Symptomatic Fibroid Management: Systematic Review of the Literature

Abstract

Background and Objectives:Symptomatic uterine fibroids are a societal and healthcare burden with no clear consensus among medical professionals as to which procedural treatment is most appropriate for each symptomatic patient. Our purpose was to determine whether recommendations can be made regarding best practice based on review and analysis of the literature since 2006.Database:A systematic search of journal articles relevant to the treatment of symptomatic uterine fibroids was performed within PubMed, clinical society websites, and medical device manufacturers' websites. All clinical trials published in English, representing original research, and reporting clinical outcomes associated with interventions for the management of symptomatic uterine fibroids were considered. Each article was screened and selected based on study type, content, relevance, American College of Obstetricians and Gynecologists score, and internal/external validity. Outcomes of interest were patient baseline characteristics, fibroid characteristics, procedural details, complications, and long-term follow-up. Random-effects meta-analyses were used to test the quantitative data. Assessment of 143 full-length articles through January 2016 produced 45 articles for the quantitative analysis. The weighted combined results from hysterectomy trials were compared with those from uterine-preserving fibroid studies (myomectomy, uterine artery embolization, laparoscopic radiofrequency ablation, and magnetic resonance-guided focused ultrasound).Conclusion:We explored trends that might guide clinicians when counseling patients who need treatment of symptomatic fibroids. We found that fibroid therapy is trending toward uterine-conserving treatments and outcomes are comparable across those treatments. Since minimally invasive options are increasing, it is important for the clinician to provide the patient with evidence-based therapeutic strategies.

Ultrasound-guided transvaginal radiofrequency ablation of uterine fibroids assisted by virtual needle tracking system: a preliminary study

“…These findings are also confirmed by a recent systematic review of the literature [29] reporting high effectiveness of miniinvasive uterine fibroids treatments. Moreover RF ablation showed higher performances if compared to UAE [10] and also a lower re-intervention rate compared to MRg-FUS [30].…”

Effect on surgical decisions: Ulipristal acetate as key player in Belgian phase IV registration trial

“…Safety of UPA was well established before the present study, [1][2][3][4] and was confirmed as a result of this trial. Although some serious adverse events were reported, these were within the range of the previous trials with UPA.…”

“…Not all fibroids warrant a surgical approach, and surgical treatment of fibroids can be challenging as the more invasive procedures hold a greater risk of complications . Hysteroscopic myomectomy is generally safer than a laparoscopic or even laparotomic approach, but is of course limited to fibroids in conjunction with the uterine cavity.…”

“…Not all fibroids warrant a surgical approach, and surgical treatment of fibroids can be challenging as the more invasive procedures hold a greater risk of complications. 2,3 Hysteroscopic myomectomy is generally safer than a laparoscopic or even laparotomic approach, but is of course limited to fibroids in conjunction with the uterine cavity. A hysterectomy to treat fibroids may hold a smaller surgical risk compared to a myomectomy but is an aggressive way to deal with benign disease and sometimes hard to accept for the patient, even if there is no longer a desire for pregnancy.…”

Correlation between the Types of Myoma and the Pathological Process

“…Міома матки на сьогоднішній день є одні-єю з найбільш розповсюджених патологій жіночої репродуктивної системи [10,14]. Частота захворю-вання варіюється за одними джерелами у 20-25% жінок репродуктивного віку [5], за іншими -від 40 до 60% [13].…”