It is a blessing and a huge honor for Dr Imtiaz Ahmad and his team to offer a “totally” non surgical definitive treatment for Adenomyosis; offered first time in Pakistan since Nov 2017.
A brief outlook on Fibroids and Adenomyosis
Fibroids and adenomyosis often occur together, but are distinct in their characteristics. The fibroid is a benign tumor that can grow in different layers of the uterus while in Adenomyosis, the uterine inner lining itself grows into the myometrium (The outer layer of the uterus which is muscular). Intersecting symptoms of adenomyosis and fibroids include menorrhagia accompanied by pains and cramps, abdominal and lower back pain and abdominal swelling. However, while uterine fibroids are commonly asymptomatic, adenomyosis comprises excruciating and crippling painful cramps and may also accompany more chronic prolonged symptoms such as heavy bleeding and blood clots especially if fibroids coexist with adenomyosis. It is substantial to ensure that the two are not misdiagnosed, since an inaccurate treatment may prove more detrimental for the patient. Ultrasound imaging is sufficient to diagnose fibroids but to rule out adenomyosis, an MRI is advised. Once the specialist is able to differentiate between fibroids and adenomyosis, he has a clear picture regarding the treatment approach to be taken. At present, the most advanced method available under the non-surgical treatment for fibroids and adenomyosis is the 3-dimensional endovascular treatment. 3-D endovascular treatment for fibroids in Pakistan has been introduced by Dr Imtiaz Ahmad, an endovascular Surgical Specialist, and an Interventional Radiologist, who is well experienced in this field and has bagged thousands of success stories so far.
Treatment for Fibroids and Adenomyosis
Surgical interventions for the treatment of fibroids and adenomyosis have, time and again, proven to be invasive and are slowly becoming obsolete for that reason. Hysterectomy (removal of the uterus) or myomectomy (removal of fibroids) are the two most common traditional surgical approaches taken towards fibroids and adenomyomectomy for adenomyosis treatment. Surgical treatments also include endometrial ablation, wherein the inner lining (endometrium) is destroyed using either heat, cold, electricity, or microwaves. Women undergoing surgical procedures to sort their miseries regarding fibroids and adenomyosis must also give up on the idea of conceiving in most cases or be mentally prepared for recurrence. On the contrary, an innovative approach under the umbrella of endovascular procedures has recently gained accolades as being a noninvasive treatment, ensuring that the uterine wall is not damaged, while still being able to get rid of fibroids and adenomyosis completely. More specifically, the best treatment for fibroids and adenomyosis available is known as Uterine Artery embolization, which is a 3-D endovascular treatment that aims at selectively targeting fibroids and adenomyosis.
3-D Precision Guided Endovascular Treatment
Endovascular treatment using 3-dimensional imaging to locate the arteries supplying blood precisely to fibroids or adenomyosis ensures an accurate treatment. The entire procedure does not only comprise the uterine artery embolization but also, a complete set of steps to increase patient compliance and comfort. These include post embolization syndrome management, superior hypogastric nerve plexus block and intra-arterial pain management. Before the endovascular treatment is performed, a complete health analysis is done to assess the medical fitness status of the patient. Once the procedure is finished, you should also expect a thorough follow-up for up to 1 year, depending on the case. In cases where the goal is to achieve pregnancy, fertility status is also kept in check. In short, the treatment in itself is incomplete if the follow-up is not diligently done and as advised.
The 3-D precision-guided endovascular treatment uses live imaging to accurately locate the blood vessels supplying blood to the fibroids or adenomyosis. The imaging also helps assess the number of arteries involved and their sizes. The goal is to block the blood supply to these growths using miniature but programmed and specially engineered permanent devices. To begin, mild conscious sedation is achieved. Following, microcatheters are introduced in the patient’s body through the femoral/radial artery in the leg or wrist. This is achieved without causing any pain as a result of topical cold spray anaesthesia followed by local anaesthesia. Once the blood vessels are located, the FDA approved medical particles are then administered through the catheter. These embolic agents are small micron-sized particles that are engineered /programmed to block the blood supply to only fibroids or adenomyosis while sparing the normal uterine wall. Medical particles/Drugs used in the endovascular treatment are highly specific and are only issued to registered practitioners in America. In this way, embolization is successfully achieved.
The uterine artery embolization constitutes a major portion of the 3-D guided endovascular and may constitute approximately 60-70% of the entire treatment, through this technique management of the post embolization syndrome is also done. Specific medications are administered at the exact location of the fibroid or adenomyosis, using microcatheters, to avoid post embolization syndrome, which may prolong the recovery time if not addressed at the right moment. Moreover, intra-arterial pain management is also attempted, medications at the specific location are administered so that the extent of pain felt by the patient is reduced by many folds. Finally, to further reduce the pain, the nerves to the pelvis are relaxed using a fluoroscopic guided superior hypo gastric nerve block approach. The analgesic effect is maintained for up to 20 hours.
To conclude, this new treatment for fibroids without surgery, also targeting adenomyosis, has become the talk of the town, and it is with great pride that the best treatment for fibroids and adenomyosis was introduced in Pakistan by Dr Imtiaz Ahmad, which is now helping thousands of patients since November, 2017.
Fibroids, also medically termed as leiomyomas, are non-cancerous abnormal growth in the uterine wall. Their structure comprises smooth muscle cells of the myometrium and fibroblasts, which partake in the synthesis of the extracellular matrix. They have been reported in women of all age groups post-puberty and pose a specific set of clinical presentations that help diagnose them.
