Comparison of high-intensity focused ultrasound ablation and secondary myomectomy for recurrent symptomatic uterine fibroids following myomectomy: a retrospective study

Objective To compare the long-term symptom alleviation and re-intervention of high-intensity focused ultrasound (HIFU) ablation and secondary myomectomy for women with recurrent symptomatic uterine fibroids following myomectomy. Design A retrospective analysis. Setting A general hospital in China. Population One hundred and eighty-eight women with recurrent symptomatic uterine fibroids following myomectomy. Methods Women who underwent HIFU ablation (n = 101) and secondary myomectomy (n = 87) at Chinese PLA General Hospital from January 2008 to December 2016 were analysed. Symptom relief and recurrence were evaluated using the transformed symptom severity scale (tSSS). The additional intervention and treatment-related complications were also recorded and compared. Main outcome measures Difference in symptom alleviation, recurrence, re-intervention and complications. Results Follow-up time was comparable for the two groups (56 versus 60 months; P = 0.88). Regarding tSSS, at 3 months there was improvement in all tSSS for both treatment groups. The time to re-intervention was shorter in the myomectomy group. The cumulative risk for re-intervention after HIFU ablation at 1 and 3 years was lower than that after secondary myomectomy (0% versus 4.8%, 3.2% versus 11.9%, respectively); however, no significant difference was observed at 5 and 8 years. There were fewer adverse events in the HIFU ablation group than the myomectomy group (59.4% versus 77%, P = 0.01). Conclusions High-intensity focused ultrasound ablation of recurrent symptomatic uterine fibroids offers comparable long-term alleviation of symptoms with longer time interval to re-intervention and fewer adverse events compared with secondary myomectomy. Tweetable abstract High-intensity focused ultrasound ablation of recurrent uterine fibroids offered a longer time interval to re-intervention and fewer adverse events compared with myomectomy.