18 - Future of embolization and other therapies from gynecologic perspectives

Summary

Introduction

Since the first reports of uterine artery embolization (UAE) for treatment of fibroids, the technique has been met with more enthusiasm by radiologists and patients than by gynecologists. This is quite understandable since this new procedure threatens the traditional exclusivity of gynecologists over the treatment of uterine leiomyomas. In a fee-based healthcare system, embolotherapy constitutes a direct economic threat to gynecologists.

As a consequence, the Society for Cardiovascular and Interventional Radiology (SCVIR) in its October 2000 survey reported that only 10 501 UAEs had been performed worldwide, with 8644 in the United States. These are extremely low numbers considering that in the United States at least 200 000 hysterectomies are performed each year for fibroids. It suggests that this highly effective treatment is underutilized because of the turf issues between gynecologists and radiologists. It is clear that much of the future of UAE will be shaped by this struggle.

The advent of UAE is part of a continuum of minimally invasive procedures that have been gaining favor over the past 10–20 years. This trend, which has brought operative laparoscopy and operative hysteroscopy, will continue and impact on the future use of UAE. In a similar fashion, the trend towards the use of medical therapies such as gonadotropin-releasing hormone (GnRH) agonists will also influence the future of embolotherapy for fibroids.