Clinical Efficacy and Safety of Fertility-Preservative PUSH Surgery for Diffuse Adenomyosis: Evidence from a 11-Year Prospective Investigation

Abstract

Background: Women with diffuse adenomyosis frequently have severe symptoms, including dysmenorrhea and infertility. Though it is beneficial for long-term health if the uterus can be preserved, there is no prospective investigations to assess lesion removal, symptom alleviation and even gestations after uterus-preservative surgery. Methods: We applied self-optimized PUSH surgery for 146 patients with diffuse adenomyosis and conducted 2 to 11-year follow-up for 114 patients. We detailed procedures in uterine incision , excision of the lesion, uterus reconstruction, solutions for removing giant lesions, and assessed the clinical efficacy and fertility in follow-up. Findings: The average size and volume of the patients’ uterus decreased significantly after PUSH surgery. Operation-related complications occurred in 2.7% (4/146) of the patients. Among 114 patients who had been investigated for ≥2 years, 107 (93.9%, analytic group) had detailed records that was needed to evaluate the long-term outcomes. In analytic group, 5 cases recurred and 95.3% (102/107) of the patients had normal uterine size two years after surgery. The visual analogue scale (VAS) for dysmenorrhea significantly decreased in 102 cases, from 9.35±1.25 to 0.34±0.76 and 0.56±1.06 in the first and second year after surgery, respectively. Additionally, 97.7% of the 86 patients with severe menorrhagia had their symptoms ameliorated in the second year of follow-up. Of the 23 patients who desired for pregnancy and stopped contraception for ≥2 years, 13 (13/23,57%) individuals conceived with17 pregnancies. Twelve patients had 15 intrauterine pregnancies and 7 patients had 8 living fetus. No uterine rupture or severe complications were found in all gestations. Interpretation: This study demonstrate good performance of PUSH surgery in removing uterine lesions, ameliorating menorrhagia and preserving fertility for women with diffuse adenomyosis. Funding: Shenzhen High-level Hospital Construction Fund(YBH2019-260)，Shenzhen Key Medical Discipline Construction Fund(No.SZXK027), Sanming Project of Medicine in Shenzhen(No.SZSM202011016), Scientific Research Foundation of PEKING UNIVERSITY SHENZHEN HOSPITAL(No.KYQD2021075). Declaration of Interest: The authors declare that they have no competing interests. Ethical Approval: The research protocol was approved by the Ethics Committee of Peking University Shenzhen Hospital (IRB approval number: 20190729).