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.
Keywords: High-intensity focused ultrasound treatment; meta-analysis; symptomatic uterine fibroids; traditional surgeries; uterine artery embolization.