High-intensity focused ultrasound treatment for symptomatic uterine fibroids: a systematic review and meta-analysis

Objective This study was aimed at comparing the outcomes of high-intensity focused ultrasound (HIFU) with those of uterine artery embolization (UAE) and traditional surgeries for treating symptomatic uterine fibroids. Materials and methods We searched the following databases from their beginning to 5 November 2021: PubMed, Medline, Embase and Cochrane Library. Results Overall, 21 studies were included in this meta-analysis. The results revealed that HIFU had a higher re-intervention rate than UAE (relative risk [RR] = 4.06, 95% confidence interval [CI]: 2.47-6.69) and offered no significant advantages in reducing the symptom severity score (SSS) (mean difference [MD] = 17.01, 95% CI: 10.25-23.77) and improving the health-related quality of life (HRQoL) score (MD= -18.32, 95% CI: -24.87 to -11.78) in the treatment of symptomatic uterine fibroids. However, compared with UAE, HIFU may be associated with a higher pregnancy rate (RR = 17.44, 95% CI: 2.40-126.50) and may have a significant advantage in shortening pregnancy interval and preserving ovarian function. Moreover, upon comparing HIFU with traditional surgical treatments, the HIFU group showed significantly improved HRQoL score (MD = 2.25, 95% CI: 1.15-3.35), but the re-intervention rate (RR = 1.65, 95% CI: 0.59-4.57), pregnancy rate (RR = 1.01, 95% CI: 0.90-1.13), SSS and ovarian function did not significantly differ between the two groups. Conclusions Although HIFU has relatively high re-intervention rate, it may offer a higher pregnancy rate and shorter pregnancy interval with little influence on ovarian function, thus making it an attractive option for treating symptomatic fibroids in young women who wish to plan a pregnancy in the future.