A review of evidence‐based management of uterine fibroids

Younas, Kinza; Hadoura, Essam; Majoko, Franz; Bunkheila, Adnan

doi:10.1111/tog.12223

Cited by 24 publications

(23 citation statements)

References 60 publications

(162 reference statements)

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“…Specific patient groups may benefit from MR-HIFU such as women with a desire to conceive or as a bridge to menopause in older women. The best treatment option for uterine fibroids is influenced by a woman's symptoms, age, pregnancy wish, fibroid location, and patient's preference [41]. Besides, final therapy is also influenced by fibroid characteristics since not all fibroids are suitable for each treatment strategy.…”

Section: Discussionmentioning

confidence: 99%

The Focused Ultrasound Myoma Outcome Study (FUMOS); a retrospective cohort study on long-term outcomes of MR-HIFU therapy

et al. 2020

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Objectives Since 2004, uterine fibroids have been treated with MR-HIFU, but there are persevering doubts on long-term efficacy to date. In the Focused Ultrasound Myoma Outcome Study (FUMOS), we evaluated long-term outcomes after MR-HIFU therapy, primarily to assess the reintervention rate. Methods Data was retrospectively collected from 123 patients treated with MR-HIFU at our hospital from 2010 to 2017. Followup duration and baseline (MRI) characteristics were retrieved from medical records. Treatment failures, adverse events, and the nonperfused volume percentage (NPV%) were determined. Patients received a questionnaire about reinterventions, recovery time, satisfaction, and pregnancy outcomes. Restrictive treatment protocols were compared with unrestrictive (aiming for complete ablation) treatments. Subgroups were analyzed based on the achieved NPV < 50 or ≥ 50%. Results Treatment failures occurred in 12.1% and the number of adverse events was 13.7%. Implementation of an unrestrictive treatment protocol significantly (p = 0.006) increased the mean NPV% from 37.4% [24.3-53.0] to 57.4% [33.5-76.5]. At 63.5 ± 29.0 months follow-up, the overall reintervention rate was 33.3% (n = 87). All reinterventions were performed within 34 months follow-up, but within 21 months in the unrestrictive group. The reintervention rate significantly (p = 0.002) decreased from 48.8% in the restrictive group (n = 43; follow-up 87.5 ± 7.3 months) to 18.2% in the unrestrictive group (n = 44; follow-up 40.0 ± 22.1 months). The median recovery time was 2.0 [1.0-7.0] days. Treatment satisfaction rate was 72.4% and 4/11 women completed family planning after MR-HIFU. Conclusions The unrestrictive treatment protocol significantly increased the NPV%. Unrestrictive MR-HIFU treatments led to acceptable reintervention rates comparable to other reimbursed uterine-sparing treatments, and no reinterventions were reported beyond 21 months follow-up.

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Section: Discussionmentioning

confidence: 99%

The Focused Ultrasound Myoma Outcome Study (FUMOS); a retrospective cohort study on long-term outcomes of MR-HIFU therapy

et al. 2020

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“…Uterine fibroids (leiomyomata) are the most common benign tumours in women, with a lifetime prevalence of around 30%. 1 These tumours are overgrowths of smooth muscle and connective tissue that are hormone dependent. Fibroids may be solitary, multiple or diffuse.…”

Section: Introductionmentioning

confidence: 99%

“…The choice of treatment has to be tailored for each patient according to their wishes, the type and location of the fibroid, associated symptoms and availability of service. 1 Surgical management of uterine fibroids may be required in women with severe pressure symptoms, unresponsiveness to other therapies or in large pedunculated, subserosal or submucous fibroids. Surgical treatment can be either hysterectomy or myomectomy.…”

Section: Introductionmentioning

confidence: 99%

The role of tourniquet in myomectomy: an observational study

Sanyal¹,

Ghosh²,

Hiremath³

et al. 2019

Int J Reprod Contracept Obstet Gynecol

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Background: Leimymoma is one of the commonest benign tumours encountered in women during the reproductive age. One quarter of these women may be symptomatic. When surgical management is indicated, myomectomy may be considered as the procedure of choice. Myomectomy can be complicated by severe intraoperative haemorrhage. One of the methods to reduce blood loss during myomectomy is the mechanical application of tourniquet.Methods: A prospective observational single arm study was done with 24 women who underwent open myomectomy to determine the utility of tourniquet in reducing blood loss during the procedure. Women of reproductive age group, having symptomatic fibroid, not responding to medical therapy, not completed their family and with total uterine size not exceeding 20 weeks were included in the study while those with pregnancy, concomitant adenomyosis, cervical or broad ligament fibroid, bleeding diathesis were excluded. The 7-French pediatric feeding tube was used as tourniquet. Our primary end point was intra-operative blood loss. Secondary outcome measures included operative morbidity and blood transfusion rates.Results: It was seen that application of the tourniquet considerably reduced the amount of blood loss and made resection of the myoma much easier. 83.3% patients had a blood loss less than 200ml and the rest between 200ml and 400ml. For majority of the patients (75%) the postoperative change of PCV was between 1 and 2%.Conclusions: The infant feeding tube form of tourniquet is cheap, safe, readily available, effectively reduces blood loss during myomectomy while not adding to the complications due to the operation.

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“…Management options for fibroids can be categorised as expectant, medical, radiological or surgical. Younas et al provide a succinct summary of the evidence base behind these approaches . Expectant management is appropriate for all asymptomatic women and may be appropriate for mild symptoms (especially in perimenopausal women).…”

Section: Expectant Medical and Radiological Managementmentioning

confidence: 99%

Laparoscopic myomectomy: a review of alternatives, techniques and controversies

Bryant‐Smith

2018

The Obstetric & Gynaecologis

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Key content Laparoscopic myomectomy (LM) is considered to be particularly technically difficult because it requires advanced intracorporeal suturing. LM involves a wide continuum of surgical difficulty; surgeons must be self‐aware of both their skill‐set and their limitations when selecting appropriate patients for this surgery. The greater a woman's age, the less there is to be gained by preserving her future fertility and the greater the risk of leiomyosarcoma. Hysterectomy should be considered when fertility is no longer desired or feasible. When asking a patient to give consent for LM, the following risks must be mentioned: parasitic myomata and disseminated peritoneal leiomyomatosis, and potentially upstaging an occult malignancy (such as leiomyosarcoma). There is currently no preoperative test to definitively exclude leiomyosarcoma. Learning objectives To understand the importance of thorough preoperative counselling before LM, including the potential risks of intracorporeal morcellation. To understand the key steps involved in performing an LM. Ethical issues The potential benefits of a laparoscopic versus open myomectomy must be considered; for example, does the worsened prognosis in women with unsuspected leiomyosarcoma, inadvertently morcellated, outweigh adverse outcomes in patients who undergo open myomectomy? Since in‐bag morcellation remains an experimental technique, its possible benefits and long‐term outcomes are yet to be established.

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A review of evidence‐based management of uterine fibroids

Cited by 24 publications

References 60 publications

The Focused Ultrasound Myoma Outcome Study (FUMOS); a retrospective cohort study on long-term outcomes of MR-HIFU therapy

The Focused Ultrasound Myoma Outcome Study (FUMOS); a retrospective cohort study on long-term outcomes of MR-HIFU therapy

The role of tourniquet in myomectomy: an observational study

Laparoscopic myomectomy: a review of alternatives, techniques and controversies

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