Reference

Study type

Characteristics

Patientgroup

Controls (C)

Outcome measures and follow-up time

Results

Quality assesment study

Bhattacharya 2011

Search May 2010

Hysterectomy, endometrial ablation and Mirena for heavy menstrual bleeding- a systematic review of clinical effectiveness and cost-effectiveness analysis.

Individual patient data (IPD) meta-analysis of existing randomised controlled

trials to determine the short- to medium-term effects of hysterectomy, EA and Mirena. A population-based retrospective cohort study based on record linkage to investigate the

long-term effects of ablative techniques and hysterectomy in terms of failure rates and complications. Cost-effectiveness analysis of hysterectomy versus first- and second generation ablative techniques and Mirena.

30 RCT’s:

women with menorrhagia that underwent hysterectomy, vaginal hysterectomy, total

abdominal hysterectomy, subtotal abdominal hysterectomy, laparoscopic hysterectomy, LNG

IUS, Mirena coil and all types and variants of first- and second-generation ablative techniques

a. 7 trials first generation endometriumablation

b. 1 trial mirena

c. 14 trials first generation endometriumablation

d. 3 trials mirena

e. 5 trials mirena

a. hysterectomy

b. hysterectomy

c. second generation endometriumablation

d. first generation endometriumablation

e. second generation endometriumablation

a. Incremental cost per

QALY gained.

b. Incremental cost per

QALY gained, re-interventins.

c. amenorroea, menorrhagia, satisfaction, re-interventions

d. and e. amenorroea, menorrhagie, satisfaction, QOL, re-interventions

Hysterectomy was the most cost-effective treatment. It dominated first-generation EA and, although more expensive, produced more quality-adjusted life-years (QALYs) than second-generation EA and Mirena.

After 2 years second generation ablation significant more women had amenorroea than after first generation ablation. After hysterectomy significantly less re-interventions than after ablation and mirena.

Good systematic review.

Marjoribanks  2010

search March 2010

Cochrane review

‘surgery versus medical therapy for heavy menstrual bleeding’

12 RCT’s, 1049 women suffering menorhagia

a. oral medication

b. mirena

a. surgical treatment

b. surgical treatment

Menorrhagia (PBAC or alkaline hematine method)

QOL, satisfaction, side effects, re-interventiions.

Follow-up 5 year

In comparisons of LNG-IUS versus conservative surgery or hysterectomy, at one year there was no statistically significant difference in satisfaction rates nor in most measures of quality of life, though adverse effects were significantly less likely with conservative surgery –ablation- (RR 0.51 (95% CI 0.36 to 0.74); NNT = 4 (95% CI 3 to 7), three studies). Conservative surgery was significantly more effective than LNG-IUS in controlling bleeding at one year (RR 1.19 (95% CI 1.07 to 1.32); NNT = 7 (95% CI 5 to 19), five studies).

 Good systematic review.

Lethaby 2009

Search August 2009

Cochrane review

‘endometrial resection/ablation techniques for heavy menstrual bleeding’

21 RCT’s, 3395 premenopausal women

Inclusion criteria:

• women regular heavy periods

Exclusion criteria:

• postmenopausal bleeding

• irregular menses and intermenstrual bleeding;

• pathological causes of HMB;

• iatrogenic causes of HMB

First generation ablation

12 comparisons

Second generation ablation

1. PBAC scores

2. Satisfaction

In the comparison of the newer 'blind' techniques (second generation) with the gold standard hysteroscopic ablative techniques (first generation), there was no evidence of overall differences in the improvement in HMB or patient satisfaction.

Good systematic review.

