Comparison of two invasive non-surgical treatment options for uterine myomas: uterine artery embolization and magnetic resonance guided high intensity focused ultrasound-systematic review.

BACKGROUND: Uterine Artery Embolization (UAE) and Magnetic Resonance guided High Intensity Focused Ultrasound (MRgHIFU) are two noninvasive treatments for uterine leiomyoma. METHODS: This systematic review, following PRISMA guidelines, analyzed the effectiveness of two treatments by comparing percent fibroid volume shrinkage immediately after the procedure and after 3, 6, 12 and 24 months of follow-up and also assessed and compared common complications following treatment. The search utilized Science Direct, PubMed, MEDLINE, Google Scholar and BioMed Central databases, selecting manuscripts published during the period 2000 and 2020. Studies with premenopausal patients with previous treatments for uterine leiomyoma and/or with other pelvic diseases were excluded. RESULTS: Twenty-nine papers satisfied inclusion and exclusion criteria. Results were pooled and stratified by treatment and follow-up time. Weighted fibroid volume percent shrinkage after UAE was statistically significantly greater than MRgHIFU at 6, 12, and 24 months follow-up times. However, UAE had statistically significantly more complications, such as pain, nausea and vomiting. However, this study cannot conclude that UAE is more effective than MRgHIFU due to confounding factors.

Myoma expulsion after embolization: case report and literature review.

Uterine artery embolization (UAE) is a very efficient treatment modality for myoma. A rare complication of this procedure is vaginal expulsion of the uterine myoma (expelled myoma) which may occur in 3 to 5% of cases during a period of 3 to 48 months. We report a case of myoma expulsion after embolization, discussing diagnosis and treatment. A literature review was also conducted. A 40-year-old patient sought medical care on 5/2/2021 with intermittent pelvic pain and hypermenorrhagia. Vaginal ultrasound revealed an enlarged uterus (253 cm3) with myomas. The largest intramural myoma measured 7 cm. Uterine artery embolization was performed on 11/11/2021, without any complications. On 12/7/2021, during clinical examination an expelled myoma was observed entirely inside the vaginal canal. A vaginal myomectomy was performed, without any complications. At 15 months after the initial follow-up, the patient is doing well.

A Prospective Intervention Trial on Tailored Radiofrequency Ablation of Uterine Myomas.

Background and Objective: Investigating the use of radiofrequency myolysis (RFM) for the treatment of fibroids through less invasive access by combining transvaginal ultrasound, hysteroscopy and laparoscopy. Materials and Methods: Fifty-four premenopausal women with 106 symptomatic uterine myomas. Patients underwent RFM in three ways: Vaginal Ultrasound-guided RFM (VU-RFM), Laparoscopic RFM (L-RFM) and Hysteroscopic-RFM (H-RFM). The mean patient age was 43 years; 52 symptomatic uterine myomas were subserosal, 44 intramural and 10 submucosal. The outcomes evaluated at 1 and 12 months after RFM were myoma size (volume-diameter), "Uterine Fibroid Symptom and Quality of Life (UFS-QOL)" questionnaire and a 10-point Visual Analogue Scale (VAS). The therapy was completed with a single ablation in all patients, no complication was registered. The average number of fibroids treated per intervention was two with the use of different accesses: 64/106 VU-RFMs (60.4%), 32/106 L-RFMs (30.2%) and 10/106 H-RFMs (9.4%). Results: Volume and diameter of fibroids were significantly reduced by, respectively, 51.3% and 20.1% in the first 30 days post-intervention (p < 0.001) up to a maximum of 73.5% and 37.1% after the second follow-up visit at 12 months (p < 0.001). A similar trend was shown in terms of disability with a progressive and significant reduction of symptoms (menorrhagia, dysmenorrhea, dyspareunia and pollakiuria) demonstrated by percentage variation of UFS-QOL Symptom Severity and VAS scores to -74.3% and -45.3% as well as -84.9% and -74.3%, respectively, at 1 and 12 months after RFM (p < 0.001). An overall improvement in the quality of life was also demonstrated by a significant increase in the UFS-QOL total score of +38.2% in the first 30 days post-intervention up to +44.9% after the second follow-up visit at 12 months (p < 0.001). The overall average surgery time of the RFM for each patient was 48 minutes, and the time to treat each fibroid by Vaginal Ultrasound-guided RFM (23 min) was found to be significantly less than those of laparoscopy or hysteroscopy (respectively 35 and 34 min) (p < 0.05). An electromagnetic virtual needle tracking system (VNTS) was successfully tested during the RFM procedures, and real-time contrast-enhanced ultrasound (CEUS) has proven to be effective in determining the duration of myolysis through the identification of eventual residual areas of enhancement within the fibroids. Conclusion: Radiofrequency can be considered a minimally invasive and safe procedure for the treatment of uterine myomas through the customization and possible combination of transvaginal, laparoscopic or hysteroscopic accesses. The standardization of the ablation technique with pre-intervention biopsy and new technologies such as VNTS and CEUS spares healthy uterine tissue and may change the future management of symptomatic uterine fibroids.

