Elsevier

Fertility and Sterility

Volume 101, Issue 2, February 2014, Pages 472-487.e8
Fertility and Sterility

Original article
Uterus-sparing operative treatment for adenomyosis

https://doi.org/10.1016/j.fertnstert.2013.10.025Get rights and content
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Objective

To review systematically the literature on uterus-sparing surgical treatment options for adenomyosis.

Design

Systematic literature review.

Setting

Tertiary academic center.

Patient(s)

Women with histologically proven adenomyosis treated with uterus-sparing surgical techniques.

Intervention(s)

Conservative uterine-sparing surgery for adenomyosis classified as (1) complete excision of adenomyosis, (2) cytoreductive surgery or incomplete removal of the lesion, or (3) nonexcisional techniques, with studies selected if women with adenomyosis were treated surgically without performing hysterectomy.

Main Outcome Measure(s)

The cure rate after interventional strategies, the rate of symptom (dysmenorrhea and menorrhagia) control, and pregnancy rate in each group of intervention.

Result(s)

A quality assessment tool was used to assess the scientific value of each study. In total, 64 studies dealing with 1,049 patients were identified. After complete excision, the dysmenorrhea reduction, menorrhagia control, and pregnancy rate were 82.0%, 68.8%, and 60.5%, respectively. After partial excision, the dysmenorrhea reduction, menorrhagia control, and pregnancy rate were 81.8%, 50.0%, and 46.9%, respectively.

Conclusion(s)

Uterine-sparing operative treatment of adenomyosis and its variants appear to be feasible and efficacious. Well-designed, comparative studies are urgently needed to answer the multiple questions arising from this intriguing intervention.

Key Words

Adenomyoma
adenomyosis
cytoreductive surgery
juvenile cystic adenomyoma
uterus-sparing surgery

Cited by (0)

G.F.G. has nothing to disclose. T.M. has nothing to disclose. B.T. received unrestricted research grants, travel grants, and honoraria from Merck Sharp and Dohme and Merck Serono, and travel grants and honoraria from IBSA and Ferring.