Lethaby 2010

Search December 2008

Cochrane ‘endometrial resection and ablation versus hysterectomy for heavy menstrual bleeding’

7 RCT’s, 1192 premenopausal women

Inclusion criteria:

• women regular heavy periods

Exclusion criteria:

• postmenopausal bleeding

• irregular menses and intermenstrual bleeding;

• pathological causes of HMB;

• iatrogenic causes of HMB

endometrium resection/

ablation

hysterectomy

1. menstrual bleeding (PBAC)

2. re-interventions

3. QOL

4. hospital stay/ return to work, etc

5. satisfaction

Follow-up 4 years

There was a significant advantage in favor of hysterectomy in the improvement in HMB (OR=0.04, 0.01 to 0.2 at one year) and satisfaction rates (up to four years post surgery) (OR=0.5, 0.3 to 0.8 at 2 years) compared with endometrial ablation. Although many quality of life scales reported no differences between surgical groups, there was some evidence of a greater improvement in some health domains (social functioning, energy, pain and general health) for hysterectomy patients. Repeat surgery was more likely after endometrial ablation than hysterectomy (OR= 16.7, 5.8 to 48.6).

Good systematic review.

Lethaby 2011

search June 2009

Clinical evidence Fibroids (uterine myomatosis, leiomyomas).

GnRH analogues, LAVH, TAH, abdominal myomectomy, laparoscopic myomectomy, TLH, TVH, UAE, TCRM, ablation, MRgFUS, myolysis.

Systematic review and GRADE evaluation

Inclusion: women with fibroids.

1. Oral medication

2. pre-operative medical treatment

3. surgical treatment

1. myoma related symptoms

2. pregnancies

3. recurrence myomas

4. postoperative recovery

5. QOL

6. complications

LAVH: likely to be beneficial (faster recovery, less post operative pain compared to AUE)

AUE: likely to be beneficial (less myoma related complaints compared vermindert myoom-gerelateerde klachten vergeleken met expectatief beleid)

TLH: likely to be beneficial (minder post operatieve koorts, kortere opnameduur, sneller herstel vergeleken met AUE)

vaginale hysterectomie: likely to be beneficial (minder bloedverlies, pijn, koorts, kortere opnameduur vergeleken met AUE)

GRADE table good.

Only outcomes of LAVH, AUE, TLH were used.

Spiezio 2008

comprehensive review.

Hysteroscopic myomectomy: a comprehensive

review of surgical techniques.

Woman with uterus myomatosus and AUB

19 studies on hysteroscopic myomectomy and the effect on AUB, not systematically reviewed

none

effect on AUB

Bleeding control in 69.5%-100% of the cases after hysteroscopic myomectomy

No systematic review.

Conclusions can be used with the annotation of ‘very low quality of evidence’.

van der Kooij 2011

Systematic review and meta analysis of 4 RCT’s

Uterine artery embolization versus surgery in the treatment

of symptomatic fibroids: a systematic review and meta-analysis.

inclusion: women with symptomatic uterine fibroids

292 patients UAE

223 patients myomectomy/hysterectomy

(1) intraprocedural results

(at the time of the procedure), (2) early postprocedural results (first 24 hours, during hospital stay or day 1 to day 30), (3) late postprocedural results

(between 30 days and 6 months), (4) follow-up at 6 months, (5) follow-up at

1 year, (6) follow-up at 2 years, (7) follow-up at 3 years, (8) follow-up at 4

years, and (9) follow-up at 5 years.

On the short-term, uterine artery embolization showed fewer blood loss, shorter hospital stay, and quicker resumption of work.

Mid- and long-term results showed comparable health-related quality of life results and a higher reintervention rate in the uterine artery embolization

group (OR 5.41; 95%CI 2.48 – 11.81), whereas both groups were equally satisfied.

Only QOL after 5 years was used. 

Moss 2011

RCT

Randomised comparison of uterine artery

embolisation (UAE) with surgical treatment in

patients with symptomatic uterine fibroids

(REST trial): 5-year results

Women aged ‡18 years with symptomatic fibroids who were considered to justify surgical treatment.

106 patients UAE

51 patients surgery (myomectomy/ hysterectomy)

Quality of life at 5 years, as assessed by the Short Form General Health Survey (SF-36). Secondary measures included complications, adverse events and the need for further intervention.

