Treatment Of Fibroids Research Articles

Application of transabdominal ultrasound- and laparoscopy-guided percutaneous microwave ablation for treating uterine fibroids: 24-month follow-up outcomes.

To determine the ablation efficacy of transabdominal ultrasound- and laparoscopy-guided percutaneous microwave ablation (PMWA), to investigate whether the risk of damage to adjacent organs and endometrium due to this technique can be reduced or even avoided. We also evaluated the clinical efficacy of this technique in the treatment of uterine fibroids of different sizes and at different locations over a 24-month follow-up period. This study included 50 patients with uterine fibroids who underwent transabdominal ultrasound- and laparoscopy-guided PMWA from August 2018 to July 2020. Lesions were confirmed by pathology. The technical efficacy and complications of PMWA were assessed. The lesion diameter, lesion volume, lesion location, and contrast-enhanced ultrasound (CEUS) features before PMWA and within 24h after PMWA were recorded. Magnetic resonance imaging (MRI) was used for follow-up at 3 and 6months after PMWA. Transvaginal ultrasound was used for follow-up at 24months after PMWA. A total of 50 patients with uterine fibroids received treatment. The median ablation rate of uterine fibroids was 97.21%. The mean lesion volume reduction rates were 32.63%, 57.26%, and 92.64% at 3, 6, and 24months after treatment, respectively. The size and location of uterine fibroids did not significantly affect the ablation rate and the rate of lesion volume reduction. No major complication was found during and after the procedure. Transabdominal ultrasound- and laparoscopy-guided PMWA can be utilized to safely enhance the ablation rate while minimizing ablation time and avoiding harm to adjacent organs and the endometrium. This technique is applicable for treating uterine fibroids of different sizes and at varying locations. ChiCTR-IPR-17011910, and date of trial registration: 08/07/2017.

The impact of epigallocatechin gallate, vitamin D, and D-chiro-inositol on early surgical outcomes of laparoscopic myomectomy: a pilot study.

A prospective investigation to assess the impact of 3months of treatment with epigallocatechin gallate (EGCG), vitamin D and D-chiro-inositol (DCI) in the treatment of uterine fibroids (UF) with laparoscopic myomectomy as evidenced by surgical outcomes and effect on liver function. Non-pregnant or lactating women aged between 30 and 40years were scheduled for laparoscopic myomectomy to treat symptoms or looking to conceive. After enrollment, patients were assigned to either (1) intervention group, assuming a total of 300mg EGCG, 50μg vitamin D, and 50mg DCI divided in 2 pills per day for 3months, or (2) control group, including untreated women scheduled to undergo laparoscopic myomectomy after 3months. 91 patients completed the study. The comparison of the surgical outcomes between the intervention (n = 44) and the control (n = 47) groups revealed that the treatment significantly reduces the duration of surgery (41.93 ± 7.56min vs 56.32 ± 10.63min, p < 0.001). Moreover, the treatment also reduced blood loss during surgery (149.09 ± 25.40mL vs 168.41 ± 21.34mL, p < 0.001), resulting in treated patients having higher Hb levels at discharge 11.27 ± 0.82mL vs 10.56 ± 0.82mL, p < 0.01). The surgery induced an increase in AST and in total bilirubin regardless of the assigned group, and the treatment induced no change in liver function. Our data suggest that EGCG plus vitamin D, and DCI could represent a safe option for women with UF scheduled for laparoscopic myomectomy, improving surgical outcomes without affecting liver functionality.

Factors influencing magnetic resonance imaging changes associated with pelvic bone injury after high-intensity focused ultrasound ablation of uterine fibroids: a retrospective case-control study.

