The use of transcatheter embolisation to treat uterine fibroids.

Uterine leiomyomata (fibroids) are the commonest benign pelvic tumours. Therapeutic options include hormone manipulation or surgical management, myomectomy if the patient wishes to retain fertility, or hysterectomy. We describe the use of transcatheter arterial embolisation in a patient who presented with a large uterine fibroid and pressure symptoms. CASE REPORT A forty-two year old female patient presented with acute urinary retention. She was admitted to hospital where a urethral catheter was passed. She described a several month history of occasional difficulty commencing the flow of urine but was otherwise well with no relevant past medical history. Initial assessment included ultrasound, which showed a large uterine fibroid lying at the posterior aspect of the uterus, with a diameter in excess of ten centimetres. Hypervascularity was observed on colour doppler imaging. After discussion of therapeutic alternatives with the patient, we decided on transcatheter percutaneous embolisation of the uterine arteries. Prior to the procedure a prophylactic iv bolus of cefuroxime (750 mg) and metronidazole (400 mg) was given. The procedure was performed under conscious sedation (midazolam and fentanyl) with physiological monitoring.