There were no significant differences between groups in

any of the eight components of the SF-36 scores at 5 years

(minimum P = 0.45). Symptom score reduction and patient

satisfaction with either treatment was very high, with no

group difference. The 5-year intervention rate for treatment failure or complications was 32% (UAE arm) and 4% (surgery arm), respectively. The initial cost benefit of UAE over surgery at 12 months was substantially reduced because of subsequent interventions, with treatments being cost neutral at 5 years.

Only QOL after 5 years was used. 

Gupta 2012

Search nov 2011

Systematic review.

Uterine artery embolization for symptomatic uterine fibroids.

Randomised controlled trials (RCTs) of UAE versus any medical or surgical therapy for symptomatic uterine fibroids.

a. 291 patients UAE (3 trials)

b. 157 patients UAE

c. 121 patients UAE

a. abdominal hysterectomy

b. surgery

c. myomectomy

1. Patient satisfaction (up to 12-24 months and at five years).

2. Further interventions

There was moderately good evidence that there is no significant difference between UAE and surgery in patient satisfaction rates at two years (OR 0.69, 0.40 to 1.21, 516 women, 5 trials) nor at five years (OR 0.90, 95% CI 0.45 to 1.80, 295 women, 2 trials). UAE was associated an increased surgical reintervention rate. This increase in the surgical reintervention rate may balance out the initial cost advantage of UAE (reinterventions within 2 years: OR 5.64, 95% CI 2.92 to 10.90, 486 women, 4 trials; within 5 years: OR 5.79, 95% CI 2.65 to 12.65. 289 women, 2 trials).

Good systematic review

Wheeler 2012

Search jan 2011

Clinical Practice Guideline for Abnormal Uterine Bleeding:

Hysterectomy versus Alternative Therapy

On the basis of findings from a systematic review, clinical practice guidelines were developed. Rating the quality of evidence and the strength of recommendations followed the Grades for Recommendation Assessment, Development, and Evaluation system

a. 1167 patients hysterectomy

b. 236 patients hysterectomy

c. 63 patients hysterectomy

d.     ablatio, mirena, medication

bleeding, quality of life, pain, sexual health, patient

satisfaction, need for subsequent surgical treatment, and

adverse events

Table 3, 4 and 5

GRADE table used.

Garza Leal 2011

Prospective cohort study.

Laparoscopic Ultrasound-Guided Radiofrequency Volumetric Thermal Ablation of Symptomatic Uterine Leiomyomas: Feasibility Study Using the Halt 2000 Ablation System

women with myomas without child wish

31 women Laparoscopic Ultrasound-Guided Radiofrequency Volumetric Thermal Ablation

none

patient safety, frequency of adverse events, repeat intervention rate

because of myoma symptoms, and the symptom and HRQL

scores from the UFS-QOL questionnaire.

At 3, 6, and 12 months, respectively, mean symptom severity scores improved significantly compared with baseline, by 59.7% (95% CI, 44.8–74.7), 71.7% (95% CI, 55.7%–87.7%), and 82.0% (95% CI, 70.9%–93.1%). The increase in mean health-related quality-of-life scores over time reached statistical significance (p =0.001): 60.15 (95% CI, 51.6%–68.7%) at baseline, 87.9 (95% CI, 82.1%–93.7%) at 3 months, 90.8 (95% CI,82.1%–99.5%) at 6 months, and 97.8 (95% CI, 96.2–99.4) at 12 months. There were no procedure-related repeat treatments after radiofrequency ablation.

Randomisatie: -Toewijzing verborgen: -

Behandelaar geblindeerd: -

Patiënt geblindeerd: -

Effectbeoordelaar geblindeerd: -

Interventie- en controlegroep vergelijkbaar: -

Follow-up voldoende: +

Intention-to-treat analyse: nvt

Financiering: nvt

Overig: dit zijn niet per definitie vrouwen met menorrhagia. Het is een hele kleine studie groep zonder controle groep.