The application of high-intensity focused ultrasound (HIFU) in the treatment of uterine fibroids is becoming increasingly widespread, and postoperative collateral thermal damage to adjacent tissue has become a prominent subject of discussion. However, there is limited research related to bone injury. Therefore, the aim of this study was to investigate the potential factors influencing unintentional pelvic bone injury after HIFU ablation of uterine fibroids with magnetic resonance imaging (MRI). A total of 635 patients with fibroids treated with HIFU in the First Affiliated Hospital of Chongqing Medical University were enrolled. All patients underwent contrast-enhanced MRI (CE-MRI) pre- and post-HIFU. Based on the post-treatment MRI, the patients were divided into two groups: pelvic bone injury group and non-injury group, while the specific site of pelvic bone injury of each patient was recorded. The univariate and multivariate analyses were used to assess the correlations between the factors of fibroid features and treatment parameters and pelvic bone injury, and to further analyze the factors influencing the site of injury. Signal changes in the pelvis were observed on CE-MRI in 51% (324/635) of patients after HIFU. Among them, 269 (42.4%) patients developed sacral injuries and 135 (21.3%) had pubic bone injuries. Multivariate analyses showed that patients with higher age [P=0.003; odds ratio (OR), 1.692; 95% confidence interval (CI): 1.191-2.404], large anterior side-to-skin distance of fibroid (P<0.001; OR, 2.297; 95% CI: 1.567-3.365), posterior wall fibroid (P=0.006; OR, 1.897; 95% CI: 1.204-2.989), hyperintensity on T2-weighted imaging (T2WI, P=0.003; OR, 2.125; 95% CI: 1.283-3.518), and large therapeutic dose (TD, P<0.001; OR, 3.007; 95% CI: 2.093-4.319) were at higher risk of postoperative pelvic bone injury. Further analysis of the factors influencing the site of the pelvic bone injury showed that some of the fibroid features and treatment parameters were associated with it. Moreover, some postoperative pain-related adverse events were associated with the pelvic bone injury. Post-HIFU treatment, patients may experience pelvic injuries to the sacrum, pubis, or a combination of both, and some of them experienced adverse events. Some fibroid features and treatment parameters are associated with the injury. Taking its influencing factors into full consideration preoperatively, slowing down treatment, and prolonging intraoperative cooling phase can help optimize treatment decisions for HIFU.

The role of socioeconomic status in uterine fibroid awareness and treatment: a narrative review.

Uterine fibroids, known as leiomyomas, are non-cancerous tumors in women. Uterine fibroids disproportionately affect African American women, as they are more common and severe. Uterine fibroids are the leading cause of hysterectomy in African American women. Over 80% of African American women will receive a uterine fibroids diagnosis before 50. Myomectomies (removal of uterine fibroids) and hysterectomies (removal of the uterus) are more prevalent in African American women due to more significant symptoms. Socioeconomic status, including education and income, influences access to healthcare, with some treatments directly affected by insurance coverage and the cost of the procedure. This review aimed to characterize the socioeconomic disparities and inequities regarding uterine fibroids awareness, perceptions, and treatment and to understand how socioeconomic status impacts knowledge and treatment of uterine fibroids. Recognition of the treatment barriers and decisions due to socioeconomic status is a critical step in ensuring equitable treatment options for women diagnosed with uterine fibroids. A narrative literature review was conducted using PubMed, MedLine, and Google Scholar. A total of 98 articles were returned. After adjusting for the exclusion criteria, 10 articles were included in this review. The review demonstrated the disparities in treatment options based on race and socioeconomic status. Low-income women were more likely to receive more invasive treatment, which resulted in more time off work and increased medical bills. In addition, women in lower-income brackets frequented the emergency department at an increased level. This review underscored the need for additional research to learn about the role of socioeconomic status in uterine fibroid awareness and treatment.

Low Serum Vitamin D3 Levels among Premenopausal Women with Uterine Fibroids: A Cross-Sectional Study

Background: Uterine fibroids are the most common benign tumors in women of reproductive age, with an incidence ranging from 5.4% to 77%, leading to significant morbidity and affecting quality of life. Earlier studies suggested that uterine fibroids are more likely to develop in those women with low levels of serum vitamin D. Subsequently, the objective of the current study was to investigate the association of serum vitamin D3 levels in premenopausal women with uterine fibroids. Methodology: A cross-sectional study was conducted at Indira IVF Hospital and Fertility Clinics located in India. The study was conducted from April 2022 to November 2022. In this study, a total of 160 women [80 cases and 80 controls] were enrolled. Women diagnosed with at least one uterine fibroid measuring 2 cm in size through a transvaginal scan were considered as cases, in comparison to healthy controls. Results: The mean serum vitamin D3 levels for the case and control groups were 10.85 ± 3.34 ng/ml and 19.64 ± 5.50 ng/ml, respectively. Serum vitamin D3 was significantly lower (P &lt; 0.001) in women with uterine fibroids compared to healthy controls. Additionally, a significant association was observed between serum vitamin D3 levels and the number of fibroids in the case group (P &lt; 0.001). This indicates that as the level of serum vitamin D3 decreases, the number of fibroids increases gradually. Conclusion: Our study suggests that women with uterine fibroids tend to have low serum vitamin D3 concentrations. Therefore, serum vitamin D3 concentration needs to be considered along with other risk factors in the treatment of uterine fibroids..

