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Three-month treatment with ulipristal acetate prior to laparoscopic myomectomy of large uterine myomas: a retrospective study

  • Simone Ferrero
    Correspondence
    Corresponding author at: Academic Unit of Obstetrics and Gynecology, IRCCS AOU San Martino—IST, Largo R. Benzi 10, 16132 Genoa, Italy. Fax: +39 010511525.
    Affiliations
    Academic Unit of Obstetrics and Gynecology, IRCCS AOU San Martino—IST, Largo R. Benzi 10, 16132 Genoa, Italy

    Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Italy
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  • Franco Alessandri
    Affiliations
    Unit of Obstetrics and Gynecology, IRCCS AOU San Martino—IST, Largo R. Benzi 10, 16132 Genoa, Italy
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  • Valerio Gaetano Vellone
    Affiliations
    Department of Surgical and Diagnostic Sciences, IRCCS San Martino Hospital and National Institute for Cancer Research, University of Genoa, Largo Rosanna Benzi 1, 16132 Genoa, Italy
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  • Pier Luigi Venturini
    Affiliations
    Academic Unit of Obstetrics and Gynecology, IRCCS AOU San Martino—IST, Largo R. Benzi 10, 16132 Genoa, Italy

    Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Italy
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  • Umberto Leone Roberti Maggiore
    Affiliations
    Academic Unit of Obstetrics and Gynecology, IRCCS AOU San Martino—IST, Largo R. Benzi 10, 16132 Genoa, Italy

    Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Italy
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      Abstract

      Objective

      To assess the usefulness of 3-month treatment with ulipristal acetate (UPA) before laparoscopic myomectomy of large uterine myomas.

      Study design

      This retrospective analysis of a prospectively collected database included women of reproductive age requiring laparoscopic myomectomy with the following characteristics: FIGO type 3, 4 or 5 myomas; largest diameter of the main myoma ≥10 cm; number of myomas ≤3; largest diameters of the other myomas ≤5 cm (second myoma) and ≤3 cm (third myoma). Patients either underwent direct surgery (group S) or were treated before surgery with UPA for 3 months (group UPA).

      Results

      The mean (±SD) intraoperative blood loss was lower in group UPA (507.1 ± 214.9 ml) than in group S (684.2 ± 316.8; p = 0.012). The total operative time was lower in group UPA (137.6 ± 26.8 min) than in group S (159.7 ± 26.8 min; p < 0.001); there was no significant difference in the suturing time between the two study groups (p = 0.076). Hemoglobin drop was lower in group UPA (1.1 ± 0.5 g/dl) than in group S (1.3 ± 0.7 g/dl; p = 0.034). Six patients in group S and no patient in group UPA required postoperative blood transfusions (p = 0.031). Complications were not different between the two groups (p = 0.726). Moreover, preoperative treatment with UPA caused a significant increase in hemoglobin levels (11.9 ± 1.6 g/dl) compared with baseline (9.1 ± 1.1 g/dl; p < 0.001).

      Conclusion

      A 3-month treatment with UPA before laparoscopy for large uterine myomas decreases intraoperative blood loss, hemoglobin drop, postoperative blood transfusion and length of surgery.

      Keywords

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