Myoma expulsion after minimally invasive therapeutic strategies: a systematic review

Uterine leiomyomas are very common benign tumors of the myometrium which often occur in women in fertile age. They can cause pain, heavy bleeding, fertility impairment. Historically, the treatment available for this condition was only the surgical one. During the last decades, several new therapeutic possibilities became available to treat fibroids in a minimally invasive way, with the aim to avoid surgery and its possible complications. The aim of this review is to focus on these new techniques and on their complications, with particular regard to myoma expulsion.

This study consists of a systematic review of the most recent scientific Literature, focusing on the final outcomes of minimally invasive treatments. We tried to answer the question if these uterus sparing approaches effectively were decisive for patients without any further treatments. In fact, the slice of patients who is mainly affected by myomas is the one of women in their fertile age, in which hysterectomy is obviously not suggested (in order let them complete the family planning) but the treatment of myomas should be pursued to relieve the symptoms and also to improve fertility. Another question we analyzed is the correlation between these minimally invasive techniques and spontaneous myoma expulsion. We conducted bibliographic research on scientific databases, identifying no. 35 papers which suited to our study.

The overall expulsion rate in patients minimally - invasive treated was 14.4%, and among the different non - surgical minimally invasive techniques, MrgFUS seems to be related to the highest rate of myoma expulsion. Fibroid expulsion is resolutive in most cases, but in 1.4% of cases additional medical care to remove residual fibroid tissue is required. Severe adverse events of these procedures (utero - enteric fistule, uterine necrosis, sepsis) were observed in 0.9% of women.

Fibroids expulsion can be considered not an adverse but a favorable event after fibroids' treatment. The expulsion (that in some cases can be asymptomatic or mild symptomatic) can lead to improvement of symptoms, and in the end turns out to be resolutive in most cases. Further studies are needed, especially to evaluate the efficacy and the fibroid expulsion rate of the newest minimally invasive techniques.