Comparison of Costs, Re-Intervention Rates, and Length of Hospital Stay for Three Uterus Sparing Interventions for Uterine Fibroids: A 2-Year Retrospective Claims Analysis.

To describe two-year post-operative outcomes, and healthcare utilization of three uterus-sparing interventions used to treat women with intramural and/or subserosal uterine fibroids. This was a post-market, randomized, prospective, multi-center, longitudinal, interventional, and comparative clinical study to evaluate the costs and health outcomes of LAP-RFA vs the standard uterine conserving technologies (myomectomy and UAE) for the treatment of symptomatic uterine fibroids in women who desire uterine conservation. For this RCT study, 54 subjects were randomized on a 1:1 ratio across the three procedures and followed out to two years. Their results were compared to retrospective US insurance claims from the IBM MarketScan® Commercial Database from 2017-2020 for 96,854 women who underwent a uterus-sparing procedure for fibroids. Mean ambulatory surgical center costs and the mean out-patient hospital costs were lowest for LAP-RFA ($13,134 and $14,428) and highest for UAE ($28,214 and $19,131). The total two-year re-intervention rate of any subsequent procedure (AM, LM, LAP-RFA, or UAE) was lowest in AM group (0%) followed by LM (4.2%), LAP-RFA (11%), and UAE (33%). Mean peri-operative reintervention costs and the mean reintervention total costs were $2429 and $5939 for LAP-RFA, $2122 and $8368 for LM, $4410 and $11,942 for AM, and $8113 and $46,692 for UAE subjects. In the RCT study, the average length of hospital stay was significantly less for the LAP-RFA group subjects (8.2 hours) in contrast to both the laparoscopic myomectomy group subjects (16.0 hours) and the abdominal myomectomy group subjects (33.6 hours). Despite the small numbers, two-year reintervention rates followed a similar pattern as the IBM MarketScan data. In comparing these three non-invasive approaches, LAP-RFA was associated with the lowest peri-operative cost, and UAE was associated with the highest peri-operative cost. Further studies are needed to assess the cost, effectiveness, and subject satisfaction with each procedure.

A comparative study on myomectomy and total hysterectomy in the treatment of perimenopausal uterine fibroids

A comparative study on myomectomy and total hysterectomy in the treatment of perimenopausal uterine fibroids

Evidence based homoeopathic treatment of intramural fibroid: A case report

Evidence based homoeopathic treatment of intramural fibroid: A case report

A Case-Based Study on the Effectiveness of Embospheres as Embolizing Agent in the Treatment of Symptomatic Uterine Fibroids

Introduction: Embolization of the uterine arteries (UAE) has been approved as a minimally invasive technique for the treatment of uterine fibroid and maintaining fertility; different agents are used in this technique; embospheres have nowadays become widely used in many centers. Aim: assess the effectiveness and safety of Embospheres as Embolizing agents in treating symptomatic uterine fibroids among Iraqi patients. Methods: This was a mixed retrospective-prospective study conducted at Ibn Sina Hospital; the study included 17 patients who were managed and followed up during the period 2018 - 2020 included 17 Iraqi women with symptomatic uterine fibroids and were managed with embolization of uterine arteries using Embosphere as an embolization agent followed for six months by MRI to monitor changes in size &amp; IV contrast enhancement. Results: The mean age of the patients was 39.5 (range: 266-49) years. Single fibroids were reported in 70.6\% of the cases and multiple fibroids in 29.4%, the median number of fibroids was significantly reduced after UAE, (P\(&lt; \)0.05) and the median size reduced by more than 50%, from 11 cm to 5 cm after UAE, (P\(&lt; \)0.05). More than 70% of fibroids decreased in size, and 17.6% disappeared. After UAE, during the follow-up period, 17.6% of women got pregnant safely. Unfortunately, two patients did not get the benefit. Conclusions: Embospheres were safe and effective as an Embolizing agent in treating symptomatic uterine fibroids with good outcomes and no serious adverse effects or complications.

