Pretreatment bowel manipulation during ultrasound-guided high-intensity focused ultrasound therapy for posterior wall uterine masses

Meng-Hsing Wu, Wu MH, Zhang Y, Yu Zhang, Dexin Chen, Chen D, Zhou N, Ningbo Zhou, Hui Li, Li H, Peng L, Lingling Peng, Min-Syuan Huang, Huang MS, Kuo TC, Tsung‐Cheng Kuo, Tsung-Cheng Kuo
Taiwanese journal of obstetrics & gynecology · 2021 · vol. 60(6) , pp. 1078–1083 · doi:10.1016/j.tjog.2021.09.020 · PMID:34794741 · W3214709668
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Pretreatment bowel manipulation with anal catheterization during ultrasound-guided HIFU therapy for posterior wall uterine masses reduced patient pain intensity, particularly sacrococcygeal and target region pain, compared to no bowel manipulation.

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Abstract

High-intensity focused ultrasound (HIFU) therapy is a noninvasive alternative to conventional abdominal surgery in obstetrics and gynecology. The aim of this study is to evaluate the reduction of pain intensity with bowel manipulation before ultrasound-guided HIFU treatment in women with posterior wall uterine fibroids and/or adenomyosis. This is a multicenter retrospective observational study. Data from all patients who underwent HIFU therapy at three HIFU clinics (Sichuan Maternal and Child Health Hospital, Xiangya Hospital of Central South University, and Kuo General Hospital) between January 2019 and December 2019 were analyzed. We compared pain intensity with and without bowel manipulation during the HIFU treatment and evaluated tolerability without intravenous sedation. The presence of discomfort or pain during the HIFU procedure was evaluated using the visual analog scale (VAS). A total of 86 women were included in this study. All women underwent HIFU therapy with the PRO-2008 system in the supine position for posterior wall uterine fibroids and/or adenomyosis. Thirty-seven women received pretreatment anal catheterization with a condom and 49 women were not subjected to bowel manipulation. All patients received pretreatment condom-catheter device were well tolerated during the procedure of bowel manipulation. During the HIFU procedure, the women who had received bowel manipulation experienced lower pain intensity, especially less sacrococcygeal pain (VAS score 1.56 ± 1.46 vs 2.89 ± 1.61), target region pain (1.54 ± 1.30 vs 2.53 ± 1.29), and radiating pain (0.13 ± 0.34 vs 0.41 ± 0.54), compared with the women without bowel manipulation. Bowel manipulation with anal catheterization before HIFU therapy for posterior wall uterine masses can be safely performed and is effective as a low risk intervention to aid in reducing potential HIFU complications related to nerve involvement.

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Outcome instruments

VAS-pain

Condition tags

adenomyosis

MeSH descriptors

Adenomyosis Extracorporeal Shockwave Therapy High-Intensity Focused Ultrasound Ablation Leiomyoma Ultrasonography, Interventional Uterine Neoplasms Adenomyosis Adenomyosis Child Female High-Intensity Focused Ultrasound Ablation Humans Leiomyoma Leiomyoma Pregnancy Retrospective Studies Treatment Outcome Ultrasonography, Doppler, Color Ultrasonography, Interventional Uterine Neoplasms

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