Kim CH 2011

Prospective cohort study.

Transvaginal ultrasound-guided radiofrequency myolysis for uterine myomas.

premenopausal women with symptomatic uterine myomas: menorrhagia, pelvic pain and/or bulk

symptom.

Exclusion criteria were the presence of more than three uterine myomas.

69 women underwent Transvaginal ultrasound-guided radiofrequency myolysis

none

normalsized sanitary products used per menstrual period to assess menorrhagia. Symptom severity subscale (SSS) of the uterine fibroids

symptom (UFS) questionnaire. Intra-operative and post-operative minor and major complications

An improvement of menorrhagia occurred 1, 3, 6 and 12 months after operation (all P < 0.001 versus baseline). Overall symptoms at 1, 3, 6 and 12 months after RF myolysis also improved (all P < 0.001 versus baseline). No major complications were observed or reported

Randomisatie: -

Toewijzing verborgen: -

Behandelaar geblindeerd: -

Patiënt geblindeerd: -

Effectbeoordelaar geblindeerd: -

Interventie- en controlegroep vergelijkbaar: -

Follow-up voldoende: +

Intention-to-treat analyse: nvt

Financiering:

Overig: inclusie criterium niet puur menorrhagia maar ook andere myoom-gerelateerde klachten. Dus komt niet geheel overeen met de PICO.

Min Zhuo 2010

Prospective cohort study.

Ultrasound-guided high-intensity focused ultrasound ablation for adenomyosis: the clinical experience of a single center

Inclusion criteria for this study were [1] age >18 years; [2] no desire to bear children; [3] dysmenorrhea and/or menorrhagia; [4] MRI evidence of typical features of adenomyosis with a depth >3 cm; [5] no previous other

treatment or therapy for adenomyosis during the previous 3 months, including

surgery; and [6] the ability to communicate clearly with the nurse or physician during the procedure.

78 patients with symptomatic adenomyosis underwent ultrasound-guided high-intensity focused ultrasound

ablation

none

Numerical Rating Scale immediately after the procedure.

Symptoms of menorrhea and dysmenorrhea were recorded with use of a 5-point categorical scale.

3 months: MRI and questionnaire on relief of complaints with 6-point categorical scale.

Scores of 1.3 -0.7 and 2.1-1.2 for patients with menorrhagia and dysmenorrhea, respectively, at 3 months after treatment were compared with those of 2.5-1.6 and 4.8-0.4 before treatment; the difference was statistically significant (P<.001 for both). Scores of 1.4 -0.8 and 2.2-1.3 at the 18-month follow-up assessment were compared with the baseline; the difference was statistically significant (P<.001 for both).Twenty-two patients

(28.6%) had 27 complications. 23 events (85.1%) did not need medical intervention. No serious complications including

death or major permanent injuries were observed.

Randomisatie: -

Toewijzing verborgen: -

Behandelaar geblindeerd: -

Patiënt geblindeerd: -

Effectbeoordelaar geblindeerd: -

Interventie- en controlegroep vergelijkbaar: nvt

Follow-up voldoende: nvt

Intention-to-treat analyse: -

Financiering:

Overig: inclusie niet alleen vrouwen met menorrhagia, geen gestandaardiseerde vragenlijsten.

Polena 2007

Retrospective cohort study.

Long-term results of hysteroscopic myomectomy in 235 patients

one or more submucous myomas at diagnostic hysteroscopy, abnormal uterine bleeding and infertility

235 patients

TCRM

none

1; Satisfaction with treatment and improvement of bleeding symptoms.

2; complications were registered in connection with surgery, readmission or clinical controls. All patients had a clinical and office hysteroscopic examination 1–2 months post-operatively. Retreatment and concurrent surgery were documented.

