Abstract
Background: Radiofrequency ablation (RFA) has emerged as a safe and effective treatment option for women with symptomatic uterine fibroids and can be delivered by laparoscopic, transvaginal, or transcervical approaches. The evidence regarding typical patient outcomes with RFA has not previously been examined in a comprehensive fashion.Materials and Methods: We performed a systematic review of prospective studies for treatment of uterine fibroids with RFA. Main outcomes were procedure time, patient recovery metrics, change in fibroid volume, symptom severity score (SSS), health-related quality of life (HRQL), and reinterventions. Data were analyzed with random effects meta-analysis and metaregression.Results: We identified 32 articles of 1283 unique patients (median age: 42 years) treated with laparoscopic RFA (19 articles), transvaginal RFA (8 articles), or transcervical fibroid ablation (5 articles). Mean procedure time was 49 minutes, time to discharge was 8.2 hours, time to normal activities was 5.2 days, and time to return to work was 5.1 days. At 12 months follow-up, fibroid volume decreased by 66%, HRQL increased by 39 points, and SSS decreased by 42 points (all P < .001 versus baseline). The annual cumulative rate of reinterventions due to fibroid-related symptoms was 4.2%, 8.2%, and 11.5% through 3 years.Conclusions: RFA of uterine fibroids significantly reduces fibroid volume, provides significant durable improvements in fibroid-related quality of life, and is associated with favorable reintervention rates.
Highlights
Uterine fibroids are the most common benign solid pelvic tumor in women, developing in *70% to 80% of women by 50 years of age.1 More than 1 in 3 women with uterine fibroids report symptoms that interfere with activities of daily living such as heavy menstrual bleeding and/or bulk symptoms.2 Self-management with nonprescription medication or lifestyle modification is common, but often unsuccessful.3 Several surgical and interventional treatments are available to women with persistent symptoms attributable to uterine fibroids, including hysterectomy, myomectomy, and uterine artery embolization
Radiofrequency ablation (RFA) may be delivered by a laparoscopic, transvaginal, or transcervical approach into the uterine fibroid to induce coagulative necrosis4 with subsequent reduction in fibroid-related symptoms
We identified 505 articles in our searches and included 32 articles of 1283 unique patients treated with RFA for uterine fibroids in this systematic review
Summary
Uterine fibroids are the most common benign solid pelvic tumor in women, developing in *70% to 80% of women by 50 years of age. More than 1 in 3 women with uterine fibroids report symptoms that interfere with activities of daily living such as heavy menstrual bleeding and/or bulk symptoms. Self-management with nonprescription medication or lifestyle modification is common, but often unsuccessful. Several surgical and interventional treatments are available to women with persistent symptoms attributable to uterine fibroids, including hysterectomy, myomectomy, and uterine artery embolization. Radiofrequency ablation (RFA) has emerged as a safe and effective treatment alternative as the procedure can be delivered in a minimally invasive fashion. RFA may be delivered by a laparoscopic, transvaginal, or transcervical approach into the uterine fibroid to induce coagulative necrosis with subsequent reduction in fibroid-related symptoms. Radiofrequency ablation (RFA) has emerged as a safe and effective treatment option for women with symptomatic uterine fibroids and can be delivered by laparoscopic, transvaginal, or transcervical approaches. Main outcomes were procedure time, patient recovery metrics, change in fibroid volume, symptom severity score (SSS), health-related quality of life (HRQL), and reinterventions. Conclusions: RFA of uterine fibroids significantly reduces fibroid volume, provides significant durable improvements in fibroid-related quality of life, and is associated with favorable reintervention rates
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