Therapeutic alternatives of uterine fibroids except medicinal treatment and embolization

Objectives. -To summarize the existing literature on therapeutic alternatives to hysterectomy and myomectomy for management of symptomatic uterine fibroids other than medicinal treatment and embolization. Patients and methods. -Pubmed, Cochrane and Embase contents were searched up to December 2010. Results. -The Nd:YAG laser appeared to be effective but equipment's cost and postoperative adherence risk limited its development. Bipolar, microwave and cryo-myolysis are still investigational. Radiofrequency thermal ablation is a less aggressive alternative when feasible under ultrasound guidance. Focused ultrasound surgery MR or ultrasound guided is accessible to approximately 10% of uterine fibroids with a rate of 60-70% of long-term symptom relief. Data following laparoscopic uterine artery occlusion suggest that outcomes are similar to those with uterine artery embolization (UAE) but with less long-term durability; by transvaginal way, there seem to be more complications. The efficiency of acupuncture remains uncertain. Conclusion. -Numerous technical innovations have been developed. However, comparative studies with validated conservative options are still needed. (C) 2011 Elsevier Masson SAS. All rights reserved.