Eighty-four percent of cases were followed-up. The median follow-up was 40 months (range 18–66 months). The procedure was classed as a success in 94.4% of patients (satisfaction). Among the cases that were classed as a failure, four patients had a repeated hysteroscopic procedure, three patients had a subsequent hysterectomy and four patients presented with abnormal uterine bleeding at follow-up.

Randomisatie: -

Toewijzing verborgen: -

Behandelaar geblindeerd: -

Patiënt geblindeerd: -

Effectbeoordelaar geblindeerd: -

Interventie- en controlegroep vergelijkbaar: nvt

Follow-up voldoende: +

Intention-to-treat analyse: -

Financiering:

Overig: Retrospectief. Geen gestandaardiseerde QOL en bloedings-klachten vragenlijst.

Holub 2004

Prospective cohort study.

Midterm follow-up study of laparoscopic dissection of uterine

vessels for surgical treatment of symptomatic fibroids

patients with symptomatic uterine fibroids confirmed by ultrasound (US) or magnetic resonance imaging (MRI) were indicated for LDUV

69 patients LDUV

none

Complications, improvement complaints, reduction myoma. Follow up 3 years.

Almost all the patients (98.5%) had a successful LDUV with a low rate (7.3%) of postoperative complications. Symptom improvement (menorrhagia or dysmenorrhoea) was 93.2%, and the average reduction in the dominant myoma was 57.8% during a follow-up period longer than 12 months. All the patients with anemia had normal

red cell counts after 3 months.

Randomisatie: -

Toewijzing verborgen: -

Behandelaar geblindeerd: -

Patiënt geblindeerd: -

Effectbeoordelaar geblindeerd: -

Interventie- en controlegroep vergelijkbaar: nvt

Follow-up voldoende: +

Intention-to-treat analyse: +

Financiering:

Overig: inclusie criterium niet menorrhagia maar myomen. Geen duidelijke primaire uitkomstmaten genoemd. Geen gestandaardiseerde vragenlijst gebruikt.

Lee 2010

Prospective case control study.

Use of uterine vessel occlusion in the management of

uterine myomas: two different approaches

[1]. Symptomatic myomas

[2]. Absence of previous abdominal or pelvic surgery

[3]. A number of visible uterine masses (myomas) less than or equal to 5 intramural or subserous myomas

[4]. A max. diameter of no more than 8 cm

[5]. An absence of prominent or significant pelvic adhesion.

44 patients

uterine artery occlusion

66 patients

uterine artery occlusion combined with

simultaneous blockage of anastomosis between the uterine and ovarian vessels

operative time (in minutes); febrile morbidity; and complications,

such as blood transfusion, wound infection or hematoma, and postembolization

syndrome. Leiomyoma-related symptoms, either menstrual problems such as menorrhagia and pain, or compression were assessed using a presence-or-absence questionnaire. At

1, 2 and 3 years, all patients underwent transvaginal ultrasonography, and any relapse of symptoms was determined. Reinterventions.

During the 3-year follow-up, the majority of patients in both groups reported symptom relief (ranging from 61.5% to 84.6% in the UVO group and 31.6% to 77.3% in the UAO group, on the basis of different kinds of symptoms). However, symptom control seemed to be different between the two groups when the follow-up time was prolonged; for example, symptom control was better in the UVO group at the end of 3 years, especially for menorrhagia (76.5% vs. 34.5%, p=0.023). The fibroid size was smaller in the UVO group, resulting in a lower re-intervention rate, compared with the UAO group (13.6% vs. 36.4%, p=0.009).

Randomisatie: -

Toewijzing verborgen: -

Behandelaar geblindeerd: -

Patiënt geblindeerd: -

Effectbeoordelaar geblindeerd: -

Interventie- en controlegroep vergelijkbaar: +

Follow-up voldoende: +

Intention-to-treat analyse: +

Financiering: niet beschreven

Overig: inclusie geen menorrhagia maar myomen. Geen gestandaardiseerde vragenlijst. Controle groep zelfde soort behandeling, dus niet goed te vergelijken met andere behandelingen.