Exploring Surgical Strategies for Uterine Fibroid Treatment: A Comprehensive Review of Literature on Open and Minimally Invasive Approaches.

Background and Objectives: Uterine myomas represent one of the most prevalent pathologies affecting the female population. These benign neoplasms originate from the smooth muscular cells of the uterus, and they can be either single or multiple. Often associated with debilitating symptoms such as pelvic heaviness, pain, constipation, and urinary dysfunctions, the surgical management of myomectomy exhibits considerable variability. This diversity in approaches is influenced by factors such as the number and size of myomas, the patient's age, and overall clinical conditions. This study aims to elucidate and compare the advantages and disadvantages of different surgical approaches, specifically endoscopic procedures versus open surgery, providing valuable insights for clinical decision making. Materials and Methods: A comprehensive bibliographic search spanning from 2013 to 2023 was systematically conducted across databases including Medline, Embase, the Cochrane Database of Systematic Reviews, and ClinicalTrials.gov. The search utilized keywords such as "myomectomy laparoscopic and open", "myomectomy open and minimally invasive", "myomectomy open and laparoscopic", and "myomectomy open vs. laparoscopic." The research methodology, along with predetermined inclusion and exclusion criteria, was established prior to the search, ensuring a systematic and rigorous approach. Subsequently, data analysis was carried out. Results: Following the study selection process, 25 articles met the eligibility criteria for inclusion in this analysis. The average numbers of myomas were 3.7 (ranging from 1 to 13.7) and 5.4 (ranging from 1 to 13.5) for the minimally invasive surgery and open surgery groups, respectively. In terms of myoma size, the total averages across studies were 7 cm (ranging from 4.8 to 14) for the minimally invasive group and 8 cm (ranging from 3.9 to 11.2) for the open surgery group. The average pregnancy and delivery rates were 29.7% (ranging from 1.8 to 100) for the minimally invasive group and 28.5% (ranging from 1.8 to 100) for the open surgery group. Regarding complications, the average rate was 14.2% (ranging from 0 to 50) for the endoscopic group and 22.3% (ranging from 0 to 60.3) for the laparotomic group. Conclusions: In conclusion, a critical factor influencing the choice of surgical approach is primarily the size and quantity of fibroids. The mini-laparotomic approach emerges as a viable alternative to endoscopy, demonstrating favorable surgical outcomes and aesthetic results. Interestingly, the type of surgical procedure appears to have no significant impact on the pregnancy rate.

Uterine Leiomyomas and Infertility: A Comparison of National and International Guidelines.

Uterine leiomyomas are the most common benign tumors of the female genital track, causing various symptoms and problems, including a possible impact on fertility.The relationship between fibroids and infertility has long been a debate among gynecologists. Management of fibroids in women with otherwise unexplained infertility worldwide lacks standardized, evidence-based guidelines. Therefore, a review of guidelines from the Royal Australian and New Zealand College of Obstetricians and Gynecologists, the American College of Obstetricians and Gynecologists, the Society of Obstetricians and Gynecologists of Canada, the Collège National des Gynécologues et Obstétriciens Français, and the American Society of Reproductive Medicine was conducted. There is agreement among all guidelines that the effect of fibroids on fertility is related to their position in the uterus and the alteration of the endometrial cavity. However, whether surgical intervention (laparotomy, laparoscopy, or hysteroscopy) is required varies among committees. More specifically, for submucous myomas, all guidelines agree that surgical intervention is needed. On the other hand, regarding intramural myomas, there is no consensus on what the approach may be. Novel treatments such as uterine artery embolization (UAE) and magnetic resonance-guided focused ultrasound surgery (MRgFUS) should only be used in clinical trial settings. Nevertheless, all guidelines agree that medical management of fibroids further delays efforts to conceive and has no role as a stand-alone treatment of fibroids; though, the use of GnRH analogues preoperatively can be useful to improve anemia and/or reduce fibroid volume. There is a need for updated international protocols to be introduced, in order to help clinicians dealing with fibroids and infertility to better suggest the optimal treatment.

