Surgeries Flashcards
Explain uterine artery embolization?
- Local anaesthetic given
- Incision made to access femoral artery using catheter
- X-rays and fluroscopy used to guide catheter
- Fed into the uterine arteries, embolic agents injected
How long does UAE take?
~1 hr
What are the risks of UAE?
- Bruising at the site
- Pain (usually worst within the first 12 hours)
- Slight fever (most patients)
- Vaginal discharge (may be bloody)
- Allergic reaction to the contrast dye
- Radiation risk from x-rays
- Premature ovarian failure
Safety netting UAE?
If vaginal discharge becomes offensive and is associated with fever and pelvic pain ?infection
Preparation advice for UAE?
- Usually admitted evening before or morning of
- May have a bladder catheter inserted
- Anaesthesia throughout usually patient controlled morphine
Aftercare UAE?
- May be well enough to go home 24 hours later
- Recommend 2 weeks off work
- Fibroids can grow back, sx may return 2 years after proceedure
What are the three routes of myomectomy?
- Abdominal (GA)
- Laparoscopic (GA)
- Hysteroscopically (LA)
What are the hospital stay lengths for each one?
- Abdominal 3-4 days
- Laparoscopic 1-2 days
- Hysteroscopic same day home
What are the risks of myomectomy?
- General anaesthetic
- Blood loss
- Infection
- Perforation of organs of the pelvis
When might fibroids recur?
More likely with multiple small fibroids rather than one large fibroid
What is the aftercare for abdominal myomectomy?
- Tender site for 10-14 days
- PCA usually for 1-2 days in hospital, then regular pain relief
- If stitches not dissolvable, removed in 5-10 days
General myomectomy after care?
- Vaginal bleeding for up to 7 days
- Don’t use tampons (increase infection risk)
- Bath/ shower as normal, but don’t use perfumed products over surgical site
- Avoid heavy lifting/ strenuous 10-14 days
- Laparoscopic: can return to work in 7-14 days (abdo longer)
- Can return to sexual intercourse once vaginal bleeding has stopped
After care for hysteroscopy (general)?
- Eat and drink as normal
- Cramping for a few days
- Avoid having sex for a week (or until any bleeding has stopped)
- Avoid using tampons during the next period, can restart after the next period
- Shower the day of proceedure and bath the next day
- GA (avoid alcohol for 2 days)
How long can bleeding and discharge continue after hysteroscopy?
- Bleeding 7-10 days
- Vaginal discharge up to 2 weeks after the procedure
Why can UAE cause premature ovarian failure?
Ovarian and uterine arteries close together and can share blood supply, risk that embolic agents can migrate to the ovarian arteries causing POF
