What to Expect with Treatment
You’ve been approved for MRgFUS treatment of your uterine fibroids! What happens next?
Arrive approximately 30 minutes before the procedure. The lower abdominal wall must be shaved (often by the patient) to prevent skin burns from tiny air bubbles trapped in the hair follicles. A Foley catheter is placed in the bladder to prevent it from filling with urine during the procedure. An IV line supplies fluids and enough light sedation to keep the patient relaxed and comfortable and to discourage movement during the procedure. However, the patient remains conscious and able to communicate with the treatment provider.
The woman lies in a prone position (face down) on the MRI table, with her head outside the chamber of the MRI device. The clinician obtains pre-treatment images to confirm that the bowel and bladder are not in the path of the ultrasound waves, and to check on the condition of the targeted fibroid(s). Pre-treatment images are also used to plan ultrasound pathways that avoid hitting scar tissue or nearby organs.
As the treatment starts, a low energy sound wave is used to check the accuracy of the target. This ultrasound wave has enough energy to be detected, but not enough to damage cells. Once the focus is established, treatment sonications raise the temperature at the focal point to 65 to 85 degrees Centigrade. Each treatment lasts 20 to 30 seconds and targets an area about the size of a bean (0.5 cubic centimeter). Between treatments, the tissue is allowed to cool down for roughly 90 seconds. During this interval, the clinician uses real-time imaging to view the extent and location of the targeted area. A series of small sonications are targeted to destroy 50 percent or more of the fibroid cells.
Women have reported feeling warmth on their skin or in the pelvic region. Some feel a “pinch” or something like a menstrual cramp during the heating cycle. The clinician talks with the woman to determine how she is feeling and describe what sensations are normal. The patient also controls a button that can stop the treatment if she experiences significant discomfort.
At the end of the treatment, the clinician may assess the remaining tissue with a contrast agent to determine the actual area of necrosis (cell death). The dead tissue will gradually be reabsorbed by the body.
Patients may feel “groggy” from the light sedation rather than from the MRgFUS procedure. Patients frequently report feeling well enough to go out for dinner after the procedure. Only 10 percent take pain medication three days later. Occasional women run a fever, and 5 percent have some skin burns due to incomplete hair removal.
Following the treatment, a woman rests for one to two hours to allow the sedation to wear off. Once the patient is released, she can return home. The doctor may recommend over-the-counter pain medication, but often none is required. Some women report menstrual-like cramping or pain in their shoulder or back from lying prone for several hours. In one clinical trial with 109 women, women returned to normal activities in less than three days, and missed an average of 1.4 work days. Their fibroid-related symptoms were generally relieved within three months.
Follow-up in most cases is minimal, and women see physicians at their next annual check-up. More than 90% of patients recorded in clinical studies have reported symptom relief. Fibroids shrink approximately 30% after every six months post-treatment. Although the fibroid is not removed, it changes from a rock solid mass to being squishy like a sponge. That in itself results in symptom relief felt as soon as a couple days after the procedure.