Uterine Fibroids treatment at The Royal Surrey and The London Clinic, Harley Street
Dr Walker's Series
Dr Woodruff J Walker, Consultant Interventional Radiologist at the Royal Surrey County Hospital and The London Clinic,
has so far carried out fibroid embolisation (UFE) on over 2,300 patients over
13 years. This has received considerable national
coverage (see About Dr Walker, Publications and TV and Newspaper Coverage) In 1996 Dr Walker commenced an ethically approved trial of fibroid embolisation at the Royal Surrey County Hospital which later included patients from The London Clinic. The results of the
trial have been reported in previous publications.
Mid Term Results
In 2002 we published an analysis of our first 400 patients(9) and a further series in 2002(10). The results
of this series indicated a very high success rate of almost 90% with a low
incidence of complications i.e. less than 1% incidence of infective
complications requiring hysterectomy, a 6% incidence of failure or
recurrence, a less than 2% (4 patients) incidence of amenorrhoea (no
periods) under the age of 45, and a 6% incidence of troublesome vaginal
discharge, usually curable by hysteroscopic procedure(8). Satisfaction
rates for the procedure (i.e. where patients stated on follow up that
they were satisfied with the procedure and would recommend it), were over 90%. Fibroid shrinkages were over 60%.
Interestingly, as techniques improved, since the early series we have
had no incidences of infection leading to hysterectomy in over 1,700
cases and the success rates are around 95%.
Patient Satisfaction with UFE
We asked patients whether or not the quality of their lives had changed
for the better since UFE, whether they would still choose to have the
procedure again and whether or not they would recommend to others and
finally we asked for the patient to give an overall level of
satisfaction with the procedure.
Our results showed that over 88% of women would recommend and choose UFE
as a form of treatment.
Over 84% of women reported improvement in Quality of Life post UFE.
The overall level of satisfaction with the procedure was over 88%.
Long Term Paper Results
In 2006 we published our long term results(2). A total of 258 women were
identified as being between 5 and 7 years post UFE and suitable for
long-term follow up. 172 completed questionnaires
were analysed. 75% of women had either a return to normal or an
improvement in menstrual flow compared with how they were prior to UFE.
More than 80% of fibroid related symptoms were resolved or improved. 88%
of women were satisfied with the outcome of the procedure at 5-7 years
and would choose UFE again or recommend it to others. The findings showed
that UFE is of benefit to women wishing to avoid hysterectomy and it
carries a low risk of complications and its benefit is sustained - more
detailed results of long term data below and under Long Term Results paper.
We have performed fibroid embolisation in over 2,300 patients. Since the early phase of the trial our complication
rate has fallen and the technique has undergone changes. The two most significant complications of fibroid embolisation are premature menopause and infection leading to hysterectomy.
We had 5 infections leading to hysterectomy in our first 500+ patients. None of these were
acute emergencies or required intensive care unit admission. Since then
in over 1,700 patients we have had no hysterectomies due to infection. With regard to amenorrhoea i.e. premature
menopause, this has occurred in 5 patients of 773 under 45 years of age
i.e. 0.6%. 4 of these, however, again were in our
first 400 patients when the technique we were using differed from our current protocol. In addition
2 of the patients
had predisposing factors for ovarian failure. Of the 5 patients 4 of them have stated that despite the amenorrhoea
they were satisfied with the procedure and would have preferred UFE to hysterectomy. These patients have all done very well.
A small minority of fibroids are expelled
spontaneously from the uterus through the vagina and occasionally these fibroids become impacted and have to be removed
by putting a small 'telescope' through the cervix into the cavity of the uterus and resecting the fibroids. This almost
invariably leads to an excellent result with a virtually normal uterus. In the 1,500 patients, 13 required hysteroscopic resection of impacted fibroids following embolisation.
The results above are from the early part of our series (last patient approximately 2001). Over the following 12 years the technique has been refined and results further improved. Success rates are now in the mid 90% and complications even rarer.
