Multimedialna platforma wiedzy medycznej Internetowa Księgarnia Medyczna Kalendarium Konferencji
Ginekologia Polska
MENU
Shortcuts Submit an article Author Guidelines Ahead Of Print Reviewers 2023

open access

Vol 93, No 3 (2022)
Review paper
Published online: 2022-02-01
View PDF Download PDF file View HTML
Get Citation

Minimally invasive treatment options for uterine fibroids — state-of-the art 2021

Jaroslaw Krzyzanowski1, Slawomir Wozniak1, Piotr Szkodziak1, Arkadiusz Krzyzanowski2, Wrona Wojciech1, Tomasz Paszkowski1
DOI: 10.5603/GP.a2021.0202
·
Pubmed: 35106750
·
Ginekol Pol 2022;93(3):242-247.
Affiliations
  1. 3rd Chair and Department of Gynecology, Medical University in Lublin, Poland
  2. Chair and Department of Obstetrics and Pathology of Pregnancy, Medical University of Lublin, Poland, Poland

open access

Vol 93, No 3 (2022)
REVIEW PAPERS Gynecology
Published online: 2022-02-01

Abstract

Objectives: Uterine leyomyomas are benign, monoclonal tumors that can cause abnormal uterine bleeding, pelvic pain, dyspareunia and/or obstruction of bladder or rectum. Women’s growing interest in treatments that avoid surgery and/or preserve the uterus has contributed to the development of minimally invasive methods.

Conducting a literature review and assessment of the effectiveness and safety of minimally invasive methods of treating fibroids, with particular emphasis on high intensity focused ultrasound.

Material and methods: Systematic review of MEDLINE, Cochrane and PubMed was performed using the following key words: uterine artery embolization, high-intensity focused ultrasound, microwave ablation, radiofrequency ablation, minimally invasive, leiomyoma, fertility, pregnancy. English abstracts relevant to the topic were selected. Full-text articles were carefully analyzed.

Results: Uterine artery embolization is a proven, widely accepted method that is effective in appropriately qualified cases. Although high focused ultrasound is still an experimental procedure, preliminary studies seem to be promising. If its efficacy and safety are confirmed in randomized controlled trials, this method may find its place in clinical practice. Microwave and radiofrequency ablation are interesting minimally invasive methods with the future potential to be recognized as a method of treating fibroids.

Conclusions: Minimally invasive methods are becoming an important treatment option for fibroids. Further research is needed to recognize these procedures as a fully-fledged alternative to surgical treatment.

Abstract

Objectives: Uterine leyomyomas are benign, monoclonal tumors that can cause abnormal uterine bleeding, pelvic pain, dyspareunia and/or obstruction of bladder or rectum. Women’s growing interest in treatments that avoid surgery and/or preserve the uterus has contributed to the development of minimally invasive methods.

Conducting a literature review and assessment of the effectiveness and safety of minimally invasive methods of treating fibroids, with particular emphasis on high intensity focused ultrasound.

Material and methods: Systematic review of MEDLINE, Cochrane and PubMed was performed using the following key words: uterine artery embolization, high-intensity focused ultrasound, microwave ablation, radiofrequency ablation, minimally invasive, leiomyoma, fertility, pregnancy. English abstracts relevant to the topic were selected. Full-text articles were carefully analyzed.

Results: Uterine artery embolization is a proven, widely accepted method that is effective in appropriately qualified cases. Although high focused ultrasound is still an experimental procedure, preliminary studies seem to be promising. If its efficacy and safety are confirmed in randomized controlled trials, this method may find its place in clinical practice. Microwave and radiofrequency ablation are interesting minimally invasive methods with the future potential to be recognized as a method of treating fibroids.

Conclusions: Minimally invasive methods are becoming an important treatment option for fibroids. Further research is needed to recognize these procedures as a fully-fledged alternative to surgical treatment.

