Quality of life 1 year after uterine artery embolization vs hysterectomy for symptomatic adenomyosis (QUESTA study)
Abstract Introduction Uterine artery embolization (UAE) is a less‐invasive alternative for hysterectomy in therapy‐resistant symptomatic adenomyosis. Comparative data are lacking. Our objective is to evaluate the non‐inferiority of UAE compared with hysterectomy in improving health‐related quality o...
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2025-08-01
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| Series: | Acta Obstetricia et Gynecologica Scandinavica |
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| Online Access: | https://doi.org/10.1111/aogs.15165 |
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| author | Lisa M. Trommelen Annika Semmler Annefleur M. deBruijn Marissa Harmsen Marieke Smink Petra F. Janssen Ilse vanRooij Jeroen vanBavel Peggy Geomini Jacques W. M. Maas Celine M. Radder Paul vanKesteren Janet Kwee Erica Bakkum Marleen deLange Robert A. deLeeuw Freek Groenman Velja Mijatovic Anne Timmermans Rutger Lely Armand Lamers Douwe Vos Gretel vanHoecke Otto Elgersma Huib A. A. M. vanVliet Lonneke S. F. Yo Andries R. H. Twijnstra Frank W. Jansen Catharina S. P. vanRijswijk Han Kruimer Carroll M. E. S. N. Tseng Sjors Coppus Mark Arntz Aloys F. J. Wust Joost G. A. M. Blomjous Laurens vanBoven Alexander Venmans Jos W. R. Twisk Judith A. F. Huirne Paul N. M. Lohle Wouter J. K. Hehenkamp |
| author_facet | Lisa M. Trommelen Annika Semmler Annefleur M. deBruijn Marissa Harmsen Marieke Smink Petra F. Janssen Ilse vanRooij Jeroen vanBavel Peggy Geomini Jacques W. M. Maas Celine M. Radder Paul vanKesteren Janet Kwee Erica Bakkum Marleen deLange Robert A. deLeeuw Freek Groenman Velja Mijatovic Anne Timmermans Rutger Lely Armand Lamers Douwe Vos Gretel vanHoecke Otto Elgersma Huib A. A. M. vanVliet Lonneke S. F. Yo Andries R. H. Twijnstra Frank W. Jansen Catharina S. P. vanRijswijk Han Kruimer Carroll M. E. S. N. Tseng Sjors Coppus Mark Arntz Aloys F. J. Wust Joost G. A. M. Blomjous Laurens vanBoven Alexander Venmans Jos W. R. Twisk Judith A. F. Huirne Paul N. M. Lohle Wouter J. K. Hehenkamp |
| author_sort | Lisa M. Trommelen |
| collection | DOAJ |
| description | Abstract Introduction Uterine artery embolization (UAE) is a less‐invasive alternative for hysterectomy in therapy‐resistant symptomatic adenomyosis. Comparative data are lacking. Our objective is to evaluate the non‐inferiority of UAE compared with hysterectomy in improving health‐related quality of life (HRQOL) for symptomatic adenomyosis, 1 year post‐treatment. Material and Methods This multicenter randomized controlled trial was converted into a prospective cohort study. It was prospectively registered at 27‐07‐2015 (NL‐OMON55436, https://onderzoekmetmensen.nl/en/trial/55436). From November 2015 to March 2022 participants with symptomatic adenomyosis eligible for hysterectomy were included and offered UAE as an alternative treatment. Primary endpoint was difference in 1‐year HRQOL scores between UAE and hysterectomy, using WHO‐QOL‐Bref and SF‐12. Non‐inferiority margin was set at five points. Secondary endpoints: WHO‐QOL‐100 facets “Pain and Discomfort” and “Sexual Activity”, adenomyosis‐related symptoms, and satisfaction. Multivariable linear mixed models were used. All outcomes were analyzed in the per‐protocol population, and repeated in the intention‐to‐treat population. Results Of 101 participants, 51 chose hysterectomy and 50 UAE. Both treatment groups were comparable at baseline, except for employment