Uterine-sparing minimally invasive interventions in women with uterine fibroids: A systematic review and indirect treatment comparison meta-analysis
Objective To evaluate the effectiveness of uterine-sparing interventions for women with symptomatic uterine fibroids who wish to preserve their uterus. Design Systematic review and indirect comparison meta-analysis. Methods MEDLINE, EMBASE, CENTRAL, conference proceedings, trial registers and refere...
| Main Authors: | , , , , , |
|---|---|
| Format: | Journal article |
| Language: | English |
| Published: |
Wiley-Blackwell Publishing Ltd
2014
|
| _version_ | 1797083523229679616 |
|---|---|
| author | Panagiotopoulou, N Nethra, S Karavolos, S Ahmad, G Karabis, A Burls, A |
| author_facet | Panagiotopoulou, N Nethra, S Karavolos, S Ahmad, G Karabis, A Burls, A |
| author_sort | Panagiotopoulou, N |
| collection | OXFORD |
| description | Objective To evaluate the effectiveness of uterine-sparing interventions for women with symptomatic uterine fibroids who wish to preserve their uterus. Design Systematic review and indirect comparison meta-analysis. Methods MEDLINE, EMBASE, CENTRAL, conference proceedings, trial registers and reference lists were searched up to October 2013 for randomized controlled trials. Main outcome measures Outcome measures were patient satisfaction, re-intervention and complications rates, reproductive outcomes, and hospitalization and recovery times. Results Five trials, involving 436 women were included; two compared uterine artery embolization with myomectomy and three compared uterine artery embolization with laparoscopic uterine artery occlusion. Indirect treatment comparison showed that myomectomy and uterine artery embolization resulted in higher rates of patient satisfaction (odds ratio 2.56, 95% credible interval 0.56-11.75 and 2.7, 95% credible interval 1.1-7.14, respectively) and lower rates of clinical failure (odds ratio 0.29, 95% credible interval 0.06-1.46 and 0.37, 95% credible interval 0.13-0.93, respectively) than laparoscopic uterine artery occlusion. Myomectomy resulted in lower re-intervention rate than uterine artery embolization (odds ratio 0.08, 95% credible interval 0.02-0.27) and laparoscopic uterine artery occlusion (odds ratio 0.08, 95% credible interval 0.01-0.37) even though the latter techniques had an advantage over myomectomy because of shorter hospitalization and quicker recovery. There was no evidence of difference between the three techniques in ovarian failure and complications rates. The evidence for reproductive outcomes is poor. Conclusion Our study's results suggest that laparoscopic uterine artery occlusion is less effective than uterine artery embolization and myomectomy in treatment of symptomatic fibroids. The choice between uterine artery embolization and myomectomy should be based on individuals' expectations and fully informed discussion. © 2014 Nordic Federation of Societies of Obstetrics and Gynecology. |
| first_indexed | 2024-03-07T01:42:48Z |
| format | Journal article |
| id | oxford-uuid:977104e0-27af-476c-9b69-f22c741932b8 |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-07T01:42:48Z |
| publishDate | 2014 |
| publisher | Wiley-Blackwell Publishing Ltd |
| record_format | dspace |
| spelling | oxford-uuid:977104e0-27af-476c-9b69-f22c741932b82022-03-26T23:59:39ZUterine-sparing minimally invasive interventions in women with uterine fibroids: A systematic review and indirect treatment comparison meta-analysisJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:977104e0-27af-476c-9b69-f22c741932b8EnglishSymplectic Elements at OxfordWiley-Blackwell Publishing Ltd2014Panagiotopoulou, NNethra, SKaravolos, SAhmad, GKarabis, ABurls, AObjective To evaluate the effectiveness of uterine-sparing interventions for women with symptomatic uterine fibroids who wish to preserve their uterus. Design Systematic review and indirect comparison meta-analysis. Methods MEDLINE, EMBASE, CENTRAL, conference proceedings, trial registers and reference lists were searched up to October 2013 for randomized controlled trials. Main outcome measures Outcome measures were patient satisfaction, re-intervention and complications rates, reproductive outcomes, and hospitalization and recovery times. Results Five trials, involving 436 women were included; two compared uterine artery embolization with myomectomy and three compared uterine artery embolization with laparoscopic uterine artery occlusion. Indirect treatment comparison showed that myomectomy and uterine artery embolization resulted in higher rates of patient satisfaction (odds ratio 2.56, 95% credible interval 0.56-11.75 and 2.7, 95% credible interval 1.1-7.14, respectively) and lower rates of clinical failure (odds ratio 0.29, 95% credible interval 0.06-1.46 and 0.37, 95% credible interval 0.13-0.93, respectively) than laparoscopic uterine artery occlusion. Myomectomy resulted in lower re-intervention rate than uterine artery embolization (odds ratio 0.08, 95% credible interval 0.02-0.27) and laparoscopic uterine artery occlusion (odds ratio 0.08, 95% credible interval 0.01-0.37) even though the latter techniques had an advantage over myomectomy because of shorter hospitalization and quicker recovery. There was no evidence of difference between the three techniques in ovarian failure and complications rates. The evidence for reproductive outcomes is poor. Conclusion Our study's results suggest that laparoscopic uterine artery occlusion is less effective than uterine artery embolization and myomectomy in treatment of symptomatic fibroids. The choice between uterine artery embolization and myomectomy should be based on individuals' expectations and fully informed discussion. © 2014 Nordic Federation of Societies of Obstetrics and Gynecology. |
| spellingShingle | Panagiotopoulou, N Nethra, S Karavolos, S Ahmad, G Karabis, A Burls, A Uterine-sparing minimally invasive interventions in women with uterine fibroids: A systematic review and indirect treatment comparison meta-analysis |
| title | Uterine-sparing minimally invasive interventions in women with uterine fibroids: A systematic review and indirect treatment comparison meta-analysis |
| title_full | Uterine-sparing minimally invasive interventions in women with uterine fibroids: A systematic review and indirect treatment comparison meta-analysis |
| title_fullStr | Uterine-sparing minimally invasive interventions in women with uterine fibroids: A systematic review and indirect treatment comparison meta-analysis |
| title_full_unstemmed | Uterine-sparing minimally invasive interventions in women with uterine fibroids: A systematic review and indirect treatment comparison meta-analysis |
| title_short | Uterine-sparing minimally invasive interventions in women with uterine fibroids: A systematic review and indirect treatment comparison meta-analysis |
| title_sort | uterine sparing minimally invasive interventions in women with uterine fibroids a systematic review and indirect treatment comparison meta analysis |
| work_keys_str_mv | AT panagiotopouloun uterinesparingminimallyinvasiveinterventionsinwomenwithuterinefibroidsasystematicreviewandindirecttreatmentcomparisonmetaanalysis AT nethras uterinesparingminimallyinvasiveinterventionsinwomenwithuterinefibroidsasystematicreviewandindirecttreatmentcomparisonmetaanalysis AT karavoloss uterinesparingminimallyinvasiveinterventionsinwomenwithuterinefibroidsasystematicreviewandindirecttreatmentcomparisonmetaanalysis AT ahmadg uterinesparingminimallyinvasiveinterventionsinwomenwithuterinefibroidsasystematicreviewandindirecttreatmentcomparisonmetaanalysis AT karabisa uterinesparingminimallyinvasiveinterventionsinwomenwithuterinefibroidsasystematicreviewandindirecttreatmentcomparisonmetaanalysis AT burlsa uterinesparingminimallyinvasiveinterventionsinwomenwithuterinefibroidsasystematicreviewandindirecttreatmentcomparisonmetaanalysis |