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
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to European Journal of Obstetrics and Gynecology and Reproductive BiologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Laparoscopic versus abdominal myomectomy: a prospective, randomized trial to evaluate benefits in early outcome.Am J Obstet Gynecol. 1996; 174: 654-658
- Randomized study of laparoscopic versus minilaparotomic myomectomy for uterine myomas.J Minim Invasive Gynecol. 2006; 13: 92-97
- A multicenter randomized, controlled study comparing laparoscopic versus minilaparotomic myomectomy: short-term outcomes.Fertil Steril. 2007; 88: 942-951
- Laparoscopic versus open myomectomy—a meta-analysis of randomized controlled trials.Eur J Obstet Gynecol Reprod Biol. 2009; 145: 14-21
- Laparoscopic myomectomy.Obstet Gynecol. 1992; 80: 884-888
- Drug safety evaluation of ulipristal acetate in the treatment of uterine fibroids.Expert Opin Drug Saf. 2015; 14: 965-977
- Ulipristal acetate versus placebo for fibroid treatment before surgery.N Engl J Med. 2012; 366: 409-420
- Ulipristal acetate versus leuprolide acetate for uterine fibroids.N Engl J Med. 2012; 366: 421-432
- Long-term treatment of uterine fibroids with ulipristal acetate.Fertil Steril. 2014; 101 (e1-18): 1565-1573
- Progesterone receptor modulator CDB-2914 down-regulates proliferative cell nuclear antigen and Bcl-2 protein expression and up-regulates caspase-3 and poly(adenosine 5′-diphosphate-ribose)polymerase expression in cultured human uterine leiomyoma cells.J Clin Endocrinol Metab. 2005; 90: 953-961
- In vivo mechanisms of uterine myoma volume reduction with ulipristal acetate treatment.Fertil Steril. 2015; 104 (e1): 426-434
- Progesterone receptor modulator CDB-2914 induces extracellular matrix metalloproteinase inducer in cultured human uterine leiomyoma cells.Mol Hum Reprod. 2008; 14: 181-191
- Ulipristal acetate modulates the expression and functions of activin a in leiomyoma cells.Reprod Sci. 2014; 21: 1120-1125
- Three-month treatment with triptorelin, letrozole and ulipristal acetate before hysteroscopic resection of uterine myomas: prospective comparative pilot study.Eur J Obstet Gynecol Reprod Biol. 2015; 192: 22-26
- Ulipristal acetate before high complexity hysteroscopic myomectomy: a retrospective comparative study.J Minim Invasive Gynecol. 2016; 23: 390-395
- Hysteroscopic myomectomy outcomes after 3-month treatment with either ulipristal acetate or GnRH analogues: a retrospective comparative study.Eur J Obstet Gynecol Reprod Biol. 2016; 198: 127-130
- Use of ulipristal acetate for the management of fibroid-related acute abnormal uterine bleeding.J Obstet Gynaecol Can. 2016; 38: 80-83
- Assessment of menstrual blood loss using a pictorial chart.Br J Obstet Gynaecol. 1990; 97: 734-739
- The FIGO classification of causes of abnormal uterine bleeding: Malcolm G. Munro, Hilary O.D. Crithcley, Ian S. Fraser, for the FIGO Working Group on menstrual disorders.Int J Gynaecol Obstet. 2011; 113: 1-2
- Preoperative treatment with letrozole in patients undergoing laparoscopic myomectomy of large uterine myomas: a prospective non-randomized study.Eur J Obstet Gynecol Reprod Biol. 2014; 181: 157-162
- Unidirectional barbed suture versus continuous suture with intracorporeal knots in laparoscopic myomectomy: a randomized study.J Minim Invasive Gynecol. 2010; 17: 725-729
- Influence of ulipristal acetate therapy compared with uterine artery embolization on fibroid volume and vascularity indices assessed by three-dimensional ultrasound: prospective observational study.Ultrasound Obstet Gynecol. 2015; 45: 744-750
- Sonographic changes of uterine fibroids after three-month treatment with ulipristal acetate.Ultrasound Obstet Gynecol. 2015; 46: 27-28
- Efficacy and safety of repeated use of ulipristal acetate in uterine fibroids.Fertil Steril. 2015; 103 (e3): 519-527
- Laparoscopic myomectomy in premenopausal women with and without preoperative treatment using gonadotrophin-releasing hormone analogues.Hum Reprod. 1999; 14: 44-48
- Pre-operative GnRH analogue therapy before hysterectomy or myomectomy for uterine fibroids.Cochrane Database Syst Rev. 2001; (CD000547)
- Efficacy of pre-operative gonadotrophin hormone releasing analogues for women with uterine fibroids undergoing hysterectomy or myomectomy: a systematic review.BJOG. 2002; 109: 1097-1108
- Gonadotropin-releasing hormone agonist in laparoscopic myomectomy: systematic review and meta-analysis of randomized controlled trials.J Minim Invasive Gynecol. 2011; 18: 303-309
- Comparison of laparoscopic myomectomy in large myomas with and without leuprolide acetate.J Minim Invasive Gynecol. 2015; 22: 992-996
- A prospective randomized study to evaluate leuprolide acetate treatment before laparoscopic myomectomy: efficacy and ultrasonographic predictors.Am J Obstet Gynecol. 1998; 178: 108-112
- Pre-operative gonadotrophin-releasing hormone agonist treatment in surgery for uterine leiomyomata.Hum Reprod. 1993; 8: 450-452
Article info
Publication history
Published online: August 10, 2016
Accepted:
August 1,
2016
Received in revised form:
July 5,
2016
Received:
April 26,
2016
Identification
Copyright
© 2016 Elsevier Ireland Ltd. All rights reserved.
