Re: ABCNEWS.com: Are Most Hysterectomies Unnecessary?
From: art fougner, md (evsono@pipeline.com)
Sun Aug 29 16:40:49 2004
As announcer and former NY Knicks great Walt Frazier would say, this
story is "All fizzle, no sizzle." we won't have real answers for at
least 5 - 10 yrs. What patients need to know is the number of patients
who will subsequently need hysterectomy following UAE.
There is literature demonstrating that patients' satisfaction following
hysterectomy is higher than that following other treatments for abnormal
bleeding.
Among women with abnormal uterine bleeding and dissatisfaction with
medroxyprogesterone, hysterectomy was superior to expanded medical
treatment for improving health-related quality-of-life after 6 months.
With longer follow-up, half the women randomized to medicine elected to
undergo hysterectomy, with similar and lasting quality-of-life
improvements; those who continued medical treatment also reported some
improvements.
Kupperman, Varner et al.
JAMA. 2004 Mar 24;291(12):1447-55.
Additionally, as cited previously, among women who conceive following
UAE, an increased number of adverse perinatal outcomes has been
reported.
Goldberg, Pereira et al.
Am J Obstet Gynecol. 2004 Jul;191(1):18-21
To the producers of 20 20, we should reply, Data please.
art
At Sun, 29 Aug 2004, Larry Glazerman wrote:
>
>Unfortunately, the part of the story that was the most valuable, namely,
>presenting options to patients, was lost in the hype and sensationalism of
>the story. I offer ALL of my patients with fibroids ALL of the following
>options:
>
>1. Do nothing
>2. Attempt to control bleeding hormonally
>3. UAE
>4. Myomectomy
>5. Hysterectomy (supracervical or total, with or without BSO, depending on
>the situation)
>
>Regarding the UAE data, I also tell them that it's only been done for less
>than 10 years, and we don't know long term data.
>
>Some patients choose UAE, more of them choose hysterectomy, usually LSH in
>my hands.
>
>FWIW, I also get quite a few patients who come to me for second opinions,
>saying "I have fibroids and my doctor told me I need a hysterectomy." I wish
>I had a nickel for every patient who, after I discuss all the options, says
>to me "I want you to just take it out."
>
>--
>Larry R. Glazerman, MD
>Ob-Gyn at Trexlertown, PC
>610-402-0161
>l.glazerman@rcn.com
>
>> -----Original Message-----
>> From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Joanne
>> Bulley, MD
>> Sent: Sunday, August 29, 2004 3:51 PM
>> To: Multiple recipients of list OB-GYN-L
>> Subject: Re: ABCNEWS.com: Are Most Hysterectomies Unnecessary?
>>
>> I like the description from the ABC article:
>>
>> She was mildly sedated for the procedure. Tiny pellets were injected
>> into a catheter inserted near the groin that is guided up to the uterine
>> arteries. The pellets stop the flow of blood to the fibroid tumors,
>> causing them to shrink and die. The pellets are made out of a plastic
>> similar to contact lenses and stay in the artery permanently.
>>
>> The outcome statistics for uterine fibroid embolization are impressive -
>> more than 90 percent symptom relief, with complications in only 2
>> percent to 5 percent of cases. Radiologists now routinely avoid the
>> arteries near the cervix and vagina - which seems to minimize the risk
>> of sexual dysfunction.
>>
>> Another advance has been the use of pain medication for the severe
>> cramping that sometimes starts during the procedure. It can often last
>> several days but can be well controlled with medication.
>>
>> How about the "Radiologists now routinely avoid the arteries near the
>> cervix and vagina - which seems to minimize the risk of sexual
>> dysfunction."
>>
>> The only uterine arteries ARE near the cervix and vagina! So what the **
>> are they talking about?!
>>
>> OK folks - who thinks 75% of those having hysts should have UAE intead?
>>
>> Joanne
>>
>> At Sat, 28 Aug 2004, rmodugno@aol.com wrote:
>> >
>> >You have received this ABCNEWS.com mail from:
>> >
>> >Robert Modugno MD
>> >rmodugno@aol.com
>> >
>> >I thought you might find this story interesting.
>> >
>> >Are Most Hysterectomies Unnecessary?
>> >http://abcnews.go.com/sections/2020/Living/fibroid_hysterectomies_040827-
>> 1.html
>>
>> --
>> Joanne Bulley, MD
>> Keene, NH, USA
>>
>> "Every gun that is made, every warship launched, every rocket fired,
>signifies
>> in the final sense a theft from those who hunger and are not fed, those
>who
>> are cold and are not clothed."
>>
>> President Dwight D. Eisenhower
>> April 16, 1953
>
--
art fougner, md
ich bin ein New Yorker