status, dysmenorrhea score, uterine volume, hemoglobin and CA125 (all adjusted for). Both treatments led to a significant increase in all HRQOL scores after 1 year. The effect differences between UAE and hysterectomy on all HRQOL domains in the per‐protocol population were: SF‐12 physical β −4.20, (95% CI −9.53 to 1.12), SF‐12 mental β −4.95 (95% CI −10.83 to 0.94); WHO‐QOL‐Bref physical β −7.42 (95% CI −18.51 to 3.68), psychological β −4.28 (95% CI −13.30 to 4.74), social relations β −2.23 (95% CI −13.09 to 8.63) and environment β 0.35 (95% CI −8.39 to 9.09). Non‐inferiority of UAE was not demonstrated within the predefined margin. Both hysterectomy and UAE improved “Pain and Discomfort” and “Sexual Activity”, with greater effect on pain after hysterectomy (β 17.17, 95% CI 4.94 to 29.41, p = 0.007). More participants were satisfied after hysterectomy (95%) than after UAE (73%). Conclusions Both UAE and hysterectomy significantly increased HRQOL for symptomatic adenomyosis. Neither non‐inferiority nor inferiority of UAE could be established. One‐year HRQOL scores were comparable; some secondary outcomes were in favor of hysterectomy. UAE is a valid less‐invasive alternative to hysterectomy, with preservation of the uterus. Hysterectomy remains the treatment of choice for patients seeking a definite solution. |
| format | Article |
| id | doaj-art-6667dbeac4804a19ac0558aec6be8fb0 |
| institution | Kabale University |
| issn | 0001-6349 1600-0412 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | Wiley |
| record_format | Article |
| series | Acta Obstetricia et Gynecologica Scandinavica |
| spelling | doaj-art-6667dbeac4804a19ac0558aec6be8fb02025-08-20T03:51:53ZengWileyActa Obstetricia et Gynecologica Scandinavica0001-63491600-04122025-08-0110481558157410.1111/aogs.15165Quality of life 1 year after uterine artery embolization vs hysterectomy for symptomatic adenomyosis (QUESTA study)Lisa M. Trommelen0Annika Semmler1Annefleur M. deBruijn2Marissa Harmsen3Marieke Smink4Petra F. Janssen5Ilse vanRooij6Jeroen vanBavel7Peggy Geomini8Jacques W. M. Maas9Celine M. Radder10Paul vanKesteren11Janet Kwee12Erica Bakkum13Marleen deLange14Robert A. deLeeuw15Freek Groenman16Velja Mijatovic17Anne Timmermans18Rutger Lely19Armand Lamers20Douwe Vos21Gretel vanHoecke22Otto Elgersma23Huib A. A. M. vanVliet24Lonneke S. F. Yo25Andries R. H. Twijnstra26Frank W. Jansen27Catharina S. P. vanRijswijk28Han Kruimer29Carroll M. E. S. N. Tseng30Sjors Coppus31Mark Arntz32Aloys F. J. Wust33Joost G. A. M. Blomjous34Laurens vanBoven35Alexander Venmans36Jos W. R. Twisk37Judith A. F. Huirne38Paul N. M. Lohle39Wouter J. K. Hehenkamp40Department of Obstetrics and Gynecology Amsterdam UMC, Location VUMC and AMC Amsterdam The NetherlandsDepartment of Obstetrics and Gynecology Amsterdam UMC, Location VUMC and AMC Amsterdam The NetherlandsDepartment of Obstetrics and Gynecology Amsterdam UMC, Location VUMC and AMC Amsterdam The NetherlandsDepartment of Obstetrics and Gynecology Amsterdam UMC, Location VUMC and AMC Amsterdam The NetherlandsDepartment of Obstetrics and Gynecology Elisabeth Tweesteden Ziekenhuis Tilburg The NetherlandsDepartment of Obstetrics and Gynecology Elisabeth Tweesteden Ziekenhuis Tilburg The NetherlandsDepartment of Obstetrics and Gynecology Elisabeth Tweesteden Ziekenhuis Tilburg The NetherlandsDepartment of Obstetrics and Gynecology Amphia Ziekenhuis Breda The NetherlandsDepartment of Obstetrics and Gynecology Maxima Medical Center Eindhoven The NetherlandsDepartment of Obstetrics and Gynecology Maxima Medical Center Eindhoven The