Long-term efficacy and reintervention of focused ultrasound ablation surgery monotherapy for adenomyosis: a systematic review and meta-analysis

Liang Hu, Danfeng Shi, Meijie Yang, Zhaorui Zou, Jinyun Chen
In: Frontiers in Medicine · 2026 · vol. 13 · doi:10.3389/fmed.2026.1855726 · W7164523040
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⚙ AI-generated summary by claude@2026-06, 2026-06-18 ⓘ

This systematic review and meta-analysis of 27 studies found that focused ultrasound ablation surgery (FUAS) monotherapy effectively reduced adenomyosis symptoms and improved sexual function, with significant long-term efficacy and a notable recurrence rate.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-18 ⓘ

This systematic review and meta-analysis evaluated long-term outcomes and reintervention after focused ultrasound ablation surgery (FUAS) monotherapy for adult women with symptomatic adenomyosis, using evidence from 27 studies (13,307 patients) identified via searches of PubMed, Embase, Web of Science, and the Cochrane Library up to February 2026. Pooled results showed a nonperfused volume ratio of 70%, with statistically significant improvements in dysmenorrhea (VAS reduction MD 3.52; remission 0.79) and menorrhagia (severity reduction MD 1.31; remission 0.75), alongside increased FSFI scores (MD 5.38), while adverse events included 0.3% major and 46% minor events; recurrence and reintervention rates were 20% and 7% overall, and 45% and 8% in long-term follow-up. The pregnancy rate pooled across included studies was 6%. A major limitation acknowledged by the authors’ framing is the inconsistency and scarcity of long-term evidence for FUAS monotherapy, prompting inclusion of non-randomized designs and reliance on available follow-up durations. This paper is centrally about endometriosis—adenomyosis specifically—because it systematically assesses FUAS long-term efficacy, adverse events, recurrence, and reintervention for adenomyosis.

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Abstract

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 .

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