Full Text:

View PDF Download PDF file View HTML
Get Citation

Keywords

fibroid; uterine artery embolization; high-intensity focused ultrasound; fertility

About this article
Title

Minimally invasive treatment options for uterine fibroids — state-of-the art 2021

Journal

Ginekologia Polska

Issue

Vol 93, No 3 (2022)

Article type

Review paper

Pages

242-247

Published online

2022-02-01

Page views

5691

Article views/downloads

1499

DOI

10.5603/GP.a2021.0202

Pubmed

35106750

Bibliographic record

Ginekol Pol 2022;93(3):242-247.

Keywords

fibroid
uterine artery embolization
high-intensity focused ultrasound
fertility

Authors

Jaroslaw Krzyzanowski
Slawomir Wozniak
Piotr Szkodziak
Arkadiusz Krzyzanowski
Wrona Wojciech
Tomasz Paszkowski

References (42)
  1. Tinelli A, Sparic R, Kadija S, et al. Myomas: anatomy and related issues. Minerva Ginecol. 2016; 68(3): 261–273.
    PubMed
  2. Sparic R, Mirkovic L, Malvasi A, et al. Epidemiology of uterine myomas: a review. Int J Fertil Steril. 2016; 9(4): 424–435.
    PubMed
  3. Williams ARW. Uterine fibroids — what's new? F1000Res. 2017; 6: 2109.
    CrossRefPubMed
  4. Al-Hendy A, Myers ER, Stewart E. Uterine fiibroids: burden and unmet medical need. Semin Reprod Med. 2017; 35(6): 473–480.
    CrossRefPubMed
  5. Szkodziak P, Pyra K, Szkodziak F, et al. The Lublin Protocol of the uterine arteries embolization in the treatment of symptomatic uterine fibroids. J Vis Exp. 2020(163).
    CrossRefPubMed
  6. Park MJ, Kim Ys, Rhim H, et al. Safety and therapeutic efficacy of complete or near-complete ablation of symptomatic uterine fibroid tumors by MR imaging-guided high-intensity focused US therapy. J Vasc Interv Radiol. 2014; 25(2): 231–239.
    CrossRefPubMed
  7. Lee JS, Hong GY, Lee KH, et al. Changes in anti-müllerian hormone levels as a biomarker for ovarian reserve after ultrasound-guided high-intensity focused ultrasound treatment of adenomyosis and uterine fibroid. BJOG. 2017; 124(Suppl 3): 18–22.
    CrossRefPubMed
  8. Ravina JH, Ciraru-Vigneron N, Bouret JM, et al. Arterial embolisation to treat uterine myomata. Lancet. 1995; 346(8976): 671–672.
    CrossRef
  9. Heavy menstrual bleeding: assessment and management. https://www.nice.org.uk/guidance/ng88 (May 24, 2021).
  10. Chen HT, Athreya S. Systematic review of uterine artery embolisation practice guidelines: are all the guidelines on the same page? Clin Radiol. 2018; 73(5): 507.e9–507.e15.
    CrossRefPubMed
  11. Ghanaati H, Sanaati M, Shakiba M, et al. Pregnancy and its outcomes in patients after uterine fibroid embolization: a systematic review and meta-analysis. Cardiovasc Intervent Radiol. 2020; 43(8): 1122–1133.
    CrossRefPubMed
  12. Czuczwar P, Stepniak A, Milart P, et al. Comparison of the influence of three fibroid treatment options: supracervical hysterectomy, ulipristal acetate and uterine artery embolization on ovarian reserve - an observational study. J Ovarian Res. 2018; 11(1): 45.
    CrossRefPubMed
  13. Wang C, Kuban JD, Lee SR, et al. Utilization of endovascular and surgical treatments for symptomatic uterine leiomyomas: a population health perspective. J Vasc Interv Radiol. 2020; 31(10): 1552–1559.e1.
    CrossRefPubMed
  14. Kröncke T, David M. MR-guided focused utrasound in fibroid treatment — results of the 4th Radiological-Gynecological Expert Meeting. Rofo. 2019; 191(7): 626–629.
    CrossRefPubMed