NetherlandsDepartment of Obstetrics and Gynecology OLVG Amsterdam The NetherlandsDepartment of Obstetrics and Gynecology OLVG Amsterdam The NetherlandsDepartment of Obstetrics and Gynecology OLVG Amsterdam The NetherlandsDepartment of Obstetrics and Gynecology OLVG Amsterdam The NetherlandsDepartment of Obstetrics and Gynecology Amsterdam UMC, Location VUMC and AMC Amsterdam The NetherlandsDepartment of Obstetrics and Gynecology Amsterdam UMC, Location VUMC and AMC Amsterdam The NetherlandsDepartment of Obstetrics and Gynecology Amsterdam UMC, Location VUMC and AMC Amsterdam The NetherlandsDepartment of Obstetrics and Gynecology Amsterdam UMC, Location VUMC and AMC Amsterdam The NetherlandsDepartment of Obstetrics and Gynecology Amsterdam UMC, Location VUMC and AMC Amsterdam The NetherlandsDepartment of Radiology Amsterdam UMC, Location VUMC and AMC Amsterdam The NetherlandsDepartment of Radiology Amsterdam UMC, Location VUMC and AMC Amsterdam The NetherlandsDepartment of Radiology Amphia Ziekenhuis Breda The NetherlandsDepartment of Obstetrics and Gynecology Albert Schweitzer Ziekenhuis Dordrecht The NetherlandsDepartment of Radiology Albert Schweizer Ziekenhuis Dordrecht The NetherlandsDepartment of Obstetrics and Gynecology Catharina Ziekenhuis Eindhoven The NetherlandsDepartment of Radiology Catharina Ziekenhuis Eindhoven The NetherlandsDepartment of Obstetrics and Gynecology LUMC Leiden The NetherlandsDepartment of Obstetrics and Gynecology LUMC Leiden The NetherlandsDepartment of Radiology LUMC Leiden The NetherlandsDepartment of Radiology Maxima Medical Center Eindhoven The NetherlandsDepartment of Radiology Maxima Medical Center Eindhoven The NetherlandsDepartment of Obstetrics and Gynecology Radboud UMC Nijmegen The NetherlandsDepartment of Radiology Radboud UMC Nijmegen The NetherlandsDepartment of Radiology OLVG Amsterdam The NetherlandsDepartment of Radiology OLVG Amsterdam The NetherlandsDepartment of Obstetrics and Gynecology Ziekenhuisgroep Twente Hengelo The NetherlandsDepartment of Radiology Elisabeth Tweesteden Ziekenhuis Tilburg The NetherlandsEpidemiology and Data Science Amsterdam UMC, Vrije Universiteit Amsterdam The NetherlandsDepartment of Obstetrics and Gynecology Amsterdam UMC, Location VUMC and AMC Amsterdam The NetherlandsDepartment of Radiology Elisabeth Tweesteden Ziekenhuis Tilburg The NetherlandsDepartment of Obstetrics and Gynecology Amsterdam UMC, Location VUMC and AMC Amsterdam The NetherlandsAbstract Introduction Uterine artery embolization (UAE) is a less‐invasive alternative for hysterectomy in therapy‐resistant symptomatic adenomyosis. Comparative data are lacking. Our objective is to evaluate the non‐inferiority of UAE compared with hysterectomy in improving health‐related quality of life (HRQOL) for symptomatic adenomyosis, 1 year post‐treatment. Material and Methods This multicenter randomized controlled trial was converted into a prospective cohort study. It was prospectively registered at 27‐07‐2015 (NL‐OMON55436, https://onderzoekmetmensen.nl/en/trial/55436). From November 2015 to March 2022 participants with symptomatic adenomyosis eligible for hysterectomy were included and offered UAE as an alternative treatment. Primary endpoint was difference in 1‐year HRQOL scores between UAE and hysterectomy, using WHO‐QOL‐Bref and SF‐12. Non‐inferiority margin was set at five points. Secondary endpoints: WHO‐QOL‐100 facets “Pain and Discomfort” and “Sexual Activity”, adenomyosis‐related symptoms, and satisfaction. Multivariable linear mixed models were used. All outcomes were analyzed