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Can HIFU treatment be recommended for fibroid?

Mar 2013
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Practicing since : 1998
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i have a big fibroid of 17 cm, pls advise if HIFU treatment can be recommended for this big fibroid?
Posted Mon, 8 Apr 2013 in General Health
Answered by Dr. Aarti Abraham 47 minutes later
Thanks for your query.

Fibroids do not need treatment unless symptomatic, however this big a fibroid does require treatment. Generally this size of fibroids does not respond to conventional medical treatments, hence surgery is a must.

The mainstay of treatment of symptomatic fibroids has been surgery, which could be either myomectomy (removal of the fibroid), or hysterectomy (removal of the uterus). Of these, only hysterectomy ensures that the patient will never suffer from fibroids again, but is a rather radical option for a benign tumour that only requires symptomatic relief. Also, a hysterectomy is followed by a lengthy recovery period before the patient returns to normal activities. Both hysterectomy as well as myomectomy can also be done laparoscopically (key-hole surgery), dramatically reducing the post- operative morbidity. However, even these are invasive techniques, and the risks and possible complications of surgery and anesthesia remain a constant threat.

MRI guided HIFU or Magnetic Resonance Imaging-     guided High Intensity Focused Ultrasound is an innovative mode for genuinely non-invasive treatment of fibroids. Under MRI guidance, sound waves are passed into the body and focused into the fibroid to heat and coagulate the tissues.

The procedure is gaining wide acceptance because of the ease of use, exemplary safety and minimal disruption in the patients' daily routine. This is a day-care surgery, where the patient reports to the clinic for the procedure, undergoes the procedure and is able to walk out and go home after the procedure. The patient is able to go back to her regular routine within the next 24 hours, and the symptomatic relief obtained with this procedure is comparable to that following a myomectomy in the long term .

The patient is awake throughout the procedure and does not require any anaesthesia as there is minimal discomfort during the procedure. It is an out-patient procedure, where the patient walks in, undergoes preparation, treatment, is observed for a couple of hours, and is able to walk out comfortably. She can return to normal activities the next day. As the procedure is done under MRI guidance, there is absolutely no radiation involved.

The patient experiences relief from her symptoms by the next menstrual cycle, and the treated fibroid gradually shrinks in size over the next few months.

The success of the treatment is evaluated immediately after the treatment by performing a contrast enhanced MRI to delineate the ablated and the non-perfused volume.

As such, MRI guided HIFU satisfies the need for a non-invasive procedure that is a safe, gentle, and convenient way to provide long-lasting relief from the symptoms caused by uterine fibroids.

There are a few more points I wish to highlight :

1. Most patients benefit from HIFU and symptomatic relief is sustained for two plus years. Up to 16-20% of patients will require additional treatment. You should consider this while making your decision.

2. Medical literature so far gives no upper limit in the size of fibroids for which HIFU is considered. As it is a relatively new procedure, most studies quoting success rates for HIFU do not involve a 17 cm. big fibroid. You must discuss this with your doctor before proceeding.

3. The years of experience of the performer and the expertise and patient volume of the centre where you plan to get it done are important details which will affect the success of HIFU.

4. As fibroids are almost always benign, with a neglible percentage (0.07% of operated patients ) showing the presence of a sarcoma (malignancy),fibroids only require treatment for the alleviation of symptoms due to the fibroid. However, the risk of malignancy increases with the increasing size of the fibroid. HIFU is not recommended for fibroids with a high risk of malignancy.

5. If the fibroid is easily accessible, ( subserous or pedunculated ), then myomectomy is also a lucrative option you can consider.

6. In the best of hands, a 17 cm. fibroid can also be laparoscopically removed.

Please consider this information and make an informed choice after discussing with your Consulting Doctor.

Take care, all the best, and feel free to ask further questions.

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