Pregnancy and symptomatic relief following ultrasound‐guided transvaginal radiofrequency ablation in patients with adenomyosis

Abstract

Aim To report the reproductive results and symptomatic relief of patients with adenomyosis who attempted to conceive after ultrasound‐guided radiofrequency ablation (RFA). Methods Of 182 consecutive patients with adenomyosis who had undergone RFA, only 81 patients were eligible for this study. Pregnancy outcomes, postoperative complications, preoperative and postoperative pictorial blood loss assessment chart scores, and pain scores were evaluated. Results Of these 81 patients, 74 were infertile and seven were single at the time of RFA. The mean age at the time of operation was 35.8 years. The mean duration from the time of RFA to conception was 18.9 months (range, 2–72 months). Fifty‐nine patients tried natural conception, while 22 patients attempted conception with assisted reproductive techniques. Twenty‐nine (35.8%) patients achieved 39 pregnancies. Except for the 23 patients who did not actively try to conceive and who inevitably or arbitrarily discontinued pregnancy attempts, the pregnancy success rate reached 50%. Twenty‐two (84.6%) of the 29 patients delivered 24 (66.7%) live babies (nine vaginal deliveries and 15 cesarean sections). Twelve (33.3%) pregnancies ended in spontaneous abortions. No uterine ruptures occurred. Paired sample t‐tests revealed that preoperative pictorial blood loss assessment chart and pain scores were significantly (P < 0.05) different from the postoperative scores at 1‐, 3‐ and 6‐months. Conclusion RFA could be considered a minimally‐invasive treatment option for patients with adenomyosis who desire to maintain fertility and alleviate symptoms.

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

“…Both the VAS and SSS scores significantly decreased after the combined treatment and were maintained at a very low level during the 3-year follow-up. It is difficult to compare the present results with the previous studies in which RFA was solely applied because the severity of the adenomyosis and follow-up period are different [4][5][6]. The results in our study also showed that the mean uterine volume significantly decreased by 57% at 1 year after procedure.In the previous studies, the 1-year uterine volume reduction rate of single RFA was 41 À 47% [4][5].…”

“…Image-guided tumor ablation techniques (radiofrequency, microwave and high-intensity focused ultrasound) have been introduced for the treatment of adenomyosis in the recent years. The safety and effectiveness of this relatively new strategy for adenomyosis is under evaluation [4][5][6][17][18][19][20].…”

“…Complete ablation of the adenomyotic tissue is difficult because the boundary between the adenomyotic lesion and the normal tissue is unclear under ultrasound guidance during the application of thermal energy. The mean ablation rate reported ranged from 50% to 76% [4][5][6][17][18][19][20]. It is plausible that residual lesions may continue to grow and relapse [21][22].…”

“…As a new conservative therapy, ultrasound-guided (USguided) radiofrequency ablation (RFA) is a minimally invasive, safe, and effective treatment for symptomatic uterine adenomyosis [4][5][6]. It can be performed as an outpatient procedure without general anesthesia and previous studies have reported that it can provide symptomatic relief and uterine volume reduction [4][5][6]. However, our previous study also showed that approximately 20% of patients had recurrences after ablation [4].…”

Image-guided thermal ablation in the management of symptomatic adenomyosis: a systematic review and meta-analysis

“…Finally, 38 articles , met all inclusion criteria and were included in this meta-analysis. The types of ablation were HIFU in 28 studies , PMWA in five studies [46][47][48][49][50] and RFA in four studies [51][52][53][54]. Besides, one study [45] compared PMWA with RFA in the management of AD.…”