BACKGROUND:

• Interventions to remove fibroids but retain the uterus include
  • Uterine artery embolization (UAE)
  • Radiofrequency ablation (RFA)
  • (Laparoscopic) ligation and cryoablation
  • High-intensity focused ultrasound (HIFU)
• Sandberg et al. (Fertility and Sterility, 2018) compared the efficacy of uterine-sparing treatment options for fibroids

METHODS:

• Systematic review and meta-analysis
• Participants: Women with uterine fibroids undergoing a uterine-sparing intervention
• Primary outcomes
  • Reintervention risk after uterine-sparing treatment for fibroids after 12, 36, and 60 months
  • Quality of life outcomes, based on validated questionnaires (scale 0 to 100)
    • Severity Symptom Score (SSS): Score decreases with improvement
    • Health-Related Quality of Life questionnaire (HRQL): Score increases with improvement
  • The first group of procedures used an abdominal approach
    • Myomectomy (abdominal, laparoscopic and robotic combined)
    • Uterine artery embolization (UAE)
    • Artery ligation
    • High-intensity focused ultrasound (HIFU)
    • Laparoscopic radiofrequency ablation (RFA)
    • Cryoablation
  • The second group of procedures used a hysteroscopic approach, used for intracavitary fibroids
    • Hysteroscopic myomectomy
    • Hysteroscopic RFA

Results:

• The analyses included 85 articles, totaling 17,789 women
• 87% of women had abdominal approach and 12.2% had a hysteroscopic approach
• Reintervention risk after 12 months
  • Varied from 0.3% (laparoscopic RFA, 95% CI 0–1.6%) up to 15% (cryoablation, 1 study)
• Reintervention risk after 36 months
  • Varied from 1.2% (myomectomy, 95% CI 0–5.2%, 4 studies) to 34.7% (HIFU, 95% CI 27.3%–42.4%, 4 studies)
• Reintervention risk after 60 months was
  • Myomectomy: 12.2% (95% CI 5.2%–21.2%)
  • UAE: 14.4% (95% CI 9.8%–19.6%)
  • HIFU: 53.9% (95% CI 47.2%–60.4%)
  • 7% (95% CI 4.8%–9.5%) for hysteroscopic myomectomy
• No studies were available at 60 months for artery ligation, laparoscopic RFA, and cryoablation
• Quality of life improved after treatment for all options
• The HIFU procedure had the least favorable outcomes
• Subanalysis for hysterectomy as reintervention
  • At 36 months, hysterectomy reintervention varied from 0.6% (myomectomy) to 8.1% (laparoscopic RFA)
  • at 60 months, hysterectomy reintervention was as follows
    • Myomectomy: 7%
    • UAE: 9.4%
    • HIFU 22.2%

Conclusions:

• Reintervention was greatest for HIFU to treat fibroids
• The authors point out that
  • Population selection may be an issue in the HIFU studies
  • Although HIFU is FDA approved since 2004 and morbidity is low, more study may be warranted, especially long-term outcomes
  • Hysterectomy reintervention following UAE was <10%
  • Available evidence did not allow for adjustments based on infertility as an indication for treatment

Learn More – Primary Sources

Reintervention risk and quality of life outcomes after uterine-sparing interventions for fibroids: a systematic review and meta-analysis

Related ObG Topics:

Managing Fibroids: Medical and Surgical Options

High-Intensity Ultrasound for Fibroids – What are the Pregnancy Outcomes?

Uterine Artery Embolization or Focused Ultrasound for Uterine Fibroids?