What does HIFU mean?

HIFU is an acronym which stands for High Intensity Focused Ultrasound.

Are all HIFU procedures performed in HIFU Center “Sveta Marina” successful?

Yes. All assessed and approved for treatment patients have underwent successful HIFU procedures.


What is the principle of operation of HIFU?

The ultrasound beam passes through the tissue without damaging it – similar to diagnostic ultrasound. It is just in the focal point, where with the help of special transducer the energy of the ultrasound generates enough heat so that the pathogenic cell can be targeted and destroyed.

Is it possible HIFU treatment to be unsuccessful? If so, must it be repeated, when, is there any risk? Should it be again HIFU treatment advised or it could be replaced by another therapy to remove the uterine fibroid/-s?

The aim of the simulation examination before HIFU-ablation is to select only and precisely the appropriate for the treatment patients. In other words, these cases, in which 80-90% of tumor-necrosis in a single procedure are expected to be achieved. In some very rare cases an additional second procedure may be needed to achieve the desired result.


What is the difference between “high-frequency” and “high-intensity” ultrasound?

Sometimes there is a confusion about the difference between “high-intensity”(HIFU) and “high-frequency”(for ultrasound diagnostic)transducers. HIFU works with frequencies from 0,5 to 2Mhz, while US diagnostic transducers work with frequencies from 2,5 to 10MHz.

How long does HIFU procedure take?

On the average -2-3 hours. The time of the treatment is very individual.


How can we be sure that HIFU model JC treats only the pathogenic cells and no adjacent tissues would be damaged?

The ultrasound guidance, unique for the system, allows the physician to correct the direction, position and intensity of the ultrasound beam according to the observed tumor image in real time and to compare it with MRI/CT image.

What happens to the treated tissue?

As a result of the ultrasound ablation coagulation necrosis is formed in the tumor, which the human organism gradually “resorbs” in time and as a result the nodule shrinks in size.


Is it true that no severe side effects are observed after HIFU procedure?

In cases where the tumor formation is located close to the   surface of the skin it is possible, rarely though, some red rash or small blisters to appear (similar to those after sunburn) on the skin. Some people may feel internal discomfort after the procedure, which also soon disappear. Standard, over the counter pain-relief medications can be taken.

Is there any pain?

During the treatment the patient may feel slight discomfort in the pelvic region. This is normal and indicates that the therapy is effective.


What types of tumors can be treated with HIFU model JC?

Benign tumors: 1uterine fibroids (myoma); 2 breast fibroadenoma; 3. Uterine adenomyosis  (local form)

Malignant tumors of: pancreas, liver, kidney, breast, soft tissues – as a whole – dense, solitary tumors and single metastasis in the liver. In cases of malignant tumors, the patient must have underwent 1-3 courses of chemotherapy or radiotherapy before the HIFU procedure, because in these cases HIFU is an integral part of their complex treatment.

What type of anesthesia is administered when HIFU for uterine fibroids is performed?

The patient is sedated–she is conscious during the procedure.


Is HIFU out-patient procedure?

Because the therapy is 100% non-invasive and extracorporeal, hospital stay is not mandatory. However, the patients usually stay at the HIFU-center one day for medical supervision.

What is the recovery period after the treatment – is there any special routine that I must follow?

The patients recover in 1-2 days after HIFU-treatment, returning to their usual routine, however, after HIFU-ablation each patient is briefed on what to expect. The only restriction is to refrain from sexual intercourse in the first month after HIFU- ablation.


Can HIFU therapy be administered, after other forms of cancer treatment have been received (such as chemotherapy, radiotherapy etc.)?

Yes. Due to the fact that the procedure is non-toxic and non-ionizing, it will not cause the appearance or aggravation of symptoms from other conventional types of therapy (nausea, hair loss in chemotherapy) formerly used. This is the reason why HIFU therapy can be applied as many times as necessary to achieve the desired results. 

Is there any pain after HIFU treatment?

There might be a pain similar to the menstrual one a few days after the procedure.


Is it possible for the cancer cells to reappear after HIFU procedure?

The cancer cells, which were treated with HIFU are dead. There is some evidence that HIFU stimulates the immune system, which additionally helps to decrease the risk from the development of new tumors.

Is there any special diet that is necessary to follow before and after the procedure?

The approved patients are given special diet that they must start 4 days before the treatment. After that the patients can return to their usual diet.



What types of uterine fibroids can be treated with HIFU?

Most patients with uterine fibroid are appropriate for HIFU treatment as a first method of choice.

What time after the procedure can I resume my fitness program/sport activities?

Depends on the program and the sport, but it is good to slow down the physical activity during the first month after HIFU treatment.


What time after HIFU treatment can women expect pregnancy?

It depends on the rate at which the uterus is recovering. If all other parameters are within norm and the fibroid is the only hindrance to pregnancy, in general, the conception could be expected from 6 months to 1 year after the procedure. We recommend MRI examination to be performed beforehand to assess the current state of uterine recovery.


Are there any follow-up examinations after the treatment – how many and in what periods?

It is mandatory to go to control examinations after the procedure. They are scheduled in 1, 3, 6 and 12 months after the treatment and must be carried out by certified HIFU-doctors.


What should the patient know before HIFU treatment of uterine fibroids?

No abortions should have been made in the last 3 months before the procedure; the patient should not be with inflammation of the vagina or the small pelvis; the patient should not be in her period during the HIFU procedure and must not be with any contraceptive device in use at a time of the procedure.


What time after HIFU-treatment can I resume sex life?

You must refrain yourself from sex life in the first month after the procedure (until the first control examination).


What is the price of HIFU-procedure and is it reimbursed by NHIF?

Unfortunately the HIFU-procedures are still not reimbursed by the NHIF. Initial planning and assessment whether the patient is suitable for the procedure costs 150 BGN. It is performed by qualified and certified to work with the HIFU model JC system specialists of “Sveta Marina” hospital – Pleven. All the prices of the clinical procedures are on our website, section “Process of treatment and prices”.


In which cases HIFU ablation is not recommended/ contraindicated for uterine fibroid removal?

There are strict indications and contraindications for HIFU ablation. They are assessed at the simulation examination and are  individual for each patient.


Is there any risk for the uterus during HIFU treatment?

HIFU-ablation is absolutely harmless procedure for the uterus and ovaries, and there is no risk for the woman’s child bearing potential!


What time after the procedure may I start conception attempts?

The patient must not try to conceive for at least 6 months. This period is strictly individual! It is determined by the size of the treated uterine fibroid/-s and the rate at which they shrink.


Who are the specialists that perform the procedure and what is their experience?

Dobromir Dimitrov MD, PhD – Surgeon, Tihomir Andreev MD –“Imaging diagnostic” specialist; Dobrinka Gincheva MD -Gynecologist