The Focused Ultrasound Myoma Outcome Study (FUMOS); a retrospective cohort study on long-term outcomes of MR-HIFU therapy.

OBJECTIVES: Since 2004, uterine fibroids have been treated with MR-HIFU, but there are persevering doubts on long-term efficacy to date. In the Focused Ultrasound Myoma Outcome Study (FUMOS), we evaluated long-term outcomes after MR-HIFU therapy, primarily to assess the reintervention rate. METHODS: Data was retrospectively collected from 123 patients treated with MR-HIFU at our hospital from 2010 to 2017. Follow-up duration and baseline (MRI) characteristics were retrieved from medical records. Treatment failures, adverse events, and the nonperfused volume percentage (NPV%) were determined. Patients received a questionnaire about reinterventions, recovery time, satisfaction, and pregnancy outcomes. Restrictive treatment protocols were compared with unrestrictive (aiming for complete ablation) treatments. Subgroups were analyzed based on the achieved NPV < 50 or ≥ 50%. RESULTS: Treatment failures occurred in 12.1% and the number of adverse events was 13.7%. Implementation of an unrestrictive treatment protocol significantly (p = 0.006) increased the mean NPV% from 37.4% [24.3-53.0] to 57.4% [33.5-76.5]. At 63.5 ± 29.0 months follow-up, the overall reintervention rate was 33.3% (n = 87). All reinterventions were performed within 34 months follow-up, but within 21 months in the unrestrictive group. The reintervention rate significantly (p = 0.002) decreased from 48.8% in the restrictive group (n = 43; follow-up 87.5 ± 7.3 months) to 18.2% in the unrestrictive group (n = 44; follow-up 40.0 ± 22.1 months). The median recovery time was 2.0 [1.0-7.0] days. Treatment satisfaction rate was 72.4% and 4/11 women completed family planning after MR-HIFU. CONCLUSIONS: The unrestrictive treatment protocol significantly increased the NPV%. Unrestrictive MR-HIFU treatments led to acceptable reintervention rates comparable to other reimbursed uterine-sparing treatments, and no reinterventions were reported beyond 21 months follow-up. KEY POINTS: • All reinterventions were performed within 34 months follow-up, but in the unrestrictive treatment protocol group, no reinterventions were reported beyond 21 months follow-up. • The NPV% was negatively associated with the risk of reintervention; thus, operators should aim for complete ablation during MR-guided HIFU therapy of uterine fibroids. • Unrestrictive treatments have led to acceptable reintervention rates after MR-guided HIFU therapy compared to other reimbursed uterine-sparing treatments.

Health Education Using Telephone and WeChat in Treatment of Symptomatic Uterine Myoma with High-Intensity Focused Ultrasound.

BACKGROUND Adopting modern communication methods in traditional healthcare services is a trend of modern medicine. In this study we explored the value of telephone and WeChat in health education on uterine myoma by high-intensity focused ultrasound (HIFU). MATERIAL AND METHODS A total number of 426 patients diagnosed with symptomatic uterine myoma from April 2017 to September 2017 were selected and randomly divided into a routine preoperative education group (175 patients) and a telephone/WeChat preoperative health education group (251 patients). The patients in the routine preoperative education group received routine preoperative education, whereas those in the telephone/WeChat preoperative health education group received telephone/WeChat preoperative health education. Patients were evaluated before and after treatment. RESULTS Compared with the routine preoperative education group, the patients in telephone/WeChat preoperative health education group had less preoperative and postoperative anxiety, less postoperative pain, and higher treatment satisfaction (P<0.05). CONCLUSIONS Health education using telephone and WeChat preoperatively can reduce preoperative and postoperative anxiety, postoperative pain, and early postoperative inflammatory response in patients with uterine myoma, and can improve treatment satisfaction.

