Outpatient multimodality management of large submucosal myomas using transvaginal radiofrequency myolysis

Study Objective: To evaluate the safety and efficacy of transvaginal radiofrequency myolysis (RFM) with or without combined hysteroscopy for treatment of large submucosal leiomyomas with a substantial intramural portion. Design: Retrospective observational study (Canadian Task Force classification III). Setting: Hospital outpatient department. Patients: Twenty-four patients with large submucosal leiomyomas with a substantial intramural portion. Interventions: Transvaginal RFM with or without combined hysteroscopy. Measurements and Main Results: Twenty-four patients with large submucosal leiomyomas with a substantial intramural portion were enrolled to undergo stepwise RFM. Additional hysteroscopic myomectomy was performed in 6 patients at 3 to 6months after RFM. Myoma volumes were measured via 3-dimensional ultrasonography before RFM and at 1, 3, 6, 12, and 24months postoperatively. Symptom severity was assessed using the Uterine Fibroid Symptom and Quality of Life questionnaire and the Health-Related Quality of Life questionnaire. The total volume reduction rate 24months postoperatively was 84.2%. Symptom severity and health-related quality of life scores demonstrated substantial improvements at 12months after RFM. Conclusions: RFM with or without hysteroscopy is an effective treatment for large myomas with deep intramural positioning, and it seems safe for use in all patients with submucosal myoma-related symptoms.