Ultrasound Guided Transvaginal Radiofrequency Myolysis For Symptonatic Uterine Myomas

Background:Uterine myomas are the most common type of benign tumors in reproductive aged women.most women with myomas remain asymptomatic but approximately 25% of women experience symptoms.they can cause symptoms, such as menorrhagia, pressure symptoms, dyspareunia, secondary dysmenorrhoea, pelvic pain and reproductive problems such as infertility and miscarriage.relief of symptoms is the major goal in management of women with significant symptoms. The type and timing of any intervention should be individualized, based upon factors such as age, severity of symptoms, type of myoma, size and location of myoma, reproductive plans and obstetrical history.Radiofrequency myolysis is a minimally invasive procedure which provides significant clinical improvement and myoma volume reduction by destroying the myoma tissues without harming overlying organs or tissues. The main objective of this study was to evaluate the feasibility, efficacy and safety of ultrasound guided transvaginal radiofrequency myolysis.Methods:46 premenopausal women with symptomatic uterine myomas underwent transvaginal radiofrequency myolysis under ultrasound guidance as an outpatient procedure. The inclusion criteria were premenopausal women ①with symptomatic uterine myoma②who declined hysterectomy or myomectomy③desiring future pregnancies④not responsive to medical therapies⑤with non-pedunculated subserosal myomas⑥with normal endometrial findings on endometrial biopsy.The procedure was performed within three to seven days of menstruation cycle.The sonographic evaluations of the myoma were performed before radiofrequency myolysis and at three, six and twelve months after myolysis. The myoma related symptom severity and quality of life was assessed using the uterine fibroid symptom and health-related quality of life (UFS-QOL) questionnaire before the procedure and at twelve months follow-up.Results:Mean age of patients was 40.8 ± 6.5 years. Mean initial size of the dominant myoma was 4.8 ± 1.1 cm. The mean reduction rate of the volume of the dominant myoma was 53.8% at three months,72.1% at six months, and 83.0% at twelve months, follow-up evaluation. The symptom severity scale (SSS) and health-related quality of life (HR-QOL) showed significant improvement after twelve months of treatment. No intraoperative or postoperative complications were observed or reported. The reoperation rate was 8.7%. After 15 months and 18 months of radiofrequency myolysis, two patients successfully conceived and delivered healthy babies with no complications being reported during labor or delivery.Conclusions:Ultrasound-guided transvaginal radiofrequency myolysis might be a safe, effective and minimally invasive outpatient procedure for treating symptomatic uterine myomas in terms of clinical improvements of myoma-related symptoms and myoma volume reduction.