Uterine fibroid treatment with magnetic resonance-guided focused ultrasound surgery (MRgFUS): Inclusion and exclusion criteria

Background: Patients affected by uterine fibroids were evaluated to define inclusion and exclusion criteria for treatment with Magnetic Resonance-guided Focus Ultrasound Surgery (MRgFUS), the non-invasive technique considered as an efficient alternative to hysterectomy and myomectomy. Methods: From October 2011 to December 2015, 174 patients aged from 23 to 51 years, affected by uterine fibroids (size ranging from 2 to 14 cm) were evaluated in our clinical unit, to define candidature for MRgFUS treatment. Symptomatic patients were submitted to preliminary MRI. The severity of symptoms was evaluated with the UFS-QOL questionnaire. All patients were clinically examined to verify the absence of all conditions reported by the exclusion criteria grid. Results: 54 out of 174 patients were considered suitable for MRgFUS and treated; in 16 out of 174 patients, suitable for MRgFUS, treatment was declined because MRI evaluation, performed on the treatment’s day, showed interposition of bowel and/or bladder. 104 out of 174 were not candidate to MRgFUS, due to interposition of bowel and bladder (46/104), presence of pedunculated fibroids (18/104), large abdominal scars (18/104), close proximity to the spine and nerve roots (22/104). Conclusions: In our study, applying the inclusion and exclusion criteria, the percentage of treatable and treated patients was 40% and 31%, respectively. Diriment in the choice of MRgFUS over myomectomy is the possibility to achieve the same result (disappearance or marked reduction of the fibroid) without risks and complications related to conventional surgery. Furthermore, hospitalization times are sensibly reduced to one day only and the convalescence is maximum 2-3 days.