibroids are large and multiple. Complications and Recovery times are similar to open hysterectomy. Subsequent pregnancy and childbirth if it occurs are typically managed by Caesarean section.
Hysteroscopic myomectomy is useful for small (less than 3cm) intracavity sub-mucosal fibroids. It can be used in combination with fibroid embolisation to manage multiple fibroids or larger intracavity fibroids. Recovery after hysteroscopic myomectomy is usually very quick.
Laparoscopic Myomectomy is useful for sub serosal fibroids no larger than 9cm and usually single or few in number. It can be combined with Fibroid Embolisation where fibroids are multiple.
The combination of Fibroid Embolisation and Myomectomy is a very useful management option. The embolisation should deal with all the fibroids and the myomectomy can effectively debulk the largest fibroids.
Recurrence rates after Myomectomy depends largely on the number of fibroids at time of presentation. When solitary fibroid recurrence rates are low. When multiple recurrence of fibroids should be expected after myomectomy and this is more likely than after embolisation.
Nigel Hacking
Interventional Radiologist now known as an Image Guided Surgeon
Nigel was a Consultant Interventional Radiologist at Southampton University Hospitals for over 30 years. He was one of the UK Pioneers in UFE commencing in 1997.
In 1998 he set up Fibroid Caribbean, a service for private and health service patients requiring UFE throughout the Caribbean, based out of Trinidad.
In 2009 he helped set up the Fibroid centre at the Aga Khan University Hospital in Nairobi, Kenya and has performed over 300 UFE procedures there. This expanded to almost 100 patients at the Aga Khan Hospital in Dar es Salaam in 2017. By 2019 Dr Hacking had trained a team of Interventional Radiologists locally to take over the service in Kenya.
He is working with a South African team of Interventional Radiologists to expand UFE into several centres in South Africa, as well as helping set up UFE centres in Namibia, Botswana and several other countries in Sub-Saharan Africa. He has performed over 4000 UFE procedures to date and he is now one of the most experienced practitioners in UFE in the world.
Fibroid Caribbean Your Path to Minimally Invasive UFE with Dr. Nigel Hacking
We can provide treatment at the following private Hospitals in Trinidad