Pregnancy after uterine artery embolization using Gelfoam™.

We present a case study of a patient who underwent uterine artery embolization (UAE) using Gelfoam™ (Pfizer, New York, NY, USA) and had a subsequent pregnancy. Our patient, a 38-year-old female (4 Gravida/2 Para), underwent UAE for treatment of symptomatic myoma in September 2005. At the patient's seven-month post procedure visit, she experienced a 43.9% volume reduction in uterine size and 74.5% reduction in volume of the largest fibroid and relief of bulk symptoms and menorrhagia. The patient had a term delivery of healthy twin infants 15 months post embolization.

Efectividad de la combinación magnetoterapia/laserterapia/homeopatía en el tratamiento del mioma uterino / Effectiveness of magnetic therapy/laser therapy/homeopathy combination in the treatment of uterine myoma

Fundamento: el fibroma uterino constituye un problema de salud que afecta a las mujeres en edad reproductiva, los tratamientos electivos, basados en la cirugía y la embolización de la arteria uterina, aunque reportan éxito, son invasivos y riesgosos.Objetivo: evaluar los efectos del tratamiento combinado de la magnetoterapia con laserterapia y homeopatía en mujeres con mioma uterino, remitidas a la consulta de medicina natural y tradicional del policlínico universitario Rafael Izquierdo”, entre julio de 2015 y marzo de 2016.Métodos: se realizó una intervención en 25 mujeres entre 20 y 49 años, con diagnóstico de mioma uterino, en el periodo de tiempo y área antes mencionados. Las pacientes se distribuyeron al azar en dos grupos, al primero le fue aplicada la terapia combinada y al segundo el tratamiento hormonal (medroxiprogesterona). El seguimiento se hizo de forma clínica y por ultrasonograma, a los tres y seis meses después de culminar el tratamiento.Resultados: a los seis meses el grupo estudio redujo el tamaño del tumor en 21,34 mm3, más que el control; en este último, a los tres meses el 7,7 por ciento redujo intensamente el tumor, mientras en el 92,3 por ciento fue moderada; a los seis meses los pacientes con reducción intensa se incrementaron al 30,8 por ciento; en el grupo de estudio solo el 16,7 por ciento alcanzaron la reducción intensa del tumor. En la reducción del tamaño del útero no existieron diferencias significativas entre ambos grupos. La evolución clínica fue superior en el grupo control.Conclusiones: la terapia hormonal mostró mejores resultados clínicos y ultrasonográficos; en ambos tratamientos se demostró inocuidad (AU)

Background: uterine fibroma is a health problem that affects women in reproductive age. Elective treatments based on surgery and uterine arterial embolization, although successful, are invasive and risky.Objective: to assess the effects of a combined treatment with magnetic therapy, laser therapy and homeopathy in women with uterine myoma referred to the department of natural and traditional medicine at “Rafael Izquierdo” Teaching Polyclinic from July 2015 to March 2016.Methods: an intervention study was carried out with 25 women of the 20 to 49 age group with a diagnosis of uterine myoma, in the place and during the period herein mentioned. Patients were distributed at random into two groups. The first group received a combined therapy, while the second group received hormonal treatment (medroxiprogesterone). Follow-up was conducted clinically and by ultrasound, at 3 and 6 months after the end of the treatment. Results: at 6 months of treatment, the study group reduced the tumor size in 21, 34 mm3, more than in the control group; the latter, at 3 months, reduced the tumor intensively in 7,7 percent, while 92,3 percent was moderate. At 6 months, the patients with intense reduction increased to 30,8 percent. In the study group only 16,7 percent reached the intense reduction of the tumor. Concerning the reduction of the uterus size there were no remarkable differences between the two groups. Clinical progress was higher in the control group.Conclusions: Hormonal therapy showed better clinical and ultrasonographic results; both treatments were Harmless (AU)

[LAPAROSCOPIC MYOMECTOMY AFTER ULIPRISTAL ACFTATF TRFATMFMT.]

