Evaluation of rectal endometriosis treatment with high-intensity focused ultrasound versus surgery: A clinical retrospective multicenter trial

Gil Dubernard, C Devantay, Chloé Devantay, Devantay C, Charles‐André Philip, Warembourg S, Sophie Warembourg, Nguyen-Ba E, Emilie Nguyen-Ba, Emilie Nguyen‐Ba, T. Dennis Thomas, Benjamin Merlot, Merlot B, Horace Roman
International Journal of Gynecology & Obstetrics · 2025 · vol. 172(2) , pp. 1245–1254 · doi:10.1002/ijgo.70478 · PMID:40842102 · W4413440613
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This study found that high-intensity focused ultrasound (HIFU) for rectal endometriosis resulted in similar symptom improvement and quality of life compared to surgery, but with significantly fewer postoperative complications.

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Abstract

OBJECTIVE: We conducted a comparative retrospective bicentric study of rectal endometriosis treatment with high-intensity focused ultrasound (HIFU) and surgery in terms of symptoms and treatment-related morbidity at 6 months. METHODS: All patients with a single symptomatic rectal nodule who had failed hormonal treatment were included in the present study. Patients' symptomatology was assessed using questionnaires: gynecologic and digestive symptoms (visual analog scale [VAS]), health status (MOSSF-36), fecal incontinence (Wexner), constipation (Knowles Eccersley Scott Symptom [KESS] score) and overall sexual health (FSFI). We also assessed the morbidity according to the Clavien-Dindo classification. RESULTS: A total of 120 patients, 60 in each group, received HIFU or rectal surgery. The characteristics of rectal nodules were similar in both groups. In the HIFU and surgery groups, Clavien-Dindo grades 2 and 3 complication rates were 3.3% versus 21.7% (P = 0.002) and 0% versus 10% (P = 0.01), respectively. Hospitalization duration was also significantly shorter for the HIFU group (1 vs 3 days; P < 0.001). In the HIFU group, significant improvement was observed in acute pelvic pain/dysmenorrhea (P < 0.001), dyspareunia (P < 0.001), diarrhea (P < 0.001), tenesmus/spasms (P < 0.001), pain on defecation (P < 0.001), and urinary urgency (P < 0.026). In the surgical arm, significant improvement was observed in acute pelvic pain/dysmenorrhea (P < 0.017), diarrhea (P < 0.002), tenesmus/spasms (P < 0.001), and pain on defecation (P < 0.002). In both groups, an improvement in FSFI, KESS, and Wexner scores and health status was noted at 6 months. CONCLUSION: In selected patients with only one rectal location, HIFU treatment enables a similar symptom-related and quality-of-life outcome with a significant reduction in the risk of postoperative complications.
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Abstract

Objective We conducted a comparative retrospective bicentric study of rectal endometriosis treatment with high-intensity focused ultrasound (HIFU) and surgery in terms of symptoms and treatment-related morbidity at 6 months.

Methods

All patients with a single symptomatic rectal nodule who had failed hormonal treatment were included in the present study. Patients' symptomatology was assessed using questionnaires: gynecologic and digestive symptoms (visual analog scale [VAS]), health status (MOSSF-36), fecal incontinence (Wexner), constipation (Knowles Eccersley Scott Symptom [KESS] score) and overall sexual health (FSFI). We also assessed the morbidity according to the Clavien–Dindo classification.

Results

A total of 120 patients, 60 in each group, received HIFU or rectal surgery. The characteristics of rectal nodules were similar in both groups. In the HIFU and surgery groups, Clavien–Dindo grades 2 and 3 complication rates were 3.3% versus 21.7% (P = 0.002) and 0% versus 10% (P = 0.01), respectively. Hospitalization duration was also significantly shorter for the HIFU group (1 vs 3 days; P < 0.001). In the HIFU group, significant improvement was observed in acute pelvic pain/dysmenorrhea (P < 0.001), dyspareunia (P < 0.001), diarrhea (P < 0.001), tenesmus/spasms (P < 0.001), pain on defecation (P < 0.001), and urinary urgency (P < 0.026). In the surgical arm, significant improvement was observed in acute pelvic pain/dysmenorrhea (P < 0.017), diarrhea (P < 0.002), tenesmus/spasms (P < 0.001), and pain on defecation (P < 0.002). In both groups, an improvement in FSFI, KESS, and Wexner scores and health status was noted at 6 months.

Conclusion

In selected patients with only one rectal location, HIFU treatment enables a similar symptom-related and quality-of-life outcome with a significant reduction in the risk of postoperative complications. CONFLICT OF INTEREST STATEMENT Professor Dubernard is a consultant for EDAP TMS company. However, the authors declare no conflict of interest for this study. DATA AVAILABILITY STATEMENT Research data are not shared.

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Outcome instruments

VAS-pain

Condition tags

endometriosisdysmenorrheadyspareunia

MeSH descriptors

Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis

Citation neighborhood

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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