Treatment Of Uterine Fibroid Through Complementary Medicine And Alternative Therapy Approaches: A Case Series

The study aims to provide the alternative methods for the management of uterine fibroid. In this case series, we conducted a case series of 8 patients with symptomatic uterine fibroids. The patients were assigned to take Ayurvedic medicines and Intrauterine Uttarbasti with 4-5ml with Kapharbuda-har oil for 3 months. Intrauterine Uttarbasti was given for 7 days in a month, after the end of mensuration. Investigations like USG (pelvis region) and % haemoglobin, were conducted before and after the treatment. Investigations revealed a decrease in uterine fibroid size, after the treatment. In 3 patients there was about 40%-80% reduction in fibroid size. In 3 patient’s fibroids were completely cured while in 2 patients, 16-27 % of fibroid size got decreased. Concurrently, menstrual blood flow as well as other symptoms like abdominal pain associated with fibroids also got resolved, after the treatment. Based on the results, we can conclude that Ayurvedic treatments are very effective in managing the size of uterine fibroid as well as symptoms associated with uterine fibroid. Further research is required to evaluate the mechanism of drug action, effectiveness and unfavourable consequences of the treatment.

A comparative analysis of phytochemicals versus synthetic drugs/nanomedicines in the treatment of uterine fibroid: a systematic review

A comparative analysis of phytochemicals versus synthetic drugs/nanomedicines in the treatment of uterine fibroid: a systematic review

Therapeutic effects of in vivo administration of an inhibitor of tryptophan 2,3-dioxygenase (680c91) for the treatment of fibroids: a preclinical study

ObjectiveFibroids are characterized by marked overexpression of Tryptophan 2,3 dioxygenase (TDO2). The objective of this study was to determine the effectiveness of in vivo administration of an inhibitor of TDO2 (680C91) on fibroid size and gene expression. DesignAnimal and ex vivo human study. SubjectsSCID mice bearing human fibroid xenografts treated with vehicle and TDO2 inhibitor. InterventionDaily intraperitoneal administration of 680C91 or vehicle for two months and in vitro studies with fibroid explants. Main Outcome MeasuresTumor weight and gene expression profile of xenografts and in vitro mechanistic experiments using fibroid explants. ResultsCompound 680C91 was well-tolerated with no effects on blood chemistry and body weight. Treatment of mice with 680C91 resulted in 30% reduction in the weight of fibroid xenografts after two months of treatment and as expected lower levels of kynurenine, the byproduct of tryptophan degradation and an endogenous ligand of AhR (aryl hydrocarbon receptor) in the xenografts. The expression of CYP1B1 (cytochrome P450 family 1 subfamily B member 1), TGF-β3 (transforming growth factor beta 3), FN1 (fibronectin), CDK2 (cyclin-dependent kinase 2), E2F1 (E2F transcription factor 1), IL-8 (interleukin 8) and SPARC (secreted protein acidic and cysteine rich) mRNA, were lower in the xenografts of mice treated with 680C91 as compared with vehicle controls. Similarly, the protein abundance of collagen, FN1, CYP1B1 and SPARC were lower in the xenografts of 680C91 treated mice as compared with vehicle controls. Immunohistochemical analysis of xenografts indicated decreased expression of collagen, Ki67 and E2F1 but no significant changes in cleaved caspase 3 expression in mice treated with 680C91. The levels of kynurenine in the xenografts showed a direct correlation with the tumor weight and FN1 levels. In vitro studies with fibroid explants showed a significant induction of CYP1B1, TGF-β3, FN1, CDK2, E2F1, IL8 and SPARC mRNA by tryptophan which could be blocked by co-treatment with 680C91 and the AhR antagonist CH-223191. ConclusionThe results indicate that correction of aberrant tryptophan catabolism in fibroids could be an effective treatment through its effect to reduce cell proliferation and ECM accumulation.

