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A Systematic Review of Minimally Invasive Treatments for Uterine Fibroid-Related Bleeding.
Zhang, Jiahui; Go, Virginia-Arlene; Blanck, Jaime Friel; Singh, Bhuchitra.
Afiliação
  • Zhang J; Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, USA.
  • Go VA; Department of Obstetrics and Gynecology, Saint Joseph Hospital Denver, Denver, CO, USA.
  • Blanck JF; Informationist Services, Welch Medical Library, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
  • Singh B; Division of Reproductive Sciences & Women's Health Research, Department of Gynecology & Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA. bsingh10@jhmi.edu.
Reprod Sci ; 29(10): 2786-2809, 2022 10.
Article em En | MEDLINE | ID: mdl-34480321
Newer minimally invasive techniques provide treatment options for symptomatic uterine fibroids while allowing uterus preservation. The objective of this review was to analyze the efficacy of uterine-preserving, minimally invasive treatment modalities in reducing fibroid-related bleeding. A comprehensive search was conducted of PubMed, Embase, PsycINFO, ClinicalTrials.gov, Scopus, and Cochrane Library databases from inception to July 2020. English-language publications that evaluated premenopausal women with fibroid-related bleeding symptoms before and after treatment were considered. Randomized controlled trials were assessed for bias with the established Cochrane Risk of Bias Tool 2.0 and observational studies were assessed for quality under the New Castle-Ottawa Scale guidelines. Eighty-four studies were included in the review, including 10 randomized controlled trials and 74 observational studies. Six studies on myomectomy demonstrated overall bleeding symptom improvement in up to 95.9% of patients, though there was no significant difference between mode of myomectomy. Forty-one studies on uterine artery embolization reported significant reduction of fibroid-related bleeding, with symptomatic improvement in 79 to 98.5% of patients. Three studies suggested that embolization may be superior to myomectomy in reducing fibroid-related bleeding. Six studies reported that laparoscopic uterine artery occlusion combined with myomectomy led to greater reduction of bleeding than myomectomy alone. Fifteen studies demonstrated significantly reduced bleeding severity after radiofrequency ablation (RFA). Additional research is needed to establish the superiority of these modalities over one another. Long-term evidence is limited in current literature for magnetic resonance-guided focused ultrasound surgery, cryomyolysis, microwave ablation, and laser ablation.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Neoplasias Uterinas / Miomectomia Uterina / Leiomioma Tipo de estudo: Clinical_trials / Etiology_studies / Guideline / Observational_studies / Systematic_reviews Limite: Female / Humans Idioma: En Revista: Reprod Sci Assunto da revista: MEDICINA REPRODUTIVA Ano de publicação: 2022 Tipo de documento: Article País de afiliação: Estados Unidos País de publicação: Estados Unidos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Neoplasias Uterinas / Miomectomia Uterina / Leiomioma Tipo de estudo: Clinical_trials / Etiology_studies / Guideline / Observational_studies / Systematic_reviews Limite: Female / Humans Idioma: En Revista: Reprod Sci Assunto da revista: MEDICINA REPRODUTIVA Ano de publicação: 2022 Tipo de documento: Article País de afiliação: Estados Unidos País de publicação: Estados Unidos