Data Sheet 1_Long-term efficacy and reintervention of focused ultrasound ablation surgery monotherapy for adenomyosis: a systematic review and meta-analysis.docx

Background The clinical management of adenomyosis remains challenging. Pharmacological therapies and surgical approaches for adenomyosis have shown benefits but present important limitations, such as side effects, recurrence, and loss of fertility. In recent years, focused ultrasound ablation surgery (FUAS) has emerged as a promising uterus-preserving alternative. Nevertheless, it has not yet been approved by major regulatory authorities worldwide for the treatment of adenomyosis, and relevant evidence on the long-term efficacy of FUAS as well as the need for reintervention is scarce. Objective Aimed to systematically evaluate the long-term outcomes and reinterventions of FUAS for adenomyosis. Methods A comprehensive literature search was conducted in PubMed, Embase, Web of Science, and the Cochrane Library to identify relevant studies published up to February 2026, which investigated the clinical outcomes of adenomyosis patients undergoing FUAS monotherapy. Study selection and data extraction were independently performed by two researchers each. Fixed-effect and random-effect models were utilized to calculate synthesized effect sizes. Mean differences (MDs) were used for continuous outcomes, and proportions were used to assess dichotomous outcomes. Results A total of 27 studies involving 13,307 patients were included in this review. The pooled nonperfused volume ratio (NPVR) was 70%. The reduction in dysmenorrhea VAS score was 3.52 (95% CI: 3.15–3.90), with a dysmenorrhea remission rate of 0.79 (95% CI: 0.75–0.83). The reduction in menorrhagia severity score was 1.31 (95% CI: 1.21–1.40), with a menorrhagia remission rate of 0.75 (95% CI: 0.69–0.81). The female sexual function index (FSFI) score increased by 5.38 (95% CI: 2.77–8.00). All improvements were statistically significant (p < 0.001). The incidence of major adverse events was 0.3%, whereas minor adverse events occurred in 46% of cases. The pooled pregnancy rate was 6%. The overall reintervention and recurrence rates were 7 and 20%, respectively, while the long-term reintervention and recurrence rates were 8 and 45%, respectively. Conclusion FUAS is a noninvasive, safe, and effective treatment for adenomyosis, demonstrating sustained long-term efficacy with a favorable reintervention rate. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/view/CRD420261329888.