Ambat 2009

RCT.

Uterine artery embolization versus laparoscopic occlusion of uterine vessels for management of symptomatic uterine fibroids

symptomatic women with enlarged uteri that corresponded in size to 12–20 weeks of pregnancy

10 patients uterine artery embolization

10 patients

laparoscopic occlusion of uterine vessels

The primary aim of the study was to compare symptomatic improvement in menstrual blood loss [PBACs] following LOUV compared with UAE. The secondary outcomes measured were postoperative pain, reduction in

uterine and fibroid volumes, and adverse effects and complications

following these procedures.

At 6 months, there was no significant difference in the mean reduction in menstrual blood loss, uterine volume, and volume of the dominant fibroid between the two groups (P=0.436, P=0.796, P=1.00, respectively). However, higher pain scores were recorded on day 1 in the UAE group compared with the LOUV group (P=0.0002).

Randomisatie: +

Toewijzing verborgen: -

Behandelaar geblindeerd: -

Patiënt geblindeerd: -

Effectbeoordelaar geblindeerd: -

Interventie- en controlegroep vergelijkbaar: +

Follow-up voldoende: +

Intention-to-treat analyse: +

Financiering:

Overig: veel te kleine studie groep, wel hoeveelhied bloedverlies gestandaardiseerd.

Hald 2007

RCT.

Laparoscopic Occlusion Compared With

Embolization of Uterine Vessels

women with fibroid and increased amounts of bleeding, pressure symptoms, and an expressed desire not to have a hysterectomy

29 patients UAE

29 patients bilateral laparoscopic

occlusion of uterine vessels

The change in Pictorial Bleeding Assessment

Chart score from baseline to 6 months after treatment was the primary outcome measure. Secondary: postoperative pain and adverse events, clinical failure.

The percentage reduction in Pictorial Bleeding Assessment Chart scores did not differ between the treatment groups (52% after uterine leiomyoma embolization and 53% after laparoscopy, P =0.96). The study had 52% power to detect a 20% difference on the PBAC. Fewer participants in the group treated with uterine leiomyoma embolization complained of heavy bleeding after 6 months (4% comparedwith 21%, P=0.044).

Randomisatie: +

Toewijzing verborgen: -

Behandelaar geblindeerd: -

Patiënt geblindeerd: -

Effectbeoordelaar geblindeerd: -

Interventie- en controlegroep vergelijkbaar: +

Follow-up voldoende: +

Intention-to-treat analyse: +

Financiering:

Overig: goede studie, wel wat klein.

Kim HS 2011

Prospective cohort study.

MR-guided High-intensity Focused

Ultrasound Treatment for

Symptomatic Uterine Leiomyomata:

Long-term Outcomes

Consecutive pre- or perimenopausal women, 18 years of age or older, with symptomatic leiomyomata and interested in a prospective nonrandomized study of MR-g HIFU were recruited

40 patients MRgFUS

none

The primary study endpoint was the assessment of the longterm clinical effectiveness of MR-g HIFU treatment for

symptomatic uterine leiomyomata. Clinical effectiveness of MR-g HIFU was defined by the changes in patient symptoms and was quantitatively assessed through the symptom and health-related quality-of-life (QOL) scores from the Uterine Fibroid Symptom and Quality of Life questionnaires.

The mean baseline volume of treated leiomyomata was 336.9 cm3. The mean improvement scores for transformed SSS was 47.8 (P < .001) and for tUFS-QOL was 39.8 (P < .001) at 3 years. The mean volume decrease in treated leiomyomata was 32.0% (P < .001), and, in the uterus, the volume decrease was 27.7% (P < .001) at 3 years. There were no long-term complications.

