Plastic bullets saved woman from hysterectomy


Last updated at 09:38 31 August 2005

Josephine Silvester, a charity administrator from Wiltshire, was told at the age of 30 that a fibroid condition could stop her having children. But after a revolutionary procedure which fired plastic bullets into her womb, Joesphine conceived a daughter within three years.


Until 1998, I had perfectly normal periods. Then they started to become heavy, and quite uncomfortable. I didn't really consider why, I just put up with it. However, in 1999, I had an appendectomy. Afterwards, the surgeon told me I had a bulging uterus and that I might have fibroids.

I had never heard of them before but I went to see my GP who referred me to a consultant, Mr Bond, at the local private hospital in Wroughton, just outside Swindon.

I had an ultrasound scan which confirmed that I had two large fibroids and several smaller ones, mostly at the top of my womb.

The consultant explained that fibroids are made out of muscle and fibrous tissue. My fibroids were moderately large - the biggest two were five centimetres and four centimetres in diameter - but the consultant said he had seen some which were the size of a nine-month pregnancy.

Some fibroids cause bloating or compression of organs. They can press on the bladder and cause bladder weakness, or the bowel and cause constipation or even sciatica.

I felt relatively lucky just to have the heavy periods. (The fibroids increase the size of the womb lining, which makes the blood loss heavier.)

The consultant also explained that the fibroids can affect fertility. The theory is that they alter the shape of the womb lining and prevent the egg from implanting properly. They can also cause miscarriage because they simply squeeze the foetus out of the way around half way though the pregnancy.

All this was pretty grim news. I was just 30, and Richard and I were thinking about starting a family. The last thing we wanted to hear was that we would be facing difficulties.

Chances of conceiving 'decreasing all the time'

Worse still, when we went back to our GP he said that my chances of conceiving were decreasing all the time. He said I had to either put up with the fibroid symptoms and start trying for a baby straight away, or give up on having a family and have a full hysterectomy. That really did freak me out.

By now my periods were getting much worse. It was often impossible for me to leave the safety of the house or the office for any length of time.

I had been trying for about a year to get pregnant and nothing was happening, which was very disheartening. In September 1999, our GP referred me back to Mr Bond and he gave us our options.

I could either have a full hysterectomy - which we didn't want - or I could have a myomectomy, where the fibroids are surgically removed. The downside of this is that scar tissue can also cause fertility problems or can necessitate a full hysterectomy later on.

New procedure offered

Then he told us about a new procedure called embolisation. He explained that it was in the early research stage, and when we said we were interested he referred us on to Dr Woodruff Walker at the Royal Surrey County Hospital in Guildford.

We saw Dr Walker in September 2000. He gave me ultrasound and MRI scans so that he could see exactly where and how big the fibroids were.

He explained that embolisation involved putting a substance called polyvinyl alcohol (PVA) into the blood supply of the fibroids to kill them.

He was also confident that he could help me to increase my chances of having a baby. I felt as if I had been given a reprieve.

I went in for the operation on December 4, 2000. Richard came with me and I was extremely nervous. I was given a sedative and a local anaesthetic was injected into my right groin.

Dr Walker put a thin tube into my groin and fed it into the blood supply of the uterus and into the womb. I was there for about an hour and all I felt was a bit of pulling and a warm sensation when they fired the PVA 'bullets'.

The worst part was afterwards. I was in a lot of pain and had a morphine pump, but even so that night was very uncomfortable.

I had morphine for 24 hours, and was in hospital for another night. But the next day I was walking around without any pain and was discharged.

Periods back to normal in six months

My first period afterwards was lighter and six months later they were normal. I went back to Dr Walker for an ultrasound at eight weeks, which showed that the fibroids had already started to shrink, and at ten months I had an MRI scan which showed that my uterus had shrunk by 82 per cent -which was fantastic.

Once we could see that the fibroids would be no danger to any unborn child, we went ahead and tried in earnest for a baby. We were thrilled when in the summer of 2003 we discovered I was pregnant.

Sarah was born in March last year and I had my second baby, Katherine, two weeks ago. I am lucky and grateful to have been referred to Dr Walker. Not every woman has a chance, simply because they and their doctors don't know about this operation.


Dr Woodruff Walker is consultant diagnostic and interventional radiologist at the Royal Surrey County Hospital and The London Clinic. He has pioneered fibroid embolisation in the UK and has treated more than 1,200 patients.

He says: "Fibroids are common in women in their 30s and 40s. Around 30 per cent have a fibroid, although many never have any symptoms. But for those who do, fibroids can make their life a misery.

"No one is quite sure how they are formed but we do know that there is a genetic element and that they are growth-sensitive to hormones, mainly oestrogen but also progesterone.

Explaining procedures

"The normal treatment for women is a hysterectomy, and there are 30,000 carried out for this reason in the UK each year.

"A hysterectomy involves about five days in hospital and two months recovering at home. There is also a relatively high mortality rate, of around 1 in 1,500, and a 3 to 4 per cent possibility of serious complications such as a perforated bowel or bladder, infection or abscesses.

"However, if the patient wants to have children there are a few options. She can hope the fibroids won't continue to grow or interfere with a pregnancy. She can have a myomectomy, or - if the fibroids are small and few - keyhole surgery to remove them.

"The problem with these two options is that not all of the fibroids may be removed, and they can grow back.

"Embolisation provides an answer to this dilemma. It is quick to carry out, the recovery time is very short and, best of all, it kills all the fibroids - even the tiny ones within the womb."

Five-year study reveals success of new treatment

"I have just finished a five-year study following up the patients who have had embolisation and there was a 85 per cent success rate of fibroid shrinkage and an excellent pregnancy rate.

"Jo decided to go ahead with embolisation because she felt it gave her the best chance of going on to have a baby.

"The actual operation took about an hour and went very well. It is not a painful procedure internally, so Jo simply had a small local anaesthetic in the right groin.

"She also had a mild sedative because it would be very boring for her to lie there fully conscious for an hour or so.

"Once her skin was numb, we inserted a tiny catheter into Jo's femoral artery, which feeds the two uterine arteries. We passed the catheter into the left uterine artery, and once it was about halfway down we released the PVA particles. The procedure is then repeated in the right uterine artery.

"After that, it was a question of waiting for the PVA to do its job, which is to silt up the blood vessels which feed the fibroids and starve them to death.

"Once the fibroids are dead, they start to liquefy and then shrink or break up and pass out of the body.

"We think, although we are not certain, that it is the death of the fibroids, or rather the nerves around them, which cause the post-operative pain that Jo and others experience.

"Jo had quite a bad time, but generally one-third of patients report mild pain, one-third moderate and one-third severe. However, it is controllable with painkillers, and it is nearly always gone by the time they leave hospital on the third day.

"Within six weeks most patients are reporting a decline in their symptoms. Jo was typical, in that her first period post-operatively was less painful and heavy than before, and by the time we scanned her at ten months her periods were back to normal and her womb had shrunk by more than 80 per cent.

"Jo has got rid of her fibroids without surgery, scarring, or risk of reoccurrence. And she went on to have two lovely little babies. You can't ask for much better than that.

Cost of embolisation: NHS (excluding costs of stay in hospital) - £700. Privately (including costs of stay) - £5,000.

For more details go to Dr Walker's website -

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