Urinary and Sexual Function Outcomes After Ultrasound-Guided High-Intensity Focused Ultrasound for Uterine Fibroids: Associations of Lower Urinary Tract Symptoms with Fibroid Location and Uterine Morphology

Background/Objectives: Uterine fibroids may contribute to lower urinary tract symptoms (LUTS) through pelvic mass effects, but urinary and sexual outcomes after ultrasound-guided high-intensity focused ultrasound (USgHIFU) and their anatomical correlates remain unclear. We evaluated 6-month urinary and sexual outcomes, described urinary changes by dominant fibroid location, and explored associations between uterine morphology and baseline urinary symptom burden. Methods: This retrospective study included 75 women with paired baseline and 6-month urinary assessments (anterior, n = 45; non-anterior, n = 30). Measures included the Overactive Bladder Symptom Score (OABSS), Urogenital Distress Inventory-6 (UDI-6), Incontinence Impact Questionnaire-7 (IIQ-7), International Consultation on Incontinence Questionnaire–Urinary Incontinence Short Form (ICIQ-UI SF), and Female Sexual Function Index (FSFI; n = 63); pretreatment magnetic resonance imaging (MRI) characterized uterine anatomy. Results: At 6 months, OABSS decreased from 3.51 ± 3.07 to 2.57 ± 2.29 (p = 0.005); UDI-6, IIQ-7, and ICIQ-UI SF also improved (all p ≤ 0.009), and OABSS ≥ 3 prevalence declined from 53.3% to 40.0% (p = 0.002). Mean urinary symptom scores decreased in both location groups. The larger longitudinal-diameter subgroup had higher baseline OABSS (4.20 vs. 2.71; p = 0.034) and OABSS ≥ 3 prevalence (70.0% vs. 34.3%; p = 0.003), whereas the corresponding comparisons for uterine volume and anteroposterior diameter were not significantly associated. The mean FSFI total score increased from 21.6 ± 5.8 to 26.5 ± 6.6 (summary-derived conservative p-value bound, p < 0.005). Conclusions: USgHIFU was associated with improved urinary symptoms, urinary symptom-related quality of life, and sexual function. The exploratory association between the longitudinal-diameter groups and baseline overactive bladder symptom burden warrants confirmation using continuous measurements and adjusted analyses.