  15. Chen J, Chen W, Zhang L, et al. Safety of ultrasound-guided ultrasound ablation for uterine fibroids and adenomyosis: a review of 9988 cases. Ultrason Sonochem. 2015; 27: 671–676.
    CrossRefPubMed
  16. Chen J, Li Y, Wang Z, et al. Committee of the Clinical Trial of HIFU versus Surgical Treatment for Fibroids. Evaluation of high-intensity focused ultrasound ablation for uterine fibroids: an IDEAL prospective exploration study. BJOG. 2018; 125(3): 354–364.
    CrossRefPubMed
  17. Lozinski T, Filipowska J, Pyka M, et al. Magnetic resonance-guided high-intensity ultrasound (MR-HIFU) in the treatment of symptomatic uterine fibroids - five-year experience. Ginekol Pol. 2021 [Epub ahead of print].
    CrossRefPubMed
  18. Keserci B, Duc NM. Magnetic resonance imaging parameters in predicting the treatment outcome of high-intensity focused ultrasound ablation of uterine fibroids with an immediate nonperfused volume ratio of at least 90. Acad Radiol. 2018; 25(10): 1257–1269.
    CrossRefPubMed
  19. Ikink ME, Nijenhuis RJ, Verkooijen HM, et al. Volumetric MR-guided high-intensity focused ultrasound versus uterine artery embolisation for treatment of symptomatic uterine fibroids: comparison of symptom improvement and reintervention rates. Eur Radiol. 2014; 24(10): 2649–2657.
    CrossRefPubMed
  20. Barnard EP, AbdElmagied AM, Vaughan LE, et al. Periprocedural outcomes comparing fibroid embolization and focused ultrasound: a randomized controlled trial and comprehensive cohort analysis. Am J Obstet Gynecol. 2017; 216(5): 500.e1–500.e11.
    CrossRefPubMed
  21. Bakry MA, Fawzi MM, Shaban MH. Oxytocin administration improves efficiency of HIFU treatment of uterine fibroids. J Anesth Clin Res. 2020; 11(3): 1000943.
    CrossRef
  22. Lozinski T, Filipowska J, Krol P, et al. Oxytocin administration in high-intensity focused ultrasound treatment of myomata. Biomed Res Int. 2018; 2018: 7518026.
    CrossRefPubMed
  23. Wu Q, He M, Wang J, et al. Effects of oxytocin on high intensity focused ultrasound (HIFU) ablation of adenomysis: a prospective study. Eur J Radiol. 2014.
    CrossRef
  24. Lee JS, Hong GY, Park BJ, et al. Ultrasound-guided high-intensity focused ultrasound treatment for uterine fibroid & adenomyosis: A single center experience from the Republic of Korea. Ultrason Sonochem. 2015; 27: 682–687.
    CrossRefPubMed
  25. He M, Jacobson H, Zhang C, et al. A retrospective study of ultrasound-guided high intensity focussed ultrasound ablation for multiple uterine fibroids in South Africa. Int J Hyperthermia. 2018; 34(8): 1304–1310.
    CrossRefPubMed
  26. Cheung VYT, Lam TPW, Jenkins CR, et al. Ovarian reserve after ultrasound-guided high-intensity focused utrasound for uterine fibroids: preliminary experience. J Obstet Gynaecol Can. 2016; 38(4): 357–361.
    CrossRefPubMed
  27. Jiang Z, Li Q, Li W, et al. A comparative analysis of pregnancy outcomes of patients with uterine fibroids after high intensity focused ultrasound ablation and laparoscopic myomectomy: a retrospective study. Int J Hyperthermia. 2021; 38(1): 79–84.
    CrossRefPubMed
  28. Zou M, Chen L, Wu C, et al. Pregnancy outcomes in patients with uterine fibroids treated with ultrasound-guided high-intensity focused ultrasound. BJOG. 2017; 124(Suppl 3): 30–35.
    CrossRefPubMed
