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Channel 10 News October 10, 2005 Dr. Kirsch - UAE

Dr. Kirsch is a Subspecialty Board-Certified Interventional Radiologist.  He has practiced in the Philadelphia area since 1990 and currently practices at Roxborough Memorial Hospital.  As of August 1, 2002, he has treated over 1,325 women for their fibroids with UAE - more than any other physician in the world.

Fibroids are benign tumors of the uterus. They are not cancers, but can cause symptoms such as excessive bleeding during or between periods, pressure on the bladder or rectum, discomfort during sexual relations or  interference with fertility. Symptoms from fibroids, the most common of which is excessive bleeding, can be anywhere from mild to disabling. 

One of the most effective treatments for bleeding is to stop the blood supply to the bleeding area by blocking the vessels from the inside.  This is known as “embolization”.  Embolization of the arteries to the uterus  has been used as a treatment for severe bleeding after surgery or childbirth since at least the late 1970s. Uterine Artery Embolization (UAE) was first used as a treatment for fibroids in France in the late 80’s or early 90’s, and the first report was published in Lancet in 1995.  Drs. Goodwin (IR) and McLucas (Gyn) started performing UAE for fibroids in Los Angeles in the first quarter of 1996.  Dr. Francis Hutchins, Jr., a Gynecologist, saw an article by Dr. McLucas and asked me to perform UAE in the second half of 1996. 

UAE has an extensive track record of safety and efficacy for other causes of bleeding.  When I started to offer UAE, there was already more than five years experience of fibroid treatment by UAE in France. 

I see all patients for a consultation before scheduling any procedure. Before seeing me, a patient should have an ultrasound or MRI examination of the pelvis and a blood count, and should also have had a Pap smear within the last year. After seeing me, some patients may need to see their gynecologist for an office procedure called an endometrial biopsy, which is similar to a Pap smear. 

On the day of the procedure, a woman is admitted to the Short Procedure Unit, than has blood drawn, an IV started  and a catheter placed  in the bladder.  Antibiotics are administered and choices of conscious sedation and spinal analgesia are offered. 

Next, the patient goes to the Radiology Department for ultrasound pictures of the pelvis to measure the uterus and size of the fibroids.  This information is used to decide on any changes that need to be made from the routine procedure and as a baseline for further follow-up studies. 

The procedure is performed in the Angiography Suite.  The radiologist sterilizes the skin lying on top of a large artery located in the groin area and numbs it with a local anesthetic.  A needle is inserted into the artery and exchanged for a plastic catheter about the thickness of a strand of spaghetti. 

Watching under X-ray, the radiologist then maneuvers the catheter into the main arteries supplying the uterus, and injects small plastic particles to plug up the blood vessels supplying the fibroids.  X-ray dye is injected through the catheter to show the vessels during this process. 

When the procedure is completed, the catheter is removed from the artery and pressure is applied at the small puncture site to stop the bleeding.  The patient must typically stay in bed for about six hours to avoid any bleeding at the puncture site.  She can sit up, eat, read, or watch television. 

Because of the loss of blood supply to the fibroids, cramping can occur shortly after the procedure, so she must stay overnight in the hospital.  A trained nursing staff knows the proper techniques to handle patients following the UAE procedure, and each patient receives round-the-clock attention, as needed. 

The next day, the patient is released with detailed instructions and phone numbers to contact me if necessary.  Any necessary prescriptions are given at this time.  The next day, I call to see how the patient is doing  and answer questions.   During the entire recovery process, I answer every email and phone call. 

In about three months, an ultrasound of the pelvis is taken to measure the reduction of the uterus and fibroids.  At this time, the average woman’s uterus has decreased by 50 percent in volume, and volume reduction continues for as much as a year, if not longer.  Individual fibroids decrease by  about 65 percent, if not more, at three months. After three months, a follow-up with patient’s gynecologist is required. 

Physicians need to be specifically trained in the UAE procedure. I was part of a committee that drafted a standard for UAE training, which all physicians should complete before  performing the procedure. 

In addition, I was instrumental in the design of the FIBROID (Uterine Artery Embolization Fibroid Registry for Outcomes Data) Registry, which obtains data on many women having the procedure.  The Registry is sponsored by CIRREF (Cardiovascular and Interventional Radiologist Research and Education Foundation), the research arm of the Society of Cardiovascular & Interventional Radiology, and brings together  scientific, technical, medical, academic research organizations, the U.S. Food and Drug Administration, industry, and consumers.  

The purpose of the Registry is to assess the procedure’s durability, impact on quality-of-life and fertility and to obtain data that will allow researchers to compare UAE to other fibroid treatments.  More information can be found at www.fibroidregistry.org  

For more information on the UAE procedure, check out www.fibroidcorner.com or contact Robert L. Worthington-Kirsch, MD, FSCVIR at Image Guided Surgery Associates, PC, e-mail  kirsch@igsapc.com.

Coming in late September, www.hopeforfibroids.org, Hope Waltman, Founder.

Copyright:  Today's Woman August 2002 Issue, Lancaster, Pennsylvania