These benign masses of tissue may vary in size and number, however, those that cause symptoms and require fibroid treatment, have been reported to be of, or greater than 10 mm. As the size of the fibroid increases, the composition does, too. Smaller fibroids have a greater blood supply and smooth muscle cells than in larger fibroids. The location of the fibroids classifies them into three major types including subserosal fibroid that grows outside the uterus, intramural fibroid which grows in the wall of the uterus, and submucosal fibroid which grows inside the uterus.
Fibroids may directly attach to the uterus or by a peduncle, commonly known as a stalk. While fibroids are the most recurrent cause of uterus removal(hysterectomy), alternative treatment options such as fibroid embolization may be employed for women who do not prefer surgical interventions.
Fibroid symptoms- How do you know if you have Fibroids?
Even though fibroids are noninvasive and well-circumscribed, they have high morbidity. Fibroids can be diagnosed by a simple pelvic ultrasound and are usually found during one of those unrelated trips to the sonologist. They are often left undiagnosed if they are small and show no symptoms that may alert an individual. Such fibroids also require no treatment. Women often reach out for treatment because of painful symptoms including heavy menstrual bleeding with sharp pains which may lead to anemia, backaches, pelvic and bladder pressure, constipation, and frequent urination. An eventual consequence of fibroids is reproductive dysfunction and obstetric complications. Fibroid symptoms in women vary based on their size, number, and location.
Fibroid Causes- What are the risk factors?
While fibroids are a common occurrence in women in their reproductive age, those approaching their menopausal age are more likely to develop the disease. It is reported that about 25% of women beyond 30 years of age are at a risk of developing fibroids and by 50 years, the risk rises to an alarming 70%. Risk factors for developing the disease commensurate with fibroid causes and may include early menstruation, obesity, high blood pressure, caffeine, alcohol, age, and genetic factors. Interestingly, the disease is more common in African American women due to a higher prevalence of pelvic infections and genetic inheritance in their population.
While a definitive cause is yet to be understood, generally, high levels of estrogen and genetics are considered as the most common reasons for fibroid development. Additionally, women who have reached a childbearing age but do not get pregnant continually experience high levels of estrogen as part of their normal cycle, however, this has been associated with an increased risk of developing fibroids.
On the contrary, various studies have concluded a lesser incidence of fibroids in women who take oral contraceptives, attributing it to aberration in hormone levels. The same rationale is frequently used in the observation of the post-menopausal regression in fibroids.
Fibroid treatment- Is there a solution?
Surgical procedures employed as a treatment for fibroids have now become rather obsolete. Hysterectomy or uterus removal is still practiced but not recommended and is the only definitive treatment for fibroids in traditional gynecology. Myomectomy includes removal of fibroids via surgical intervention, however, there are several reports that conclude the recurrence of fibroids after myomectomy. Non-surgical treatments have been rendered as the best treatment for fibroids and have gained greater patient compliance. They are also reported to have a 90-95% success rate in the context of recurrence. These alternative to surgery methods most commonly include, uterine fibroid embolization, magnetic resonance imaging guide high intensity focused ultrasound (MR-HIFU) and laparoscopic occlusion.
Dr Imtiaz is one of the pioneers in introducing 3-D precision guided treatment of fibroids and is proud to have the largest database of successfully treated fibroid and adenomyosis patients.
3-D precision guided treatment – Best Treatment for fibroids
Uterine Fibroid embolization, also known as, uterine artery embolization constitutes up to 70-80% of the 3-D precision guided treatment besides 6-7 other procedures bundled in a single category of “3-D precision guided treatment”. The entire procedure uses real time 3-Dimensional Fluoroscopy which is a type of X-ray that shows live imaging in 3- Dimensions and begins with administering a local anesthetic in the form of “Cold Spray” applied to the skin of the groin area to numb it. Followed by injection of more local anesthetic into the skin and soft tissues overlying the right groin.An IV sedative is also administered which is moderate enough to achieve conscious sedation in which person remains awake and relaxed. Using an extremely miniaturized technique and without any skin incision the right femoral artery is accessed and a special selective catheter is introduced through the femoral artery in the leg.The catheter is guided towards the uterine artery through which the blood to the uterus is supplied. Serial 3-Dimensional images are obtained followed by placement of specialized/engineered Micro-catheters are introduced if needed to complete the embolization procedure, leading to blockage of blood flow to the fibroids or adenomyosis.
Embolic agents are small micron sized particles that are then passed through these catheters, these particle are engineered /programmed to block blood supply to fibroids or adenomyosis only sparing the normal uterine walls. Another major component of the procedure comprises intra arterial pain management done by intra arterial infusion of carefully titrated medications directly into the fibroids/adenomyosis with super selective catheters selectively placed within the uterine fibroids or adenomyosis.
Patient is ensured more comfort and is achieved via fluoroscopic guided nerve block which is effective for at least 18-20 hours post procedure. Post embolization syndrome which is an expected sequelae after any embolization procedure is dealt with there and then by infusion of specific medications directly into the fibroids/adenomyosis. The entire procedure takes around 45-60 minutes and has a high success rate amongst patients of all age groups. It is often difficult to relocate the access site since no incisions are made during the procedure. The patients are usually discharged only a few hours after the treatment in outpatient settings, or are kept overnight as under observation (23 hour admission).
Fibroid prevention- What could you have done differently?
Most causes of fibroids are linked with the overall lifestyle a woman maintains. Healthy eating, sleeping, and living habits can prevent not only fibroids but other lethal diseases, too. It is important to understand that while one woman might be more predisposed to developing fibroids, lifestyle changes can positively impact the process. Smoking cigarettes, doing drugs or alcohol consumption are injurious to health and must be stopped immediately. Additionally, eating fresh green vegetables and fruits that contain flavonoids may help in overcoming the severity of fibroid symptoms. Obesity and fibroids develop a symbiotic relationship, benefiting each other to a point where both problems peak.