Uterine myoma is the most common benign uterine tumor in women of reproductive age and occurs in 20-25 % of the worldwide population. Heavy menstrual bleeding, pelvic pressure and pain and reproductive disfunction are common symptoms that impair women's health and quality of live. No currently approved medical treatment is able to completely eliminate fibroids. Until recently, gonadotropin-releasing hormone agonist were the only available drugs for preoperative treatment of fibroids. Since February 2012, ulipristal acetate (UPA) is also approved in Europe for preoperative fibroid treatment. One-third from them need adjuvant surgical treatment.

Embolización de las arterias uterinas como alternativa de tratamiento para miomas uterinos. Experiencia en 60 pacientes / Uterine artery embolization as an alternative treatment for uterine fibroids. Experience in 60 patients

Introducción. Los miomas uterinos son los tumores sólidos benignos más comunes del aparato genital femenino. La embolización de las arterias uterinas (EAU) se presenta como una alternativa al tratamiento quirúrgico. Objetivo. Evaluar la eficacia de EAU en el manejo de los miomas sintomáticos. Establecer la tasa de éxito y evaluar la seguridad de la técnica mediante la detección de complicaciones durante el procedimiento y con posterioridad al mismo. Material y métodos. Estudio retrospectivo bicéntrico de 60 pacientes sometidas a EAU desde el año 2000 hasta el 2011 en H. General de Albacete y H. Puerta de Hierro de Madrid. Resultados. El éxito clínico de la técnica se demostró en 41 de los 60 casos (tasa de éxito global del 68% a los 4 años de seguimiento). En 7 de los 60 casos (11,6%) se presentaron complicaciones como síndrome postembolización, dolor e isquemia transitoria del 1.er y 2.° dedo del pie, que cedieron sin mayor complicación con tratamiento médico. Conclusión. La EAU es un tratamiento eficaz en mujeres con miomas sintomáticos, mostrando una alta seguridad y un bajo índice de posibles complicaciones menores (AU)

Introduction. Uterine fibroids are the most common benign solid tumors of the female genital tract. Uterine artery embolization (UAE) is presented as an alternative to surgical treatment. Objective. To evaluate the efficacy of UAE in the management of symptomatic fibroids, establish the success rate, and evaluate the safety of the technique by detecting complications during the procedure. Material and methods. A retrospective dual-center study was performed in 60 patients undergoing UAE from 2000 to 2011 in Albacete and the Puerta de Hierro General Hospital in Madrid. Results. The clinical success of the technique was demonstrated in 41 of the 60 patients (overall success rate of 68% at 4 years of follow-up) Complications occurred in 7 of the 60 patients (11.6%), consisting of embolization syndrome and transient ischemic pain in the first and second, which resolved with medical treatment and without further complications. Conclusion. UAE is an effective treatment for women with symptomatic fibroids, showing high reliability and a low rate of minor complications (AU)

Combined myomectomy and uterine artery embolization.

UNLABELLED: Objective: To evaluate the safety and efficacy of uterine artery embolization combined with endoscopic myomectomy. MATERIAL AND METHODS: We conducted a retrospective chart review of patients (n = 125) who underwent myomectomy concurrent with embolization within one month. We assessed two groups: 1) uterine artery embolization followed by hysteroscopic myomectomy and 2) uterine artery embolization followed by laparoscopic myomectomy. RESULTS: Following the combination procedures, 72% of the surveyed women reported symptom improvement. With the combined procedures, 92.5% of patients experienced reduction in myoma diameter and 87.5% of patients had decreased uterine size after an average of 4.70 months post subsequent procedure. The amount of decrease in the uterine volume (p = 0.39) and fibroid size (p = 0.23) were not significant between the two endoscopic myomectomy groups. CONCLUSIONS: Combining myomectomy with uterine artery embolization is a safe and effective procedure in treating symptoms and reducing myoma and uterine volumes.

[Uterine artery embolization for myomas treatment]. / Embolisation dans le traitement des myomes.

