Does medical debulking with gonadotrophin-releasing hormone agonist facilitate vaginal hysterectomy with a moderate enlarged uterus? A randomized control study

Is an enlarged fibroid uterus a contraindication for Non-Descent Vaginal Hysterectomy (NDVH)? Retrospective comparison between cohort whose uterine size ≥ 12 weeks and cohort whose uterine size less than 12 weeks underwent NDVH.

“…Our success in VH with larger fibroid uteri than 12 weeks has been reported in literatures as single searched item either as a case report (62) or as a prospective cohort (45,46,63,65) in different countries across the globe, or as prospective both randomized and unrandomized or retrospective both simple or propensity score-based comparisons with either TAH, TLH, RALH exploring different perioperative both clinical and financial consequences . Studies compare women underwent NDVH those with preoperative uterine size up to 12 weeks and postoperative histopathological uterine weight up to 280 grams against women with size more than 12 weeks and weight greater than 280 grams-displays similar results like we found regarding both safety and efficacy of NDVH in women with fibroids uteri larger than 12 weeks and 280 grams including Pogoda et al (1) , Shah et al (3) , Dubuisson et al (4) , Schmitt et al (36) , Wasson et al (37) , Buono et al (40) , Zaritsky et al (41) , Kammerer-Doak et al (43) , Unger et al (44) , Newbold et al (49) , Elzaher et al (51) , Deval et al (55) , Nazah et al (56) , Paparella et al (59) , Sirota et al (63) , Sahin et al (64) . According to our findings, VH for uteri larger than 12 weeks is deemed safe, despite significantly longer OR time, higher OBL, longer LOHS, longer time needed to return to usual activity and more decline in postoperative HB.…”

“…The size of the uterus can affect the ease of removal, and it is unclear whether an enlarged uterus is a contraindication for NDVH (1,4) . The large sized uterus more than 12 week was considered a traditional contraindication by most acting gynecologists who were surveyed for their opinion regrades routs for hysterectomy for benign gynecological diseases as stated in SGS's systematic review attributable to uncertainties about increased technical difficulty and risk of complications (31,33,34) , despite that a lot of pioneered gynecologists worldwide including American (2,3,(35)(36)(37)(38)(39)(40)(41)(42)(43)(44) , Canadian (45) , English (46)(47)(48)(49) , Indian (23,50,51) , Chinese (52) , Malaysian (53) ,south Africans (8,9,45,54) , French (4,(55)(56)(57) , polish (1,58) , Italian (59)(60)(61) , Greece (62) , Turkan (63)(64)(65) had been challenged the alleged uterine size as a contraindication for NDVH and they had succeeded in that task with great safety. Therefore, the goal of this retrospective research is to determine...…”

Is vaginal hysterectomy is equally safe for the enlarged and normally sized non-prolapse uterus? A cohort study assessing outcomes

“…Larger uteri can be medically debulked using preoperative regimen of GnRH agonists [9,12] in order to facilitate the vaginal approach and in our study, 43.9% of women with uteri >12 weeks received 3.6 mg of goserelin acetate (Zoladex, Astra Zeneca Ltd) (compared with 6.1% in the control group). A recent randomized controlled trial [18] found that the use of GnRH agonists can reduce the size of the uterus by up to 2 weeks and is associated with a shorter operative time and hospital stay and a greater chance of successful VH. It is likely that blood loss and operating time would have been greater in the index group had medical debulking techniques not been used.…”

The use of gonadotrophin-releasing hormone analogues in ART programs (clinical lecture)

“…Очевидно, что это мнение базируется на терапевтических эффектах а-ГнРГ при купировании клинических симптомов, характерных для указанных заболеваний. Действительно, длительное (3-6 мес) использование а-ГнРГ приводит к аменорее, на фоне которой происходит уменьшение размеров миоматозных узлов, исчезновение болей, повышение уровня гемоглобина в случае исходной анемии, улучшение общего состояния больных [4].…”