Clinical evaluation of HIFU combined with GnRH-a and LNG-IUS for adenomyosis patients who failed to respond to drug therapies: two-year follow-up results

Peng, Yan; Dai, Yu; Yu, Guiyuan; Yang, Xiaorong; Cheng, Wen; Park, Jin

doi:10.1080/02656736.2021.1967467

Cited by 8 publications

(7 citation statements)

References 24 publications

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“…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]…”

Section: Resultsmentioning

confidence: 99%

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

Liu¹,

Tian²,

Lin³

et al. 2023

Obstetrics &Amp; Gynecology

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To evaluate the risk of recurrence and reintervention after uterine-sparing treatment options for symptomatic adenomyosis, including adenomyomectomy, uterine artery embolization (UAE), and imageguided thermal ablation. DATA SOURCES:We searched electronic databases such as Web of Science, MEDLINE, Cochrane Library, EMBASE, ClinicalTrials.gov, and Google Scholar from January 2000 to January 2022. The search was conducted using the following search terms: "adenomyosis," "recurrence," "reintervention," "relapse," and "recur."METHODS OF STUDY SELECTION: All studies that described the risk of recurrence or reintervention after uterine-sparing interventions for symptomatic adenomyosis were reviewed and screened according to the eligibility criteria. Recurrence was defined as the reappearance of symptoms (painful menses or heavy menstrual bleeding) after significant or complete remission, or the reappearance of adenomyotic lesions confirmed by ultrasonography or magnetic resonance imaging. TABULATION, INTEGRATION, AND RESULTS:The outcome measures were presented as the frequency with percentage and pooled with 95% CI. A total of 42 studies (single-arm retrospective and prospective studies) that represented 5,877 patients were included. The recurrence rates after adenomyomectomy, UAE, and imageguided thermal ablation were 12.6% (95% CI 8.9-16.4%), 29.5% (95% CI 17.4-41.5%), and 10.0% (95% CI 5.6-14.4%), respectively. The reintervention rates were 2.6% (95% CI 0.9-4.3%), 12.8% (95% CI 7.2-18.4%), and 8.2% (95% CI 4.6-11.9%) after adenomyomectomy, UAE, and image-guided thermal ablation, respectively. Subgroup analysis and sensitivity analysis were performed, and the heterogeneity was reduced in several analyses. CONCLUSION: Uterine-sparing techniques were successful in treating adenomyosis with low reintervention rates. Uterine artery embolization had higher recurrence and reintervention rates than other techniques; however, patients treated with UAE had larger uteri and larger adenomyosis, indicating that selection bias may influence these results. More randomized controlled trials with a larger population are needed in the future.

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Section: Resultsmentioning

confidence: 99%

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

Liu¹,

Tian²,

Lin³

et al. 2023

Obstetrics &Amp; Gynecology

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“…Adenomyosis could be treated by medical or surgical treatment. Medical treatment includes oral contraceptives, progesterone-releasing intrauterine devices, ulipristal acetate, non-steroidal anti-inflammatory drugs and gonadotropin-releasing hormone agonists ( 5 ). These methods relieve symptoms, but the definitive treatment is surgical, first of all, hysterectomy.…”

Section: Resultsmentioning

confidence: 99%

“…Another alternative technique to treat adenomyosis in young women is USgHIFU (ultrasound-guided high-intensity focused ultrasound). This procedure has less complications and shorter hospitalization than adenomyomectomy; but, like surgery, the symptoms could come back considering the unclear boundaries of the adenomyotic lesion ( 5 ). Whether surgical removal of adenomyosis can affect fertility outcomes or not is still under debate.…”

Section: Resultsmentioning

confidence: 99%

Anti-Mullerian Hormone (AMH) and adenomyosis: Mini-review of literature of the last 5 years

et al. 2022

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IntroductionAdenomyosis is a form of endometriosis characterized by the presence of endometrial tissue in the myometrium. The correlation between anti-Mullerian hormone (AMH) expression and adenomyosis is unclear. Few studies investigated this possible correlation with promising results. The aim of this mini-review is to illustrate the potential prognostic and therapeutic role of AMH in adenomyosis.Materials and methodsA study protocol was completed conforming to the Preferred Reporting Items for Reviews and Meta-Analyses (PRISMA) guidelines for systematic reviews. We performed an electronic databases search from each database’s inception from August 2017 to August 2022 for full-text articles and published abstracts. For database searches, the following main keywords were the following text words: “adenomyosis” or “uterine endometriosis” [Mesh] AND “AMH” or “anti-mullerian hormone”.ResultsFrom the literature search, 8 abstracts of studies were retrieved and independently screened for inclusion by three authors. It was found that the most common therapeutic strategies (such as adenomyomectomy and high-intensity focused ultrasound (HIFU) do not alter AMH levels. Moreover, a higher expression of the AMH receptor II was observed in adenomyotic tissue, hence a possible therapeutic use of AMH was hypothesized.ConclusionThe available evidence shows an unclear relationship between adenomyosis and AMH. Probably, women with adenomyosis have lower levels of AMH and the surgical treatment (adenomyomectomy, HIFU) does not alter this characteristic, therefore in all of them, ovarian function is not influenced.

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“…Therefore, it can be used not only for contraception, but also to treat adenomyosis, reduce the amount of menstruation, shrink the uterine volume, and relieve dysmenorrhea. LNG-IUS is effective for adenomyosis with dysmenorrhea and menorrhagia, especially recommended for the latter ( 38 , 39 ). LNG rarely enters the peripheral circulation, so there are few systemic side effects except for minor vaginal bleeding and amenorrhea.…”

Section: Individualized Non-oral Drugs For Adenomyosismentioning

confidence: 99%

“…High intensity focused ultrasound (HIFU) is a kind of physical therapy, which has the advantages of no operation, no bleeding, no ionizing radiation and repeatability ( 38 ). It is a more accurate treatment for localized adenomyosis with good effect, and preserves the integrity of the uterus.…”

Section: High Intensity Focused Ultrasoundmentioning

confidence: 99%

Individualized conservative therapeutic strategies for adenomyosis with the aim of preserving fertility

et al. 2023

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Adenomyosis is a diffuse or localized organic disease caused by benign invasion of endometrial glands and stroma into the myometrium. It is a common disease that seriously affects reproductive health of women in childbearing age. Due to the unknown etiology and pathophysiological mechanism, and the lack of unified diagnostic criteria and effective treatment methods, total or subtotal hysterectomy has become a radical treatment for adenomyosis, which will lead to the complete loss of fertility. With the continuous exploration of the treatment to adenomyotic patients who have infertility or fertility intentions, new drugs, surgical methods and treating concepts appears. Adopt individualized conservative therapeutic strategies for patients with different conditions, preserve the uterus as much as possible and protect the patient’s fertility, which will play an important role on the follow-up assisted reproductive treatment and long-term management of adenomyosis.

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Clinical evaluation of HIFU combined with GnRH-a and LNG-IUS for adenomyosis patients who failed to respond to drug therapies: two-year follow-up results

Cited by 8 publications

References 24 publications

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

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

Anti-Mullerian Hormone (AMH) and adenomyosis: Mini-review of literature of the last 5 years

Individualized conservative therapeutic strategies for adenomyosis with the aim of preserving fertility

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