The clinical applicability of magnetic resonance image−guided high-intensity focused ultrasound (MR-HIFU) treatment of uterine fibroids is often limited due to inaccessible fibroids or bowel interference. The aim of this study was to implement a newly developed 3-step modified manipulation protocol and to evaluate its influence on the number of eligible women and treatment failure rate.
From June 2016 to June 2018, 165 women underwent a screening MRI examination, 67 women of whom were consecutively treated with MR-HIFU at our institution. Group 1 (n = 20) was treated with the BRB manipulation protocol which consisted of sequential applications of urinary bladder filling, rectal filling, and urinary bladder emptying. Group 2 (n = 47) was treated using the 3-step modified manipulation protocol which included (1) the BRB maneuver with adjusted rectal filling by adding psyllium fibers to the solution; (2) Trendelenburg position combined with bowel massage; (3) the manual uterine manipulation (MUM) method for uterine repositioning. A comparison was made between the two manipulation protocols to evaluate differences in safety, the eligibility percentage, and treatment failure rate due to unsuccessful manipulation.
After implementing the 3-step modified manipulation protocol, our ineligibility rate due to bowel interference or inaccessible fibroids decreased from 18% (16/88) to 0% (0/77). Our treatment failure rate due to unsuccessful manipulation decreased from 20% (4/20) to 2% (1/47). There were no thermal complications to the bowel or uterus.
Implementation of the 3-step modified manipulation protocol during MR-HIFU therapy of uterine fibroids improved the eligibility percentage and reduced the treatment failure rate.
Registry number NL56182.075.16
• A newly developed 3-step modified manipulation protocol was successfully implemented without the occurrence of thermal complication to the bowel or uterus.
• The 3-step modified manipulation protocol increased our eligibility percentage for MR-HIFU treatment of uterine fibroids.
• The 3-step modified manipulation protocol reduced our treatment failure rate for MR-HIFU treatment of uterine fibroids.
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Bladder filling, rectal filling, bladder emptying
Magnetic resonance image–guided high-intensity focused ultrasound
Magnetic resonance imaging
Manual uterine manipulation
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The authors state that this work has not received any funding.
The scientific guarantor of this publication is M.F. Boomsma, MD, PhD.
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The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.
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Written informed consent was obtained from all subjects (patients) in this study.
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Verpalen, I.M., van ‘t Veer-ten Kate, M., de Boer, E. et al. Development and clinical evaluation of a 3-step modified manipulation protocol for MRI-guided high-intensity focused ultrasound of uterine fibroids. Eur Radiol 30, 3869–3878 (2020). https://doi.org/10.1007/s00330-020-06780-2