#357 : Uterine Fibroids Treatment Using Radio Frequency Ablation at Hanoi Obstetrics and Gynecology Hospital, Vietnam: A Preliminary Assessment

Complicated uterine fibroids in young women, who wish to preserve fertility, and/ or unwilling to undergo surgery, or those having uterine fibroids deemed difficult for surgical intervention, need a less invasive and effective treatment method. Objectives: To evaluate the results of treatment of uterine fibroids by Radio Frequency Ablation (RFA) at Hanoi Obstetrics and Gynecology Hospital, Vietnam (HOGH) for 8 months. Materials and Methods: A cross-sectional study with longitudinal follow-up. Patients with symptomatic uterine fibroids including abnormal uterine bleeding, pelvic pain, anemia; in need of preserving fertility; without any RFA contra-indications. Results: 18 patients with 20 fibroids were met with the study’s inclusion criteria. The average fibroid size was 4.6±1.3 cm. 77,8% of patients having anemia. Average thermal ablation time was 12.2±4.1 minutes. Fibroids’ size decreased 43.6% after 1 month, 69.6% after 3 months and 83.6% after 6 months. Menstrual disorders and pelvic pain were considerably improved after 1 month and 3 months. Conclusions: RFA had good initial results in reducing fibroids size and improving relating symptoms during the study period.

Long-term Health-Related Quality of Life and Symptom Severity Following Hysterectomy, Myomectomy, or Uterine Artery Embolization for the Treatment of Symptomatic Uterine Fibroids

(Abstracted from Am J Obstet Gynecol 2023;229(3):275.e1–275.e17) Symptomatic uterine fibroids (UFs) are benign tumors diagnosed in approximately 30% of American women by the age of 50 years. Symptomatic UFs can significantly affect quality of life (QoL) and have a wide range of symptoms and severity, including pelvic pressure, dyspareunia, sexual dysfunction, infertility, and abnormal uterine bleeding.

Exploring uterine fibroids and its treatment in current scenario

Uterine Fibroids (leiomyoma) are made of muscle cells and other grow tissues grow in and around of the wall of the uterus. Uterine fibroids benign tumors in women reproduction age worldwide. Many are discovered incidentally on clinically examination. Approximately 30% of women with uterine fibroids will present with severe symptoms, which can include abdominal uterine bleeding, anemia, pelvic pain and constipation. Infertility and recurrent miscarriage may also be symptoms of fibroids, depending on their location and size, especially for sub mucous and intramural myelomas distorting the uterine cavity. Current option for symptomatic fibroid treatment includes expectant medical and surgical management radiology procedures. Ultrasound can be done, when a patient is symptomatic of uterine fibroids. Fibroids are generally classified by their location; intramural fibroids, subserosal fibroids, submucosal fibroids. The cause of uterine fibroids is unknown, But research and clinical experience proposes that genetics, hormonal imbalance, other growth factor and extracellular matrix accumulation could be the contributing factors .Although uterine fibroids are usually not dangerous, they can cause discomfort and lead to complication such as, drop in red blood cell (anemia) which causes fatigue from heavy bleeding. Our aim is to highlight the new treatments and advancements in treating uterine fibroids. Later we have also highlighted the future advancements and innovations that are used in developed countries for same.

Racial disparities between measures of area deprivation and financial toxicity, and uterine volume in myomectomy patients

BackgroundAt time of myomectomy, a surgical procedure to remove uterine fibroids, Black women tend to have larger uteri than White women. This makes Black patients less likely to undergo a minimally invasive myomectomy which has been shown to have less postoperative pain, less frequent postoperative fever and shorter length of stay compared to abdominal myomectomies. The associations between individual financial toxicity and community area deprivation and uterine volume at the time of myomectomy have not been investigated.MethodsWe conducted a secondary data analysis of patients with fibroids scheduled for myomectomy using data from a fibroid treatment registry in [location]. We used validated measures of individual-level Financial Toxicity (higher scores = better financial status) and community-level Area Deprivation (ADI, high scores = worse deprivation). To examine associations with log transformed uterine volume, we used linear regression clustered on race (Black vs. White).ResultsBlack participants had worse financial toxicity, greater deprivation and larger uterine volumes compared with White participants. A greater Financial Toxicity score (better financial status) was associated with lower uterine volume. For every 10 unit increase in Financial Toxicity, the mean total uterine volume decreased by 9.95% (Confidence Interval [CI]: -9.95%, -3.99%). ADI was also associated with uterine volume. A single unit increase in ADI (worse deprivation) was associated with a 5.13% (CI: 2.02%, 7.25%) increase in mean uterine volume.ConclusionDisproportionately worse Financial Toxicity and ADI among Black patients is likely due to structural racism – which now must be considered in gynecologic research and practice.Trial RegistrationNot applicable.

