High-intensity Focused Ultrasound for Treatment of Type 2 Submucous Myomas More Than 4 Centimeters in Diameter Prior to Hysteroscopic Myomectomy

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To assess the feasibility of treating type 2 submucous myomas more than 4 cm in diameter with high-intensity focused ultrasound (HIFU) prior to hysteroscopic myomectomy (HM). Retrospective case series evaluating HIFU treatment of type 2 submucous myomas before HM, with efficacy compared with baseline (i.e., before treatment). Teaching hospital. Five women with type 2 submucous myomas more than 4cm in diameter (mean, 5.6cm; range, 4.7-6.3cm). The mean age of the patients was 40.6 years (31-47 yr); median age 42 years. Type 2 submucous myomas were treated with HIFU. HM was performed in one step. The time between HIFU and HM was 136 days. The mean volumes of the corpora and myomas were significantly less after HIFU. The mean shrinkage of the corpora and myomas (volume before HIFU/volume before HM × 100%) were 41.4 ± 18.1% and 67.6 ± 17.0%, respectively, which did not differ statistically. All 5 of the submucous myomas changed from type 2 to type 1 or type 0 after HIFU treatment. The percentage of the uterine cavity occupied by the myoma at baseline and after HIFU was 38.8% ± 2.8% and 78.0 ± 21.4%, respectively, a significant increase associated with HIFU. The hemoglobin increased with HIFU, significantly with an elevated value of 11.0 ± 7.5. Treatment of type 2 submucous myomas more than 4 cm in diameter with HIFU before HM was effective, with reductions in myoma type (from 2 to 1 or 0) and shrinkage of myoma size. HIFU as a pretreatment should increase the safety of HM.