Ultrasound Relieves Fibroid Symptoms for 2 Years


LOS ANGELES — Patients treated with magnetic resonance-guided focused ultrasound for uterine fibroids who experience improvement maintain that improvement for 2 years, Dr. Bobbie S. Gostout said at the Obstetrical and Gynecological Assembly of Southern California.

“When you see a 48-year-old woman who wants to think about a hysterectomy, this is a great option to offer her as a bridge to menopause,” said Dr. Gostout of the department of obstetrics and gynecology at the Mayo Clinic, Rochester, Minn.

At the meeting, Dr. Gostout described the Mayo experience with 42 patients treated by the new modality who have now been followed out to 2 years.

Those 42 patients had a total of 55 treatments, though as time went on and the practitioners refined their technique there was less and less need for repeat procedures, Dr. Gostout said.

The procedures took an average of 3 hours, and only one patient had a length of stay longer than 5 hours.

None of the patients Dr. Gostout was involved with needed any pain medication stronger than an over-the-counter drug, she said.

Afterward, compared with matched total abdominal hysterectomy patients, the ultrasound patients had 83% fewer provider encounters, 66% fewer additional procedures, and 66% fewer additional diagnostic tests.

“It's not hard to care for these patients in your practice because they do so well,” Dr. Gostout said.

The patients' average score on a symptom severity scale was 61, where the average fibroid patient scores 50 on that particular scale. At 3 months, the average score had dropped to 38, and by 6 months, it had dropped to 34. “That's still true,” she said. “If patients are happy at 6 months they tend to remain happy at 24 months.”

At 24 months, the duration of bleeding experienced by the patients had dropped an average of 1 full day compared with baseline, when the mean was 6.1 days. Excess bleeding, which was defined as menstruation lasting longer than 7 days, declined by one half.

Moreover, 49% of patients who had pressure and urinary frequency as a symptom (37 patients) had complete resolution, and only 1 patient was not helped at all. Of 25 patients who had nocturia, 17 had complete resolution and only 2 had no improvement.

The one symptom that was not improved in any patients was menstrual spotting between periods.

Complications from the procedure included deep vein thrombosis in one patient, sciatic nerve pain in two patients, and diarrhea lasting 24–48 hours after the procedure in “occasional” patients, probably resulting from heating of the rectum during the procedure.

“This is by far the safest treatment I offer to my patients with uterine fibroids,” Dr. Gostout said.

She also noted that there have been eight pregnancies reported in women who have had the procedure; however, she still considers the treatment to be experimental for patients who want to have children.

Some patients who have the procedure get up off the table and describe having relief from their symptoms immediately, Dr. Gostout said. But more commonly, patients describe feeling ever-increasing relief with time, and the amount of time is highly variable.

“Most patients said they had gradual improvement over 3 months, and some had continued improvement for up to a year,” she said.

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