Myoma treatment by uterine artery embolisation (UAE) using non-spherical PVA particles or calibrated tris-acryl microspheres>500µm is effective in more than 90 % of cases in the short-term. In the long-term, menorrhagia, bulk-related symptoms and pelvic pain are significantly improved or eliminated in 75 % of cases at 5 to 7 years. At 6 months, uterine volume reduction and larger myoma volume reduction varies between 30 to 60 % and 50 to 80 % respectively. During hospital stay the complication rate is very low, less than 3 % mostly urinary infection and pain. Secondary hysterectomy for complication is less than 2 % at 3 months. Definitive amenorrhea is reported in less than 5 % of cases in women of more than 45-year of age. No significant impact of embolization on hormonal function has been reported in women less than 45 years with normal baseline function. UAE is not indicated for submucous myomas. Randomized studies comparing embolization to hysterectomy demonstrate that reinterventions are more frequently performed after embolization. Secondary hysterectomy is performed in 13 to 24 % of cases at 2 years and in up to 28 % of cases at 5 years. Hospital stay, duration of recovery and time off work are shorter after embolization compared to hysterectomy. Embolization is cheaper than hysterectomy at 12 and 24 months even taking into consideration the additional costs of imaging and reinterventions. UAE is a good alternative treatment in women with unique myoma of less than 10cm and multiple myomas around 15cm. This treatment should be proposed to women each time possible. Randomized studies comparing embolization to myomectomy demonstrate that in the short and mid-term there is no difference in terms of control of menorrhagia and bulk-related symptoms. Uterine volume reduction and quality of life were not different at 6 months. Periprocedural and 30-day complication rates are not different. At 6 months, the rate of complications is higher after myomectomy. Reinterventions are more frequent after embolization compared to myomectomy. Hospital stay, duration of recovery and time off work are shorter after embolization compared to myomectomy. UAE is less aggressive than myomectomy and should be proposed as a conservative alternative treatment. Embolization should be considered with caution in pregnancy-seeking women since there is still a lack of good quality data available in the specific group of patients. FSH level is more frequently elevated after embolization compared to myomectomy. Pregnancy rate and term pregnancy rate are higher after myomectomy compared to embolization. Spontaneous abortion is more frequent after embolization than after myomectomy. At this time, UAE is not indicated excepted in studies or in specific cases when the woman want a pregnancy. Embolization performed before myomectomy (preoperative or combined procedures) can be discussed for an individual patient but there is not enough data to support its routine use.

[Myomas management, alternatives to hysterectomy and myomectomy: what can we propose?]. / Prise en charge des myomes, alternatives à l'hystérectomie ou la myomectomie : que peut-on proposer aujourd'hui ?

Second generation endometrial ablation techniques must be used preferably as they present less complications than first generation techniques. An efficient contraception is highly recommended after thermal ablation. Myolysis techniques are still investigational, focused ultrasound myolysis MR or ultrasound-guided is accessible to approximately 10% of uterine myomas with 70% of long-term symptom relief. Outcomes of laparoscopic uterine artery occlusion are similar to those of uterine artery embolization but with less long-term durability.

Is uterine artery embolization for patients with large myomas safe and effective? A retrospective comparative study in 323 patients.

PURPOSE: To evaluate the effectiveness, safety, and complications of uterine artery embolization (UAE) in women with large fibroid tumors. MATERIALS AND METHODS: From January 2005 to February 2011, 323 patients underwent UAE for symptomatic uterine leiomyomas without adenomyosis and were included in this study. Patients were divided into two groups: those with a large tumor burden (group 1; n = 63), defined as a dominant tumor with a longest axis of at least 10 cm or a uterine volume of at least 700 cm(3); and the control group (group 2; n = 260). Tumor infarction and volume reduction were calculated based on magnetic resonance imaging findings. Symptom status was assessed with a visual analog scale. Postprocedure complications and repeat interventions were recorded. The data were analyzed with appropriate statistical tests. RESULTS: No significant differences were seen between the two groups in volume reduction of dominant tumors (46.5% in group 1 vs 52.0% in group 2; P = .082) or percentage volume reduction of the uterus (40.7% in group 1 vs 36.3% in group 2; P = .114). Also, no significant differences were seen between the two groups regarding satisfaction scores at immediate or midterm follow-up (P = .524 and P = .497) or in the presence of procedure-related complications (P = .193). CONCLUSIONS: UAE outcomes in large fibroid tumors were comparable to those in smaller tumors, without an increased risk of significant complications. Tumor size may not be a key factor in predicting successful outcomes of UAE.