HIFU: A new treatment technique comes to rescue of fibroids patients

A new technique for treating uterine fibroid and adenomyosis in Nigeria, High-Intensity Focused Ultrasound (HIFU), is raising the hope for women who may not be fit for surgery or are scared of going through open surgery (invasive) and its associated challenges.

In the last nine months, over 100 women with fibroids have been successfully treated in the country with the HIFU procedure, while others who are still suffering from health conditions are advised to avail themselves of the opportunity to improve the quality of their reproductive health and life. CHIJIOKE IREMEKA writes

TECHNOLOGY appears to be at one of its best in Nigeria’s medical sector which is now witnessing digital cut-less and bloodless surgeries for women suffering from fibroids and adenomyosis across the country.

The Guardian leant that uterine fibroids, if not treated, reduce the quality of life and reproduction of women. The health condition determines whether sperm from the male partner can meet the egg produced by the woman, or embryo implant, for fertilisation to take place and for pregnancy to occur. Fibroid also determines whether the pregnancy can continue, just as it affects the positioning of the baby.

Medical team performing open surgery on a patient

Formerly, open surgery was the major solution known to the country’s medical sector for the treatment of fibroids until the non-cut surgery (non-invasion) High-Intensity Focused Ultrasound (HIFU) came. Women are observed to be scared of the old and conventional open surgery for fear of losing their lives or wombs in the process or even developing another medical condition, especially when the operating surgeon goofed. This fear made some women give up the opportunity of giving birth to children and living healthy lives, especially those whose childlessness is caused by fibroids as in the case of a patient with massive tumors.

Apart from the fear of surgery and the accompanying pain, there are other people whose religious teachings do not permit blood transfusion which is one of the major requirements for open surgeries.

A consultant Surgeon, Dr. Ngozi Cynthia Okafor, recounted the case of a patient who was dressed and wheeled into the theatre for open surgery to remove fibroids but jumped out of the couch on seeing the surgical equipment, screaming that she would die.

“Since March 12, 2016, when the woman ran away from the hospital, she has been losing blood and is yet to become pregnant. She’s hoping for a miracle and I pray she finds one. Hers is massive and she can’t have a baby except for a miracle,” the surgeon said.

However, hope is brightened for the likes of this scared patient with the coming of HIFU Centre in Lagos for treatment of fibroids.

The Journal of Advances in Medicine and Medical Research reports that the prevalence of infertility ranged from 20 to 25 per cent among couples across Nigeria in 2018. It was ranked as the 5th highest serious global disability as the prevalence ranged from about six per cent to over 16 per cent across nations of the world.

It was learnt that HIFU uses real-time ultrasound and high-intensity ultrasound waves to generate localised heat to specifically target individual fibroids and destroy the cells. Using this treatment method, in conjunction with image guidance, the physician will be able to heat and destroy the fibroid tissue without damaging nearby tissue or the tissues that the beam passes through on its way to the target.

The Guardian gathered that this technique was first introduced in 2002 at the University of Oxford, United Kingdom (UK). Since then, it has spread to over 28 countries and regions, successfully treating over 150, 000 cases of benign and malignant tumours.

With the introduction of HIFU treatment system in Nigeria, women with benign uterine diseases are being treated in an incision-less, no-bleeding, and non-invasive manner and their uteri and fertility are preserved.

Those who spoke to The Guardian described the new fibroid treatment procedure as efficient, safe and time-friendly with minimal disconcertment. Women who are treated with HIFU will, in no time, resume their business activities as the procedure is completed within a few hours, unlike the old method which may take a whole day.

Celina Esowe, a resident of Lagos State, is one of the women who expressed a high phobia of open surgery but found this procedure a perfect option for her. She now urges other fibroid patients to go for cut-less procedures, after her bloodless surgery.

“Before HIFU, I used to experience serious menstrual pains and cramps; the flow was so painful with heavy blood clots. I searched in so many places for a solution because I was so scared of open surgery.

“I heard about HIFU and saw it on Facebook where I was searching for solution. I was interested in it because I have always had the feeling that technology could bring another means of treating fibroid without open surgery someday. So, when I saw HIFU, I didn’t entertain any fear because I expected it. When I came in contact with the expert, and with so many teachings about the HIFU, I was eager and I prayed that I would go through it successfully to get rid of fibroid. There were no challenges for me. I am not married yet.

“Ever since I had the surgery, there have been tremendous changes positively. My menstrual period is normal now with less pain and zero blood clot. No more pelvic pain. I do not need to skip work because of menstruation. I am more relaxed now. I am more confident now. The technology is superb, very easy and safe, and I recommend that every woman with fibroid should go through it instead of the normal open surgery. I have passed through the process and it is very safe and time-efficient. No cut or blood transfusion. No scars as well.

“My life now is a testimony. A few months after the procedure, I am already getting better and the symptoms are gradually diminishing every day. Though I had some little discomfort, I am very fine. I’m hoping to have my children. The technology (HIFU) is God-sent for every woman. You just lie on the stomach while the machine locates and kills the tumour using ultrasound waves. It works like magic. One minute, you are down; and the next minute, you are on your feet again with former symptoms disappearing one after the other,” Esowe explained.

A 38-year-old Patricia Omoke, from Eboyi State was diagnosed with fibroids in 2018, though she had been living with them for long. She used to experience heavy and prolonged bleeding before she got a free HIFU treatment that ended her painful experience.

“My period used to come with cramps and I would be out of action for days each month. I also struggled with heavy bleeding. When I went to the hospital to find out the cause, I was told that I had fibroids. I was asked to prepare for open surgery but I was scared. I was hoping for a miracle.

