Ultrasound-guided transvaginal radiofrequency ablation combined with levonorgestrel-releasing intrauterine system for symptomatic uterine adenomyosis treatment

Abstract

Objective: To evaluate the clinical outcomes of transvaginal ultrasound-guided radiofrequency ablation (RFA) combined with a levonorgestrel-releasing intrauterine system (LNG-IUS) for the treatment of symptomatic uterine adenomyosis. Methods: Patients with symptomatic uterine adenomyosis treated with ultrasound-guided RFA in combined with an LNG-IUS from January 2013 to January 2016 and followed up for 3 years after treatment were selected. Assessment endpoints included the uterine volume reduction rate, dysmenorrheal score, symptom severity score and adverse events. Results: Among the 72 patients, 64 completed the 3-year follow-up evaluations after treatment. No LNG-IUS expulsion was reported. Dysmenorrhea and symptom severity scores statistically significantly declined after the combined treatment of RFA and LNG-IUS was administered. The uterine volume significantly decreased, and the average reduction rate was 55%. Conclusion: Ultrasound-guided RFA combined with an LNG-IUS might be a simple, safe and effective alternative for the treatment of symptomatic adenomyosis.

Risk of Recurrence and Reintervention After Uterine-Sparing Interventions for Symptomatic Adenomyosis

“…Forty-two articles were deemed eligible for inclusion in this meta-analysis. Included articles were composed of 14 studies [7][8][9][10][11][12][13][14][15][16][17][18][19][20] regarding adenomyomectomy, 16 studies [21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36] regarding UAE, and 12 studies [37][38][39][40][41][42][43][44][45][46][47][48] regarding image-guided thermal ablation (HIFU nine studies, [37][38][39][40][41][42][43][44]…”

Ultrasound-guided microwave ablation for symptomatic adenomyosis: More areas of concern for more uniform and promising outcomes

“…reported that when the distance from the ablative margin to the endometrium was at least 3 mm, the incidence rate of vaginal discharge after ablation was 33.3%. 40 While the safe distance between the ablative margin was not mentioned at all in some other studies, 7 , 8 , 9 , 36 , 37 , 38 , 41 , 42 it might contribute to the significant variance of the incidence rate of vaginal discharge. Overall, the non-unified standard of terminating the ablation procedure may contribute to the significant difference in the clinical outcomes of patients in different studies.…”

“…However, the termination criteria adopted in previous studies were not uniform, and individual research centers implemented their own standards. Different versions that can be observed include “the hyperechoic cloud covered the entire lesion”, 36 “80–90% of the entire lesion”, 37 , 38 “3–5 mm from the margin of the lesion”, 6 , 7 , 9 and “reached 0.3 cm to the serosa inferior margin or covered more than 1/2 of the lesion range”. 39 To prevent potential thermal damage to the adjacent organs, it is recommended that the distance from the ablative margin to the serosal surface should be at least 3 mm, which is one of the safety boundary standards for ablation of adenomyosis.…”

“…Hai et al. 38 found that the improvement rate of clinical symptoms reached 98% at 3 years in patients with a significantly enlarged uterus (average uterine volume of 307 ml) after RFA treatment combined with levonorgestrel-releasing intrauterine device (LNG-IUD) implantation, which was significantly better than simple ablation treatment. The study provided clinical evidence that post-ablation adjuvant medication therapy was useful in improving the long-term outcomes of patients with adenomyosis treated with thermal ablation.…”

Current and Prospective Treatment of Adenomyosis

“…Radiofrequency ablation was also shown to maintain fertility with a pregnancy success rate reaching up to 50% making it a desirable option for patients who wish to conceive [ 75 ]. Radiofrequency ablation is also effective when combined with LNG-IUD demonstrated by a reduction of uterine volume and a decrease in dysmenorrhea [ 76 ].…”