UAE follow-up riles gynecologists. (Working with Radiologists).

Uterine artery embolization puts gynecologists in a tough spot: While laying out all a patient's options for treating symptomatic fibroids is clearly the right thing to do, most ob.gyns. have a long way to go in building better working relationships with radiologists performing the procedure before they are ever going to feel at ease referring patients for it.

Like all situations where a patient is handed over for an operation and then back to the referring physician for management afterward, good communication and continuity of care are key. But in the case of UAE, that comfort level hasn't always been reached.

A key problem is that after the procedure, the patient is often handed back to the ob.gyn., who then has to be vigilant about monitoring her for signs and symptoms of sepsis. At the same time, most patients experience a variety of postoperative side effects known as postembolization syndrome that can resemble sepsis. Patients can experience pain from the ischemic fibroid, along with nausea, vomiting, and malaise. Many also become febrile. within a few days and have a spike in their WBC counts.

But the scenario where the gynecologist is on his own managing the patient after surgery doesn't have to happen, said Dr. James B. Spies, an interventional radiologist at Georgetown University Medical Center, Washington. In fact, "it shouldn't occur that way" he said. Instead, the routine management should be handled by the interventional radiologist, consulting with the ob.gyn. in the rare case that the patient has a gynecologic complication, such as expulsion of a fibroid.

At Georgetown, patients who travel long distances for the procedure are encouraged to stay in the area for 2 or 3 days before they go back home. And all patients are discharged with a detailed set of instructions designed to answer any questions they might have. These instructions are available online at http://www.fibroidoptions.com/d-charge.htm.

"We try to be proactive in educating patients so that they are not constantly calling another physician" after surgery, Dr. Spies said.

Ideally ob.gyns. and interventional radiologists should work closely together to educate patients about the procedure and consult each other about any complications afterward. And "in most high-volume institutions, that's the way it's done," Dr. Spies said. But, he admits, just how involved the interventional radiologist is in postoperative management can vary widely.