Non-extirpative Treatments for Uterine Myomas: Measuring Success

Abstract

To analyze outcomes of nonextirpative treatments for uterine myomas compared with myomectomy. Data Sources: A systematic search of the following databases from inception to January 2020 was performed: Ovid Medline, Embase, PubMed, and Cochrane Controlled Register of Trials. Methods of Study Selection: Two authors reviewed titles and abstracts for relevance, and full articles were obtained and evaluated for inclusion. Studies were included if they compared nonextirpative interventions for uterine myomas to myomectomy and reported at least one outcome of interest. Tabulation, Integration, and Results: Of the 2010 articles identified and reviewed, 125 full text articles were reviewed, and 22 were ultimately included in the analysis. Nonextirpative treatments reviewed included uterine artery embolization (UAE; 16 studies, n = 9555 subjects), focused ultrasound (FUS; 4 studies, n = 1516), laparoscopic radiofrequency ablation (RFA; 3 studies, n = 49). UAE, FUS, and laparoscopic RFA groups were compared with patients undergoing myomectomy (n = 34 872, n = 20 677, n = 47 respectively). In comparison with myomectomy, UAE had similar quality of life scores, symptom severity scores, sexual function scores, ovarian function, and miscarriage rates following intervention. There was lower likelihood of conceiving after UAE and a higher rate of reintervention after UAE compared with myomectomy. FUS had similar postprocedure sexual function scores and reintervention rates compared with myomectomy. Laparoscopic RFA had similar quality of life scores, symptom severity scores, sexual function scores, reintervention rates, and pregnancy rates after the procedure compared with myomectomy. Conclusion: Nonextirpative treatments for uterine myomas have similar outcomes to myomectomy in multiple domains, with most available evidence comparing UAE with myomectomy.

Magnetic resonance-guided high-intensity ultrasound (MR-HIFU) in the treatment of symptomatic uterine fibroids — five-year experience

“…(2019) who reported the mean symptom reduction at 12-months at 59.9% and lesion volume shrinkage at 37.7% [53]. Moreover, MR-HIFU proved to be effective as regards the sexuality of patients with UFs, as the method was associated with similar post-procedure sexual function scores and re-intervention rates compared to myomectomy [30]. In our opinion the results may be assessed as more than promising.…”

“…According to recent analyses, non-surgical methods may lead to positive effects which are similar to those of myomectomy in various aspects. In regards those methodsthe treatment effectiveness of uterine artery embolization (UAE) was confirmed to the largest extent [30]. Some authors suggested that UAE was a safe and effective mini-invasive treatment modality for symptomatic UFs [21,31].…”

A Call-to-Action for Clinicians to Implement Evidence-Based Best Practices When Caring for Women with Uterine Fibroids

“…Whenever possible, patients should be made aware of less invasive and uterine-sparing procedures, which may minimize the risk to the patient. These include myomectomy via minimally invasive techniques when appropriate for fibroid removal and improvement of bulk symptoms or other less invasive techniques such as endometrial ablation or radiofrequency volumetric thermal ablation to control bleeding [31,60]. Myomectomy is recommended for patients wishing to preserve fertility; hysteroscopic myomectomy is generally recommended for submucosal fibroids, while laparoscopic or laparotomic myomectomy is advised for intramural and subserosal fibroids [31].…”

An update on uterine artery embolization for uterine leiomyomata and adenomyosis of the uterus

“…However, the magnitude of this difference in re-intervention rate was very small (4%) and only present in studies with a mean of at least 3 years of follow-up. 62 There is currently only limited or inconsistent scientific evidence that could inform which procedure should be preferred over another to treat symptomatic leiomyomas in patients who desire uterine preservation for future pregnancy. High intensity focused ultrasound (HIFU) for symptomatic leiomyomata has been investigated in recent years offering the advantages of being non-invasive and outpatient procedure.…”