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Effect of Mirena and a GnRHa on the outcome of HIFU for dysmenorrhea and hypermenorrhea. NRS, numerical rating scale; FPS, five-point scale; HIFU, high-intensity focused ultrasound; GnRHa, gonadotropin-releasing hormone agonist.
Source publication
Objectives
Adenomyosis is a common and refractory disease in gynecology. Preserving the uterus during treatment for adenomyosis remains a problem. High-intensity focused ultrasound (HIFU) is widely used in treatment of solid tumors. This study aimed to analyze patients with adenomyosis who were treated by HIFU and to preliminarily examine the chara...
Citations
... HIFU is the most recently developed noninvasive technique that induces thermal ablation in the target lesion by focusing beams of ultrasound waves at the desired point with minimal or no damage to the surrounding normal tissue [12,13]. In addition to the brain, prostate gland, bone, or uterine leiomyomas [13][14][15][16][17], HIFU has been successfully applied for the treatment of uterine adenomyosis [18][19][20][21]. Moreover, there have been technological advances in the HIFU system that have enabled safer and more effective treatments, which have been demonstrated in preclinical and clinical studies targeting uterine fibroids [22,23]. ...
This study aimed to investigate the efficacy and safety of using optimized parameters obtained by computer simulation for ultrasound-guided high-intensity focused ultrasound (HIFU) treatment of uterine adenomyosis in comparison with conventional parameters. We retrospectively assessed a single-institution, prospective study that was registered at Clinical Research Information Service (CRiS) of Republic of Korea (KCT0003586). Sixty-six female participants (median age: 44 years) with focal uterine adenomyosis were prospectively enrolled. All participants were treated with a HIFU system by using treatment parameters either for treating uterine fibroids (Group A, first 20 participants) or obtained via computer simulation (Group B, later 46 participants). To assess the treatment efficacy of HIFU, qualitative indices, including the clinically effective dysmenorrhea improvement index (DII), were evaluated up to 3 years after treatment, whereas quantitative indices, such as the nonperfused volume ratio and adenomyosis volume shrinkage ratio (AVSR), on MRI were evaluated up to 3 months after treatment. Quantitative/qualitative indices were compared between Groups A and B by using generalized linear mixed effect model. A safety assessment was also performed. Results showed that clinically effective DII was more frequently observed in Group B than in Group A (odds ratio, 3.69; P = 0.025), and AVSR were higher in Group B than in Group A (least-squares means, 21.61; P = 0.001). However, two participants in Group B developed skin burns at the buttock and sciatic nerve pain and required treatment. In conclusion, parameters obtained by computer simulation were more effective than the conventional parameters for treating uterine adenomyosis by using HIFU in terms of clinically effective DII and AVSR. However, care should be taken because of the risk of adverse events.
... The decrease in the menstrual score in the treatment group was significantly greater than that in the control group ( Figure 6), indicating that the menstrual volume in the treatment group significantly improved after endometrial ablation. A recent study (19) further showed that HIFU therapy can alleviate FIGURE 5 Reduction of VAS in patients after HIFU treatment. VAS, visual analog scale; HIFU, high-intensity focused ultrasound. ...
Objective
The present study aimed to investigate the clinical efficacy of endometrial ablation with high-intensity focused ultrasound (HIFU) for symptom relief in women with adenomyosis.
Methods
Between July 2014 and July 2020, 167 patients with adenomyosis treated at the Zhongshan City People’s Hospital were enrolled in this study. Patients were divided into two groups according to patient aspirations: the control group, including patients who only underwent ablation of adenomyosis lesions (group A) and the treatment group, including patients who underwent removal of adenomyosis lesions and endometrial ablation (group B).
Results
The reduced dysmenorrhea scores (visual analog scale) and menstrual volume scores (pictorial blood assessment chart) were measured before and after treatment. The scores were obtained by subtracting the postoperative scores from the preoperative scores and were compared to determine whether the symptoms had alleviated. Compared with the menstrual volume of group A, that in group B showed significant improvements. The average relief rates of dysmenorrhea in the two groups also showed significant improvement. However, the scores in group B showed a more significant improvement than those in group A.
Conclusion
Therefore, our findings suggest that endometrial ablation using HIFU may be superior to conventional therapy with regard to alleviating the symptoms of increased menstruation in women with adenomyosis.
... As a noninvasive treatment, high-intensity focused ultrasound (HIFU) ablation has been utilized in the treatment of adenomyosis. Several studies have shown the safety and efficacy of HIFU treatment for adenomyosis and no damage to the surrounding myometrium as well as ovarian function [19][20][21][22][23][24]. However, there remains no study on pregnancy outcomes of adenomyotic patients with primary infertility. ...
Objective
To evaluate the therapeutic effect of high-intensity focused ultrasound (HIFU) treatment for adenomyotic patients with primary infertility and to explore the factors that affect the pregnancy outcomes.
Materials and methods
Twenty-seven adenomyotic patients with primary infertility who underwent HIFU at HUNAN Provincial Maternal and Child Health Care Hospital, China, between July 2018 and December 2022 were retrospectively reviewed. We evaluated the pregnancy outcomes and analyzed the factors that may affect pregnancy outcomes including time to conception, pregnancy approach, gestational age, delivery mode, neonatal outcomes, and complications during pregnancy and delivery.
