Current Trends of Alternatives to Hysterectomy in Adenomyosis: A Review Article

Dilruba Zeba, Riedwan Habibur Rahman, Raiyan Muhibur Rahman, Rajib Biswas
In: Bangabandhu Sheikh Mujib Medical College Journal · 2023 · vol. 2(1) , pp. 55–58 · doi:10.3329/bsmmcj.v2i1.69600 · W4388613833
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This review article examines emerging uterine-sparing alternatives to hysterectomy for adenomyosis, including HIFU, laparoscopic procedures, and advanced imaging techniques, to address fertility preservation needs.

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This review article evaluates current trends in uterine-sparing alternatives to hysterectomy for adenomyosis, describing diagnostic and therapeutic approaches that have emerged over the past two decades. It summarizes non-invasive high-intensity focused ultrasound (HIFU) using ultrasound or MRI guidance, as well as uterine-sparing surgical and imaging-guided techniques such as laparoscopic uterine artery embolization/occlusion with plexus block and partial adenectomy, and newer laparoscopic resections using real-time intraoperative ultrasound elastography guidance. It also outlines how transvaginal ultrasound, MRI, and hysteroscopic evaluation have improved diagnosis and enabled conservative options, while noting that conventional adenomyomectomy is associated with higher recurrence risk and uterine rupture, and that hysteroscopy is not first-line therapy. This paper is centrally about endometriosis and/or adenomyosis—specifically adenomyosis—by reviewing uterine-sparing diagnostic and treatment alternatives to hysterectomy.

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Abstract

Adenomyosis is a common gynecological problem characterized by the growth of endometrial glands and stroma within the myometrium. Previously, the definitive diagnosis of adenomyosis was made through histopathology after a hysterectomy. However, in the last two decades, several uterine-sparing treatment options have emerged, including High-Intensity Focused Ultrasound (HIFU), which has become a promising option. HIFU is a non-invasive local thermal ablation technique that can be performed via ultrasound or MRI guidance. Additionally, “Laparoscopic uterine artery occlusion with uterus sparing pelvic plexus block and partial adenectomy for adenomyosis” has become a popular option. While conventional adenomyomectomy carries a high risk of recurrence and uterine rupture, some novel surgical techniques have been described to mitigate these complications and preserve future fertility. There are also “new surgical techniques of laparoscopic resection of adenomyoma under real-time intraoperative ultrasound elastography guidance”. Diagnostic imaging techniques such as transvaginal ultrasound, MRI, and hysteroscopic evaluation have revolutionized the diagnosis of adenomyosis and opened up possibilities for conservative treatment options. Hysteroscopy can be used for direct visualization and biopsy collection, though it is not the first-line treatment option. With the increasing incidence of adenomyosis and the desire for fertility preservation among younger patients, there is a growing need for effective uterine-sparing treatments. Bangabandhu Sheikh Mujib Med. Coll. J. 2023;2(1): 55-58
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Current Trends of Alternatives to Hysterectomy in Adenomyosis: A Review Article Keywords: Adenomyosis, High-Intensity Focused Ultrasound (HIFU), Conventional Adenomyomectomy, Fertility preservation, Laparoscopic uterine artery embolization, Hysteroscopic evaluationAbstract Adenomyosis is a common gynecological problem characterized by the growth of endometrial glands and stroma within the myometrium. Previously, the definitive diagnosis of adenomyosis was made through histopathology after a hysterectomy. However, in the last two decades, several uterine-sparing treatment options have emerged, including High-Intensity Focused Ultrasound (HIFU), which has become a promising option. HIFU is a non-invasive local thermal ablation technique that can be performed via ultrasound or MRI guidance. Additionally, “Laparoscopic uterine artery occlusion with uterus sparing pelvic plexus block and partial adenectomy for adenomyosis” has become a popular option. While conventional adenomyomectomy carries a high risk of recurrence and uterine rupture, some novel surgical techniques have been described to mitigate these complications and preserve future fertility. There are also “new surgical techniques of laparoscopic resection of adenomyoma under real-time intraoperative ultrasound elastography guidance”. Diagnostic imaging techniques such as transvaginal ultrasound, MRI, and hysteroscopic evaluation have revolutionized the diagnosis of adenomyosis and opened up possibilities for conservative treatment options. Hysteroscopy can be used for direct visualization and biopsy collection, though it is not the first-line treatment option. With the increasing incidence of adenomyosis and the desire for fertility preservation among younger patients, there is a growing need for effective uterine-sparing treatments. Bangabandhu Sheikh Mujib Med. Coll. J. 2023;2(1): 55-58 241 Downloads Published How to Cite Issue Section License Copyright (c) 2023 Bangabandhu Sheikh Mujib Medical College Journal This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

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adenomyosis

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Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

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