1. Walker WJ, Bratby . Magnetic Resonance
Imaging (MRI) Analysis of Fibroid Location
in Women Achieving Pregnancy After Uterine
Artery Embolisation. Cardiovascular
interventional Radiology - August 2007
2. Walker WJ, Barton-Smith P. Long-term
follow up of uterine artery embolisation -
an effective alternative in the treatment of
fibroids. British Journal of Obstetrics and
3. Walker WJ, McDowell SJ. Pregnancy after
uterine artery embolisation for leiomyomata:
at series of 56 completed pregnancies.
American Journal of Gynecology & Obstetrics
November 2006 195(5) 1266-71
4. Kundu S, Gadani S, Clements R, Asisa J,
Wilcock G, Barnwell D Comparison of surgical
periprocedural Morbidity/Mortality & Length
of Stay with UAE for Symptomatic Uterine
Fibroids. Presented SIR Canada 2006
5. Spies JB, Bruno J, Czyda-Pommersheim F,
Magee ST, Ascher S, Jha RC. Long-Term
outcome of Uterine Artery Embolisation of
Leiomyomata. Obstetrics and Gynaecology
6. Hanafi M. Predictors of leiomyomas
recurrence after myomectomy. Obstetrics and
Gynaecology 2005 Apr;105(4):877-81
7. Carpenter T, WJ Walker. Pregnancy
following uterine artery embolisation for
symptomatic fibroids: a series of 26
completed pregnancies. British Journal of
Obstetrics and Gynaecology, 112, pp321-325
8. Walker WJ, Carpenter T, Kent ASH
Persistent vaginal discharge after uterine
artery embolisation for fibroid tumours:
cause of the condition, magnetic resonance
imaging appearance, and surgical treatment.
American Journal of Obstetrics and
Gynecology, Volume 190, Issue 5, May 2004,
9.Walker WJ, Pelage JP. Uterine artery
embolisation for symptomatic fibroids.
Clinical results in 400 women with imaging
follow up. British Journal of Obstetrics and
Gynaecology. Nov 2002; 109: 1262-1272
10. Watson GMT, Walker WJ. Uterine Artery
Embolisation for the treatment of
symptomatic fibroids in 114 women: reduction
of size of size of the fibroids and women’s
views of the success of the treatment.
British Journal of Obstetrics & Gynaecology
11. Walker WJ, Pelage JP, Sutton C. Fibroid
embolisation [review]. Clinical Radiology
2002 57(5); 325-31
12. Walker WJ. Bilateral Uterine Artery
Embolisation for Fibroids - A Three and a
Half Year Experience of over 300 Cases and
Comparison with Data from other Centres. The
Yearbook of Obstetrics & Gynaecology,
Sturdee D, Oláh K, Keans D (Eds) RCOG Press
2001; Vol.9: 209-15
13. Walker WJ. Limitations of Fibroid
Embolisation. Controversies in Obstetrics,
Gynaecology & Infertility. Ben-Rafael Z,
Shohan Z, Frydman R, Monduzzi Editore 2001:
14. Pelage JP, Le Dref O, Soyer P, et al.
Fibroid related menorrhagia: treatment with
super selective embolization of the uterine
arteries and mid-term follow up. Radiology
2000,215 (2) 428-31
15. Walker WJ. Fibroid Embolisation.
Gynaecological Endoscopy. 2000; 9: 343-344
16. Jones K, Walker WJ, Sutton C.
Sequestration and Extrusion of Intramural
Fibroids following Uterine Artery
Embolisation. Gynaecological Endoscopy 2000;
17. Jones K, Walker WJ. Access Procedures to
Treat Menorrhagia in one patient.
Gynaecological Endoscopy 2000; 9: 323-5
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treatment of uterine leiomyomata: midterm
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Initial results from uterine fibroid
embolization for symptomatic leiomyomata
Journal of Vascular and Interventional
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Berkowitz RP. Selective uterine artery
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