Randomisatie: -

Toewijzing verborgen: -

Behandelaar geblindeerd: -

Patiënt geblindeerd: -

Effectbeoordelaar geblindeerd: -

Interventie- en controlegroep vergelijkbaar: -

Follow-up voldoende: +

Intention-to-treat analyse: nvt

Financiering:

Overig:

Voogt 2012

Prospective cohort study.

Volumetric feedback ablation of uterine fibroids using magnetic resonance-guided high intensity focused ultrasound therapy

pre- or peri-menopausal women with symptomatic uterine fibroids, 18–59 years of age, uterine size smaller than 24 weeks of pregnancy, dominant fibroid size of ≥3 cm and ≤12 cm, transformed Symptom Severity Score (SSS) of ≥40 points on the Uterine Fibroid Symptom and Quality of Life Questionnaire (UFS-QoL), and a normal cervical smear

33 patients MRgFUS

none

Non-Perfused Volumes (NPVs) with MR thermal dose predicted treatment volumes. Evaluation of complications or adverse events and unintended lesions. Secondary endpoints were pain (VAS 1-10) and discomfort (0-3) scores, recovery time and length of hospital stay. UFS QoL after one month.

The mean NPV calculated as a percentage of the total fibroid volume was 21.7%.  No serious adverse events were reported and Time needed to return to work and normal activities ranged from 1–19 days (mean 4.4±4.4) and 1–7 days (mean 2.3±1.8) respectively

Randomisatie: -

Toewijzing verborgen: -

Behandelaar geblindeerd: -

Patiënt geblindeerd: -

Effectbeoordelaar geblindeerd: -

Interventie- en controlegroep vergelijkbaar: -

Follow-up voldoende: ?

Intention-to-treat analyse: nvt

Financiering:

Overig: uitkomstmaten komen niet overeen met de PICO, en QOL wordt wel in M&M genoemd maar niet bij resultaten.

Gorny 2011

Retrospective cohort study.

Magnetic Resonance–guided Focused Ultrasound

of Uterine Leiomyomas: Review of a 12-month Outcome of 130 Clinical Patients

women with symptomatic uterine leiomyomas who were clinically treated with MR-guided focused US at a single institution between March 2005 and December 2009

130 patients MRgFUS

none

Patients were interviewed by phone at 3-, 6-, and 12-month to assess symptom relief (self-reported 1-100%) and whether additional procedures had been performed.

Additionally, change in pretreatment symptoms.

Additional procedures performed for relief of leiomyoma-related symptoms.

At 3-, 6-, and 12-month follow-up, 86% (90 of 105), 93% (92 of 99), and 88% (78 of 89) of patients reported relief of symptoms, respectively. Treatment-related complications were observed in 17 patients (13.1%): 16 patients had minor complications and one had a major complication (deep vein thrombosis).

Randomisatie: -

Toewijzing verborgen: -

Behandelaar geblindeerd: -

Patiënt geblindeerd: -

Effectbeoordelaar geblindeerd: -

Interventie- en controlegroep vergelijkbaar: -

Follow-up voldoende: +

Intention-to-treat analyse: nvt

Financiering:

Overig: retrospectief, geen gestandaardiseerde vragenlijsten.

 Popovic 2011

 Review (no RCT’s)

Patients with symptomatic adenomyosis

 102 patients (with pure adenomyosis; no fibroids): UAE

 none

 No previously dedicated outcome measures

Improvement rate of 83.3% after a median follow-up of 9.4 months. Urinary symptoms, pelvic heaviness, dysmenorrhea, and menorrhagia decreased significantly after embolization. Overall, more than 70% of patients showed devascularization, and uterine volumes decreased by 25%–32%. After a median follow-up of 40.6 months in the subgroup of patients with only adenomyosis, 135 of 208 patients (64.9%) reported sustained improvements after UAE. MR imaging demonstrated significant modifications after UAE. Uterine volumes and JZ thickness showed reductions of 27.4%–54.0% and 12.0%–23.9%, respectively

No comparative studies used.