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Uterine artery embolization (UAE) compared with myomectomy for the management of uterine fibroids: a systematic review and meta-analysis
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  • Emily Williams,
  • Stephen Walker,
  • Siobhan Quenby,
  • Joshua Odendaal
Emily Williams
University of Warwick

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Stephen Walker
University of Warwick Warwick Medical School
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Siobhan Quenby
Warwick Medical School
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Joshua Odendaal
University of Warwick Warwick Medical School
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Background Uterine artery embolization (UAE) and myomectomy are uterus-sparing treatments for uterine fibroids. Each carries a different risk and efficacy profile. Despite this there is a lack of direct comparison between the two techniques making treatment choice decisions difficult. Objectives To compare the therapeutic efficacy and complications of UAE versus myomectomy. Search strategy A systematic search of The Cochrane Library, Medline, and EMBASE databases was conducted using a pre-defined search strategy. The review was prospectively registered on PROSPERO (CRD42021259347). Selection Criteria All randomised controlled trials and cohort studies published between January 1995 and August 2021 directly comparing UAE and myomectomy were included. Data Collection and Analysis Meta-synthesis of raw data was performed using Review Manager 5.4.1 from the Cochrane Collaboration. A pooled estimate of efficacy was established using a fixed-effect model. Main results 8 studies were identified. UAE was associated with lower complication rates (OR 0.56; 95% CI 0.40-0.79), increased improvement in bleeding (OR 1.61 95% CI 1.07-2.43) and a shorter total recovery time (7.72 days versus 36.63 days). Whilst myomectomy was associated with a higher post-procedure quality of life (mean difference -10.56; 95% CI -15.34 - -5.79) and lower re-intervention rate (OR 5.16; 95% CI 2.41-11.04). No significant difference in procedural failure rate was seen (OR 0.67; 95% CI 0.30-1.50). Given concerns with UAE and future fertility limited post-procedure fertility outcomes were identified. Conclusions: Given differences in efficacy profiles a personalised approach to treatment discussions should be maintained. Funding: None Keywords: Uterine artery embolization, myomectomy, uterine fibroid