Ultrasound-guided high-intensity focused ultrasound ablation for adenomyosis: the clinical experience of a single center

Objective: To assess the midterm outcomes after ultrasound-guided high-intensity focused ultrasound (HIFU) ablation in treatment of patients with symptomatic adenomyosis. Design: A prospective clinical trial. Setting: University teaching hospital. Patient(s): Seventy-eight patients with symptomatic adenomyosis. Intervention(s): A single treatment session of ultrasound-guided HIFU ablation for adenomyosis. Main Outcome Measure(s): Dysmenorrhea and menorrhagia scores and the incidence of complications. Result(s): In all 78 patients, 84.6% tolerated the treatment procedure well with pain scores between 0 and 4. Treatment was terminated in only one patient because of increased blood pressure persistently. Sixty-nine patients have finished at least an 18-month follow-up; the mean follow-up time was 24.2 months. Nonperfused regions in lesions were observed in 60 (87.0%) patients on the enhanced magnetic resonance imaging scans. Scores for menorrhea and dysmenorrhea decreased. Clinical effectiveness of the treatment was observed in 62 women (89.9%) with varying degrees of symptomatic relief of dysmenorrhea. Eight patients had relapses. Twenty-two patients (28.6%) had 27 complications. Of these, four had two or more complications. Twenty-three events (85.1%) did not need medical intervention (Society of Interventional Radiology class A). No serious complications including death or major permanent injuries were observed. Conclusion(s): Ultrasound-guided HIFU ablation may be a safe and effective noninvasive alternative in the treatment of symptomatic adenomyosis. (Fertil Steril (R) 2011; 95: 900-5. (C) 2011 by American Society for Reproductive Medicine.)