Curative Effects of Two New Endometrial Ablation Procedures Using Radiofrequency Thermocoagulation for the Treatment of Severe Abnormal Uterine Bleeding

Abstract

Severe Abnormal Uterine Bleeding (SAUB) is a common gynecological disorder. The clinical characteristics include disordered menstrual cycle and massive bleeding that can cause anemia or secondary infection. Current treatment mainly relies on drug therapy or surgical removal of the uterus, each having its significant disadvantages. How to preserve the uterus, reduce the pain from surgery, and achieve better treatment effects have been well known but remaining as unresolved issues. This study aims at evaluating two types of radiofrequency (RF) thermocoagulation procedures for the treatment of SAUB: the RF-A procedure group included 25 SAUB patients ≥45 years of age treated for amenorrhea; the RF-B procedure group included 51 patients at <45 years of age treated for the control of excessive bleeding. Post-treatment ratings of menstrual satisfaction and pre-/post-treatment menstrual scores-pictorial blood loss assessment chart (PBAC)-and hemoglobin levels were collected; and the mean length of follow-up was 72 months. Also, 38 SAUB patients treated with standard drug regimens served as a control group. The results of the study showed that following RF treatment, the average long-term patient menstrual satisfaction was greater than 92 %. In both the RF groups, PBAC scores and hemoglobin levels were significantly improved from baseline (p < .05). Compared with the control group, PBAC scores and hemoglobin levels were also significantly better for the RF groups at 6-24-month post-operation. Patients experienced no hysterectomy in association with the RF procedures. In conclusion, this pilot study suggests that the novel RF procedures are both safe and effective in treating patients with SAUB. Further investigation is necessary to evaluate their application in broader clinical indication.

Treatment of Uterine Myomas by Radiofrequency Thermal Ablation: A 10-Year Retrospective Cohort Study

“…The patients who also had complicated with simple endometrial hyperplasia were treated with 2 RFTA ablation procedures according to their menopausal condition. 18 These patients no longer needed medications (such as progestins) after RFTA, and their long-term outcome was confirmed to be effective in both the groups. 18 Effectiveness on Reducing the Size of Uterine Myoma At 1, 3, 6, 12, and 24 months after RFTA, the average reduction in myoma diameter was 3.8, 3.0, 2.7, 2.4, and 2.2 cm, and the average volume reduction was 39.8%, 70.4%, 78.4%, 84.8%, and 88.3%, respectively, in group A.…”

“…18 These patients no longer needed medications (such as progestins) after RFTA, and their long-term outcome was confirmed to be effective in both the groups. 18 Effectiveness on Reducing the Size of Uterine Myoma At 1, 3, 6, 12, and 24 months after RFTA, the average reduction in myoma diameter was 3.8, 3.0, 2.7, 2.4, and 2.2 cm, and the average volume reduction was 39.8%, 70.4%, 78.4%, 84.8%, and 88.3%, respectively, in group A. In group B, the diameter reduction was 4.7, 3.7, 3.3, 2.3, and 2.3 cm, and the volume reduction was 16.9%, 59.5%, 71.3%, 90.3%, and 90.3%, respectively.…”

“…18 These patients no longer needed medications (such as progestins) after RFTA, and their long-term outcome was confirmed to be effective in both the groups. 18…”

“…In recent years, several effective endometrial ablation techniques have been developed for the treatment of severe uterine bleeding, including endometrial ablation under hysteroscopy, 19 thermal balloon, or radiofrequency ablation. 18,[20][21][22] These procedures are generally safe and effective since the operation is in the uterine cavity, not within the myometrium. In contrast, the treatment of UM using RFTA requires the insertion of coagulator into myometrium under the monitoring of ultrasound imaging; therefore, the operation is more difficult, and the accuracy of the insertion and successful thermal coagulation of various sizes of myomas directly affect its efficacy.…”

“…The coagulator has been shown in our previous study. 18 Technical and operational parameters were set as follows: 220 V ± 10%, 50 Hz ± 2%, p ≤ 60 W, I < 2 A, 600 kHz ± 15%, and power setting at 40 W. Temperature is adjustable (60°C-80°C).…”