in the per‐protocol population, and repeated in the intention‐to‐treat population. Results Of 101 participants, 51 chose hysterectomy and 50 UAE. Both treatment groups were comparable at baseline, except for employment status, dysmenorrhea score, uterine volume, hemoglobin and CA125 (all adjusted for). Both treatments led to a significant increase in all HRQOL scores after 1 year. The effect differences between UAE and hysterectomy on all HRQOL domains in the per‐protocol population were: SF‐12 physical β −4.20, (95% CI −9.53 to 1.12), SF‐12 mental β −4.95 (95% CI −10.83 to 0.94); WHO‐QOL‐Bref physical β −7.42 (95% CI −18.51 to 3.68), psychological β −4.28 (95% CI −13.30 to 4.74), social relations β −2.23 (95% CI −13.09 to 8.63) and environment β 0.35 (95% CI −8.39 to 9.09). Non‐inferiority of UAE was not demonstrated within the predefined margin. Both hysterectomy and UAE improved “Pain and Discomfort” and “Sexual Activity”, with greater effect on pain after hysterectomy (β 17.17, 95% CI 4.94 to 29.41, p = 0.007). More participants were satisfied after hysterectomy (95%) than after UAE (73%). Conclusions Both UAE and hysterectomy significantly increased HRQOL for symptomatic adenomyosis. Neither non‐inferiority nor inferiority of UAE could be established. One‐year HRQOL scores were comparable; some secondary outcomes were in favor of hysterectomy. UAE is a valid less‐invasive alternative to hysterectomy, with preservation of the uterus. Hysterectomy remains the treatment of choice for patients seeking a definite solution.https://doi.org/10.1111/aogs.15165adenomyosishysterectomyquality of lifeuterine artery embolization |
| spellingShingle | Lisa M. Trommelen Annika Semmler Annefleur M. deBruijn Marissa Harmsen Marieke Smink Petra F. Janssen Ilse vanRooij Jeroen vanBavel Peggy Geomini Jacques W. M. Maas Celine M. Radder Paul vanKesteren Janet Kwee Erica Bakkum Marleen deLange Robert A. deLeeuw Freek Groenman Velja Mijatovic Anne Timmermans Rutger Lely Armand Lamers Douwe Vos Gretel vanHoecke Otto Elgersma Huib A. A. M. vanVliet Lonneke S. F. Yo Andries R. H. Twijnstra Frank W. Jansen Catharina S. P. vanRijswijk Han Kruimer Carroll M. E. S. N. Tseng Sjors Coppus Mark Arntz Aloys F. J. Wust Joost G. A. M. Blomjous Laurens vanBoven Alexander Venmans Jos W. R. Twisk Judith A. F. Huirne Paul N. M. Lohle Wouter J. K. Hehenkamp Quality of life 1 year after uterine artery embolization vs hysterectomy for symptomatic adenomyosis (QUESTA study) Acta Obstetricia et Gynecologica Scandinavica adenomyosis hysterectomy quality of life uterine artery embolization |
| title | Quality of life 1 year after uterine artery embolization vs hysterectomy for symptomatic adenomyosis (QUESTA study) |
| title_full | Quality of life 1 year after uterine artery embolization vs hysterectomy for symptomatic adenomyosis (QUESTA study) |
| title_fullStr | Quality of life 1 year after uterine artery embolization vs hysterectomy for symptomatic adenomyosis (QUESTA study) |
| title_full_unstemmed | Quality of life 1 year after uterine artery embolization vs hysterectomy for symptomatic adenomyosis (QUESTA study) |
| title_short | Quality of life 1 year after uterine artery embolization vs hysterectomy for symptomatic adenomyosis (QUESTA study) |
| title_sort | quality of life 1 year after uterine artery embolization vs hysterectomy for symptomatic adenomyosis questa study |
| topic | adenomyosis hysterectomy quality of life uterine artery embolization |
| url | https://doi.org/10.1111/aogs.15165 |
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