Nonresective treatments for uterine fibroids: a systematic review of uterine and fibroid volume reductions

Abstract

Patients are increasingly seeking uterus-preserving, minimally invasive treatments for symptomatic uterine fibroids. This has led to a greater use of nonresective treatments such as uterine artery embolization (UAE), focused ultrasound (FUS) and more recently, radiofrequency ablation (RFA) of fibroids. This systematic review, following PRISMA guidelines, examines the change in uterine and fibroid volumes associated with UAE, FUS, and RFA. Pubmed and MedlinePlus databases were searched from 1956 to 2016. The keywords used were 'radiofrequency ablation,' 'magnetic resonance guided focused ultrasound,' 'ultrasound guided focused ultrasound', 'uterine artery embolization,' 'uterine fibroid embolization,' and 'leiomyoma' or 'fibroid'. Publications with at least 20 patients were included. Data were collected and analyzed using Microsoft Excel V R (Microsoft Corporation, Redmond, WA) software. Eighty-one relevant papers were identified: 52 related to UAE, 11 to RFA, 17 to FUS, 1 compared UAE and FUS. We report the published uterine volume and fibroid volume changes seen in these studies at 1 to 36 months. The pooled fibroid volume reductions at six months seen with RFA were 70%, UAE 54% and FUS 32%. All three types of nonresective treatment result in fibroid volume reduction. However, fibroid volume reduction is most marked with RFA, with UAE resulting in the next most volume reduction. Additional larger cohort studies, including those that are randomized and/or comparative, would enable definitive conclusions. This is the first systematic review comparing uterine and fibroid volume reduction after RFA, UAE and MRgFUS. ARTICLE HISTORY

Should Ultrasound-Guided High Frequency Focused Ultrasound Be Considered as an Alternative Non-Surgical Treatment of Uterine Fibroids in Non-Asiatic Countries? An Opinion Paper

“…In comparison with other non-interventional techniques, reduction in volume was observed after HIFU (34% ± 8%) than other techniques at 24 months follow-up (UAE 70% ± 11% and RFA (83% ± 8%) [34]. This difference with the aforementioned studies could be attributed to the fact that the initial fibroid volume was higher in the UAE and HIFU groups (UAE: 208.32 ± 112.41, HIFU 209.98 ± 77.83, RFA 84.35 ± 85.06).…”

microRNAs in female infertility: An overview

“…77,122,123 According to the location, they are classified as submucosal, intramural and subserosal leiomyomas. 123 Uterine fibroids may be asymptomatic and symptomatic in approximately 50% of cases 140 and present by abnormal uterine bleeding, abdominal or low back pain, painful coitus, urgent urination, urinary frequency, retention of urine and gastrointestinal disorders. 141,142 Risk factors of uterine fibroids are advanced age, hormone, obesity, race, early onset of menarche, nulliparity and same lesion familiar history.…”

Clinical Performance of Radiofrequency Ablation for Treatment of Uterine Fibroids: Systematic Review and Meta-Analysis of Prospective Studies

“…Sandberg et al 11 reported a reintervention rate of 0.3% at 1 year and 10.4% at 3 years, reductions in SSS of 37 points at 1 year, and increases in HRQL of 35 points at 1 year after laparoscopic RFA. Taheri et al 12 published a review comparing uterine artery embolization, various routes of RFA, and focused ultrasound and found that RFA provided a significantly greater percentage of fibroid volume reduction compared with the other treatments. No previous report has analyzed aggregate outcomes of transvaginal RFA or TFA studies.…”