Journal of minimally invasive gynecologyReview
27 Dec 2024
To comparatively evaluate the effectiveness of uterine artery embolization (UAE), focused ultrasound (HIFU), radiofrequency ablation (RFT), and laparoscopic/laparotomic surgery in the conservative treatment of uterine fibroids DATA SOURCES: The research was performed via electronic databases PubMed, EMBASE, and Cochrane Library, using the PRISMA standards.
The network included 10 randomized trials between 2000 and 2024 and 1002 randomized subjects.
The Network meta-analysis (NMA) was carried out with subroutine netmeta on R. The risk of bias was assessed using the Revised Cochrane risk-of-bias tool for randomized trials. The surface under the cumulative ranking curve (SUCRA) was computed by Bayesian NMA.
Integrations and Results: Incidences of reintervention per 100 person/year of follow-up were 4.13 (range 0 to 19.4), 16.1 (6.2 to 32.8), 14.3 (0 to 15.1) and 6 (4.3 to 6.7) for myomectomy, UAE, HIFU and RFT, respectively. The incidence rate ratios compared to myomectomy were 2.45 (95% CI = 1.38-4.37), 5.23 (95% CI = 1.59,17.3), and 4.59 (95% CI= 0.77-27.3, p=0.09) for UAE, HIFU and RFT, respectively. RTF had the highest (SUCRA=1.25% and 3%) while myomectomy had the lowest (SUCRA=98% and 95%) risk of reintervention or hysterectomy during follow-up (median 12 months, range 3-24). The risk of major complications was significantly lower after UAE (OR=0.38,95%CI=0.17-0.85) than myomectomy. The procedure with the lowest likelihood of major complications was HIFU (SUCRA=81.5%). Finally, in the evaluation of QoL at follow-up visits 60 there were no differences between the treatments studied, although the model was highly heterogeneous and inconsistent.
In analysis of randomized trials, surgical myomectomy carried the least risk of reintervention and subsequent hysterectomy during a relatively short follow up period. HIFU was the method with the lowest risk of major complications.
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