Results
Among the 27 adenomyotic patients with primary infertility, 10 patients had a total of 11 pregnancies after HIFU treatment. Of these, eight (72%) cases were natural pregnancies and three (23%) were in vitro fertilization (IVF) pregnancies. The median time to conception was 10 (range 4–25) months. There were eight (72%) successful deliveries. The rate of full-term deliveries was 90%. Of the eight live births, four (50%) were born vaginally and four (50%) by cesarean section. No severe complications occurred. The mean birth weight of newborns was 3.1 (range: 2.3–3.9) kg; all newborns developed well without complications during postpartum and breastfeeding.
Conclusions
HIFU treatment for adenomyosis could improve fertility of patients with primary infertility. HIFU is a promising therapeutic approach for patients with adenomyosis and infertility who wish to achieve pregnancy and have live birth deliveries.
... The decrease in the menstrual score in the treatment group was signi cantly greater than that in the control group (Fig. 6), indicating that the menstrual volume in the treatment group had signi cantly improved after endometrial ablation. A recent study [17] further showed that HIFU therapy can improve menorrhagia in adenomyosis to a small extent. The endometrial ablation method for menorrhagia in this study was a remedy for this de ciency. ...
This study aimed to investigate the clinical efficacy of endometrial ablation with high-intensity focused ultrasound (HIFU) for symptom relief in women with adenomyosis. Between July 2014 and July 2020, 167 patients with adenomyosis treated at the Zhongshan City People’s Hospital were enrolled in this study. Patients were divided into two groups according to patient aspirations: the control group, including patients who only underwent ablation of adenomyosis lesions (group A) and the treatment group, including patients who underwent removal of adenomyosis lesions and endometrial ablation (group B). The reduced dysmenorrhea scores (visual analog scale) and menstrual volume scores (pictorial blood assessment chart) were measured before and after treatment. Scores were obtained by subtracting postoperative scores from preoperative scores and were compared to determine whether the symptoms had alleviated. Compared with the menstrual volume of group A, group B showed significant improvements. The average relief rates of dysmenorrhea in the two groups also showed significant improvement. However, the scores in group B showed significant improvement compared with those in group A. Therefore, the findings suggest that endometrial ablation using HIFU may be superior to conventional therapy for adenomyosis at improving the symptoms of increased menstruation.
... As a noninvasive treatment, high intensity focused ultrasound (HIFU) ablation has been utilized in the treatment of adenomyosis, and several studies have shown the safety and efficacy [17][18][19][20][21]. A previous study showed that the clinical effective rate was about 80% when the non-perfused volume (NPV, indicative of successful ablation) reached 70% or higher [22]. ...
Objective
To evaluate the mid-term symptom improvement of patients with different types of adenomyosis based on magnetic resonance imaging (MRI) classification after ultrasound-guided high intensity focused ultrasound (USgHIFU) treatment.
Materials and methods
A total of 321 patients with adenomyosis who underwent HIFU and completed 18-month follow-up were retrospectively reviewed. Based on the relationship between the adenomyotic lesion and the uterine structural components on T2-weighted imaging (T2WI), adenomyotic lesions were classified as internal, external, full thickness and intramural adenomyosis. Based on the extent of the myometrial involvement, these lesions were further subclassified as asymmetric and symmetric adenomyosis.
Results
All patients completed HIFU ablation in one session. The range of median menstrual pain score in patients with asymmetric internal, symmetric internal, asymmetric external, asymmetric full thickness, symmetric full thickness, and intramural adenomyosis was between 6 and 8 points before HIFU, the median menstrual pain score decreased to 2–4 points 18-month post-HIFU (p < .005). The menstrual pain relief rate was 68.3%, 62.1%, 54.7%, 64.1%, 60%, and 100%, respectively. The median menstrual blood volume score range was between 2 and 4 points in the different groups of patients before HIFU, it decreased to 1–3 points 18-month after HIFU with a relief rate of 68.3%, 51.6%, 51.0%, 55.5%, 57.2%, and 100%, respectively. No serious complication occurred in any of these patients.
Conclusions
Based on our results, USgHIFU is safe and effective in the treatment of patients with different subtypes of adenomyosis with mid-term sustained improvement in symptoms of menstrual pain and menstrual blood volume.
... It has been widely studied in the treatment of adenomyosis and results were consistent in revealing that it is safe and effective but RCTs are lacking. HIFU showed a significant decrease in dysmenorrhea scores and in volume of adenomyotic lesions across several studies [78][79][80][81]. Menorrhagia also seems to significantly improve after treatment with HIFU in both focal and diffuse adenomyosis [82][83][84]. ...
(1) Background: Adenomyosis is a poorly understood entity which makes it difficult to standardize treatment. In this paper we review and compare the currently approved medical and surgical treatments of adenomyosis and present the evidence behind them. (2) Methods: A PubMed search was conducted to identify papers related to the different treatments of adenomyosis. The search was limited to the English language. Articles were divided into medical and surgical treatments. (3) Results: Several treatment options have been studied and were found to be effective in the treatment of adenomyosis. (4) Conclusions: Further randomized controlled trials are needed to compare treatment modalities and establish a uniform treatment algorithm for adenomyosis.