  29. Łoziński T, Filipowska J, Ludwin A, et al. The outcome of magnetic resonance-guided high-intensity ultrasound for clinically symptomatic submucosal uterine fibroid performed accidentally in very early pregnancy: a case report. Int J Hyperthermia. 2019; 36(1): 975–979.
    CrossRefPubMed
  30. Qin J, Chen JY, Zhao WP, et al. Outcome of unintended pregnancy after ultrasound-guided high-intensity focused ultrasound ablation of uterine fibroids. Int J Gynaecol Obstet. 2012; 117(3): 273–277.
    CrossRefPubMed
  31. Łoziński T, Filipowska J, Gurynowicz G, et al. The effect of high-intensity focused ultrasound guided by magnetic resonance therapy on obstetrical outcomes in patients with uterine fibroids - experiences from the main Polish center and a review of current data. Int J Hyperthermia. 2019; 36(1): 582–590.
    CrossRefPubMed
  32. Li JS, Wang Y, Chen JY, et al. Pregnancy outcomes in nulliparous women after ultrasound ablation of uterine fibroids: A single-central retrospective study. Sci Rep. 2017; 7(1): 3977.
    CrossRefPubMed
  33. Łoziński T, Filipowska J, Gurynowicz G, et al. Non-invasive therapeutic use of high-intensity focused ultrasound (HIFU) with 3 tesla magnetic resonance imaging in women with symptomatic uterine fibroids. Ginekol Pol. 2017; 88(9): 497–503.
    CrossRefPubMed
  34. Zowall H, Cairns JA, Brewer C, et al. Cost-effectiveness of magnetic resonance-guided focused ultrasound surgery for treatment of uterine fibroids. BJOG. 2008; 115(5): 653–662.
    CrossRefPubMed
  35. Moriarty P, Elizabeth A. Cost-effectiveness of uterine-preserving procedures for the treatment of uterine fibroid symptoms in the USA. J Comp Eff Res. 2014; 3: 503–514.
  36. Ierardi AM, Savasi V, Angileri SA, et al. Percutaneous high frequency microwave ablation of uterine fibroids: systematic review. Biomed Res Int. 2018; 2018: 2360107.
    CrossRefPubMed
  37. Liu H, Zhang J, Han ZY, et al. Effectiveness of ultrasound-guided percutaneous microwave ablation for symptomatic uterine fibroids: a multicentre study in China. Int J Hyperthermia. 2016; 32(8): 876–880.
    CrossRefPubMed
  38. Tsuda A, Kanaoka Y. Outpatient transcervical microwave myolysis assisted by transabdominal ultrasonic guidance for menorrhagia caused by submucosal myomas. Int J Hyperthermia. 2015; 31(6): 588–592.
    CrossRefPubMed
  39. Fu Y, Feng Q, Zhang S, et al. Application of oxytocin in ultrasound-guided percutaneous microwave ablation for treatment of hypervascular uterine fibroids: a preliminary report. Int J Hyperthermia. 2019; 36(1): 761–767.
    CrossRefPubMed
  40. Tsuda A, Kanaoka Y. Submyometrial vasopressin injection before microwave ablation of vascular-rich submucosal myomas: a preliminary case study. Int J Hyperthermia. 2019; 36(1): 739–743.
    CrossRefPubMed
  41. Yüce G, Tayarer A, Keskin HL, et al. Ultrasound guided percutaneous radiofrequency thermal ablation of symptomatic uterine fibroids - results from a single center and 52 weeks of follow up. Ginekol Pol. 2020; 91(8): 447–452.
    CrossRefPubMed
  42. Turtulici G, Orlandi D, Dedone G, et al. Ultrasound-guided transvaginal radiofrequency ablation of uterine fibroids assisted by virtual needle tracking system: a preliminary study. Int J Hyperthermia. 2019; 35(1): 97–104.
    CrossRefPubMed

Regulations

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

By VM Media Group sp. z o.o., ul. Świętokrzyska 73, 80–180 Gdańsk
tel.:+48 58 320 94 94, faks:+48 58 320 94 60, e-mail:  viamedica@viamedica.pl