Combination of HIFU with sulfur hexafluoride microbubbles in the treatment of solitary uterine fibroids: a systematic review and meta-analysis.

To assess the efficacy and safety of sulfur hexafluoride microbubbles on ultrasound-guided high-intensity focused ultrasound (HIFU) ablation of uterine fibroids. Studies that compared HIFU-microbubble combination with HIFU-only in patients with uterine fibroids were searched from inception to April 2022. The standardized mean difference (SMD) or relative risk (RR) with 95% confidence interval (CI) for different outcome parameters was calculated. Seven studies were included, with a total of 901 patients (519 in the combination group and 382 in the HIFU-only group). The energy consumption for treating 1 cm3 of the lesion in the combination group was less than that in the HIFU-only group [SMD = - 2.19, 95%CI (- 3.81, - 0.57), p = 0.008]. The use of microbubbles was associated with shortening the duration of the treatment and sonication [SMD = - 2.60, 95%CI (- 4.09, - 1.10), p = 0.0007; SMD = - 2.11, 95%CI (- 3.30, - 0.92), p = 0.0005]. The rates of significant greyscale changes during HIFU were greater in the combination group, as well as the increase of non-perfused volume ratio [RR = 1.26, 95%CI (1.04, 1.54), p = 0.02; SMD = 0.32, 95%CI (0.03, 0.61), p = 0.03]. The average sonication durations to reach significant greyscale changes and for ablating 1 cm3 of the fibroid lesion were shorter in the combination group [SMD = - 1.24, 95%CI (- 2.02, - 0.45), p = 0.002; SMD = - 0.22, 95%CI (- 0.42, - 0.02), p = 0.03]. The two groups had similar post-HIFU adverse effects, while the combination group had fewer intraprocedural adverse events like abdominal pain, sacrum pain, and leg pain. Sulfur hexafluoride microbubbles can be safely used to enhance and accelerate the ablation effects of HIFU in the treatment of uterine fibroids. The combination of HIFU with sulfur hexafluoride microbubbles offers a promising non-invasive treatment option for patients with uterine fibroids. • Sulfur hexafluoride microbubbles combined with ultrasound-guided high-intensity focused ultrasound (USgHIFU) has potential advantages in the treatment of uterine fibroids. • Sulfur hexafluoride microbubbles not only enhance the effects of USgHIFU treatment for uterine fibroids but also shorten its duration. • Sulfur hexafluoride microbubbles do not increase the incidence of USgHIFU-related adverse events in the treatment of uterine fibroids.

"I Wasn't Presented With Options": Perspectives of Black Veterans Receiving Care for Uterine Fibroids in the Veterans Health Administration.

Black women with uterine fibroids experience greater symptom severity and worse treatment outcomes compared with their White counterparts. Black veterans who use Veterans Health Administration (VA) health care experience similar disparities. This study investigated the experiences of Black veterans receiving care for uterine fibroids at VA. We identified Black veterans aged 18 to 54years with newly diagnosed symptomatic uterine fibroids between the fiscal years 2010 and 2012 using VA medical record data, and we recruited participants for interviews in 2021. We used purposive sampling by the last recorded fibroid treatment in the data (categorized as hysterectomy, other uterine-sparing treatments, and medication only/no treatment) to ensure diversity of treatment experiences. In-depth semistructured interviews were conducted to gather rich narratives of veterans' uterine fibroid care experiences. Transcribed interviews were analyzed using content analysis. Twenty Black veterans completed interviews. Key themes that emerged included the amplified impact of severe fibroid symptoms in male-dominated military culture; the presence of multilevel barriers, from individual to health care system factors, that delayed access to high-quality treatment; insufficient treatments offered; experiences of interpersonal racism and provider bias; and the impact of fertility loss related to fibroids on mental health and intimate relationships. Veterans with positive experiences stressed the importance of finding a trustworthy provider and self-advocacy. System-level interventions, such as race-conscious and person-centered care training, are needed to improve care experiences and outcomes of Black veterans with fibroids.