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 2,200 patients over
13 years. This has received considerable national
coverage (see Publicity section about Dr Walker and C.V.) 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. The results
of this series indicated a very high success rate of 86% 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 (34). 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 1,500
Long Term Results
In 2006 we published our long term results. 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 still 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:
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 86% of women would recommend and choose UAE
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%.
We have performed fibroid embolisation in over 2,200 patients. Since the early phase of the trail our complication
rate has fallen and the technique has undergone some changes. The two most significant complications of fibroid embolisation are premature menopause and infection leading to hysterectomy.
We had 5 complications in our first 500+ patients, none of which were
acute emergencies or required intensive care unit admission. Since then
in over 1,500 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. In the 1,500 patients, 13 required hysteroscopic resection of impacted fibroids following embolisation. 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.
The trial at the Royal Surrey County Hospital and London Clinic represents the largest world series of pregnancies
following Uterine Artery Embolisation (UFE). It is important to remember the population group in our trial is atypical i.e.
older and with other additional risk factors compared with the general obstetric population.
In the series of 2,000 patients we have had 105 pregnancies and the
results of these pregnancies are summaries in Table 1. Updated February 2010
|Pregnancies post fibroid embolisation
|Abortion (unwanted pregnancy)
|Baby died through knot in cord
|Still birth 37 weeks
Further to the above we now have 70 successful deliveries post UFE.
Miscarriage and complication rates: The spontaneous miscarriage rate and other complications outlined in Table 1 are no higher than in the general obstetric population.
In our trial of 2,000 women (7.5%) 150 women were trying at some stage to become pregnant.
Of these 51% went on to become pregnant. Of this sub-group (21%) had been offered hysterectomy as only form of treatment.
Thus our research shows that it is scientifically invalid as is often stated by various bodies and in areas of the literature to claim that no patient wishing to become pregnant should have fibroid embolisation.
It should be noted that a number of our patients who had had failed
myomectomies had successful pregnancies following UFE and some patients who had UFE required myomectomy.
Our results in 56 pregnancies published July 2006 in the American Journal of Obstetrics and Gynecology can be read under
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. TT Carpenter, 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 Endoscopy2000;
17. Jones K, Walker WJ. Access Procedures to
Treat Menorrhagia in one patient.
Gynaecological Endoscopy2000; 9: 323-5
18.Walker WJ. Bilateral uterine Artery
Embolization for Fibroids. Menorrhagia.
Sheth C, Sutton C (Eds). Isis Medical Media,
Oxford. April 1999: 185-93
19. Goodwin SG, McLucas B, Lee M, et al.
Uterine artery embolization for the
treatment of uterine leiomyomata: midterm
results. Journal of Vascular and
Interventional Radiology. 1999; 10: 1159-65
20. Spies JB, Scialli AR, Jha RC, et al.
Initial results from uterine fibroid
embolization for symptomatic leiomyomata
Journal of Vascular and Interventional
Radiology. 1999:10: 1149-57
21. Hutchins J FL, Worthington-Kirsch RL,
Berkowitz RP. Selective uterine artery
embolization as primary treatment for
symptomatic leiomyomata uteri. Journal of
the American Association of Gynecological
Laparoscopists 1999; 6: 279-84
22. Walker W, Green A, Sutton C. Bilateral
uterine artery embolisation for myomata:
results, complications and failures. Journal
of Minimally Invasive Therapy1999; Vol 8
23. Walker WJ. Bilateral Uterine Artery
Embolization for Fibroids. Menorrhagia.
Sheth C, Sutton C (eds). Isis Medical Media,
Oxford. April 1999: 185-93
24. Walker WJ. Arterial embolisation in
obstetrics and gynaecology with particular
reference to uterine fibroids. Advances in
Obstetrics and Gynaecology. 1999;16:2-8
25. Worthington-Kirsch RL, Walker WJ, Adler
L and Hutchins Jr FL. Anatomic variation in
the uterine arteries: a cause of failure of
uterine artery embolisation for the
management of symptomatic myomata. Journal
of Minimally Invasive Therapy, December
1999, Vol 8 (6): 397-402
26. Goodwin SC, (UCLA) USA, Walker WJ (RSCH)
UK. Uterine Artery Embolisation for the
treatment of fibroids. Current Opinion in
Obstetrics and Gynaecology 1998;10: 315-2 5.
27. Takamizawa S, Minakami H, Usui Ret
al.Risk of complications and uterine
malignancies in women undergoing
hysterectomy for presumed benign leiomyomas.
Gynecol Obstet Invest 1999; 48: 193-6
28. Dover RW, Sutton CJG, Walker WJ.
Arterial embolisation for uterine fibroids.
The results of the largest UK series.
British Journal of Obstetrics
andGynaecology.1998; 105: 52
29. Barr JD, Lemley TJ, Petrochko CN.
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Gynaecology,7th ed, Philadelphia, USA:
Lippincott, 1992: 647-62
31. Schuur KH, Bouma J. Palliative
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34. Wingo PA, HuezoCM, Rubin GL, et al. The
mortality risk associated with hysterectomy.
American Journal of Obstetrics and
35. Hill DJ, Complications of hysterectomy.
Bellaire’s Clinical Obstetric
36. Vashisht A, Studd J, Carey A, Burns P.
Fatal septicaemia after fibroid embolisation.
Lancet July 24 1999; 354:1730
37. Uterine artery embolization survey
results: 10, 500 procedures performed
world-wide. Society of Cardiovascular and
Interventional Radiology, October 1999