“Since the first scan, I started looking for a solution because I do not want surgery. I took supplements while researching online for an alternative. Last year, I got to know about this procedure on social media. I applied for the treatment at a centre and did the first scan. It was confirmed fibroid. I eventually went for the treatment on June 25, 2021. I cannot forget that experience. I was nervous being the first person. The moment I signed the consent form, I put my trust in God and went through the process of getting prepared.

“I didn’t even know when the procedure was done. I was actually asking one of the workers when the procedure was starting. I had been made to understand that I should be prepared to withstand a temperature of 60 degrees or higher and I was preparing for that, only to be told that the procedure had been completed and was successful.

“I couldn’t believe it but I was so happy. It was a wonderful experience. The fibroid wasn’t brought out, there was nothing like cutting or scraping, the fibroid is killed by the heat and over time. The dead fibroid is passed out or absorbed by the body, depending on its position. The one that is in the system is passed out, while the one in the muscle is absorbed by the system. I have not had any complications. 

“After the surgery, I noticed that the persistent back pain I had been feeling had disappeared. As soon as I got up from the table, I discovered that I didn’t feel the pain anymore. The second thing was that I wasn’t feeling the fibroid itself again. I no longer feel it while breathing and there is no discolouration on my skin from the laser,” she said. 

An Obstetrician/Gynecologist and Managing Director, Nordica Fertility Centre, Dr. Abayomi Ajayi explained that the ultra scan is converted into heat in HIFU procedure, which burns the fibroid and the blood supply.

According to him, the procedure is performed within one or two hours, depending on the size of the fibroid. “For some people that have many fibroids – 10 to 15 – the expert doesn’t have to do all of them in one sitting, it may take four to five hours. Hence, it is advisable for the physicians to do it twice,” he said.

Who Needs HIFU
The Guardian learnt that it is necessary to undergo Magnetic Resonance Imaging (MRI) before the surgery is done and that the journey begins with an ordinary scan because sometimes some of the things called fibroids are not fibroids.

Ajayi said: “There is a condition called adenomyosis. At a fibroid care centre, experts do not only do HIFU but also laparoscopic (an operation performed in the abdomen or pelvis using small incisions with the aid of a camera) surgery for fibroid. After two hours of observation, the patient is ready to go home.

“Of course, that is the reason for the test and scans. It is not every patient that is treated. If you are too obese, the distance between the uterus and where the energy is delivered is about 12cm. Imagine an obese woman in whom the only coverage area is about 4cm. That may not be effective. Therefore, an obese woman may not be able to use the system. Such a person may go for surgery and even at that level, he or she is a surgical risk. The concern is the woman’s health and the options available. It’s either losing weight or going for surgery. Women should not die from fibroid.”

The Gynecologist said experts must be careful about those who have done midline incisions.

“We must ascertain that there is a safe pathway for insertion. We cannot treat anybody who cannot communicate. Patients should be able to go home happily; there should be no skin burns. Those who have fibroids that are near the backbone have to tell us if they are having back pain before the surgery. 

“We must ensure that the intestines are free of gas and excreta. The patient is placed on a diet for three days before the surgery, which rids the intestine of faeces and gas. With HIFU, the fibroid does not come out. The fibroid is dead and so your body absorbs it. What we look out for is the shrinking rate.

“We expect that after about three months of surgery, about 35 per cent of the fibroid should have shrunken; in about six months, 50 per cent and in one year, 75 per cent. The symptoms disappear almost immediately. The problem with fibroid is that it is affecting the quality of life. No fibroid should be left inside of the uterus and with the machine, we do not want to heat the inside of the uterus too much, especially for those who want to have children. The rarest fibroids are the ones in the inside of the endometrium and they are the most troublesome.”

“We are delighted every time a woman walks in with fibroids and or adenomyosis and she leaves a few hours later devoid of the torment of her ailment. The relief we see on their faces gives us joy that the new treatment method is bringing relief to our womenfolk who would ordinarily have been scared of open surgery, and may have decided to live their lives with the pain, discomfort, blood loss,” Ajayi added.

On another category of people that would go for HIFU treatment, a specialist in HIFU and Obstetrician/ Gynecologist, Dr. Amarachukwu Njoku said that those that had been diagnosed with uterine fibroids or adenomyosis were qualified for the treatment. Women who have done fibroid surgery in the past and are still experiencing the same can also be treated with HIFU.

“Another set of people, who belong to that group, is people that do not have fibroids. They have a condition called adenomyosis, which is like endometriosis, but the bleeding is inside the muscle of the uterus. When you present it to the doctor, it looks like a fibroid but in Nigeria, we do not exchange medical records.
“The first doctor who had operated on a patient should be able to reveal the history of the patient. Most of the time, the patient goes to another doctor because she feels that the first doctor was not good enough. The new doctor will make the same mistake because he does not know that it is adenomyosis. And if the doctor is not well trained, he might not be able to distinguish between adenomyosis and fibroid. That is why MRI is compulsory because we cannot rely entirely on scans despite the resolution of the ultra scan. If a doctor is not well trained, by the time he finishes with the adenomyosis surgery, the uterus might not be able to carry the baby.

“It is so important to identify whether it is fibroid or adenomyosis because the follow up for the two of them is different. About 30 to 70 per cent of those who have fibroids present with adenomyosis. It is a common thing that people are not being properly diagnosed and it keeps showing up.

“Sometimes, the recurrence is because the diagnosis of the problem has not been made. These are some of the things we want to reduce over time. We need to make a proper diagnosis before a treatment plan. When you have had the treatment, we follow you up for one year.

“You have a three-month post-HIFU visit where we do a scan. We do MRI before HIFU. One week before HIFU, we do a repeat MRI to tell us how successful we have been. Three months after, we will do a scan to see the shrinkage level of the fibroid. Six months after, we do another scan and we see you after one year. You will fill quality of life form to ensure that the symptoms you came with are gone.”