Role of leuprolide acetate depot in hysteroscopic surgery: a controlled study

Perino, Antonio; Chianchiano, N.; Petronio, M; Cittadini, E

doi:10.1016/s0015-0282(16)55790-2

Cited by 75 publications

(36 citation statements)

References 14 publications

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“…After three months of treatment, the patients in Mencaglia and Tantini's study 24 had 61 ± 10% reductions in fibroid size with an associated reduction in vascularization. Similar findings were reported by Arcaini et al 25 Perino et al 26 A total of 11 articles were selected for review. Crosignani et al in 1996 20 reviewed data from the English language literature and found that inducing amenorrhea in patients with menorrhagia and severe anemia before both conservative and definitive surgeries for uterine fibroids raises hemoglobin and hematocrit values to within normal range, limits homologous blood transfusion and enables surgeries to be scheduled with the patients in better condition.…”

Section: Methodssupporting

confidence: 63%

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Hysteroscopic Myomectomy: Is There a Place for Pretreatment with GnRH Agonist?

Okohue¹

2009

WJOLS

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Uterine fibroids (also known as myomas or leiomyomas) are the commonest benign solid tumours found in the female genital tract. Hysteroscopic myomectomy presently represents the standard minimally invasive surgical procedure for treating submucous fibroids. Whether treatment with GnRH agonist before hysteroscopic myomectomy offers significant advantages is still a matter of debate.A literature search was performed using Medline and the Google search engine, Springerlink and Highwire Press. A total of 11 articles were selected for review.GnRH agonist use prior to hysteroscopic myomectomy probably has potential benefits in terms of reduction in size of the fibroid and improvement of hemoglobin level, especially in patients with underlying secondary anemia. However, universally acceptable guidelines on the indications and duration of pretreatment whether administered monthly or as daily injections are lacking. Large randomized controlled trials are urgently needed to clarify the gray areas.

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Section: Methodssupporting

confidence: 63%

“…There seems to be an agreement that a 6-8 weeks course will be sufficient to shrink the fibroid by 30-50%. 24,26 In a recent study Stamatellos and Bontis 38 suggested a prolongation of therapy for 2-4 months in patients presenting with anemia with the addition of iron supplements to correct for the anemia.…”

Section: Discussionmentioning

confidence: 99%

Hysteroscopic Myomectomy: Is There a Place for Pretreatment with GnRH Agonist?

Okohue¹

2009

WJOLS

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“…While prospective studies evaluating this combined modality are rare [6,9,14,25], the use of GnRH-a before hysteroscopic myoma resection is well established. This has been shown to be very useful from the clinical point of view, with Donnez et al [7] reporting a high success rate after GnRH-a pretreatment in a great number of patients.…”

Section: Discussionmentioning

confidence: 99%

“…While the aim of endometrial ablation is to reduce menstrual blood flow in therapy-refractory menorrhagia, most patients desire postoperative amenorrhea. To achieve a successful postoperative outcome, hormonal pretreatment given before endometrial ablation and myoma resection may be an important factor [9][10][11][12][13][14].…”

Section: Introductionmentioning

confidence: 99%

Benefit of GnRH Analogue Pretreatment for Hysteroscopic Surgery in Patients with Bleeding Disorders

Römer¹

1998

Gynecol Obstet Invest

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Hysteroscopic surgery is widely used for the treatment of patients suffering from menorrhagia. In different studies, pretreatment of the endometrium with GnRH analogues (GnRH-a) prior to endometrial ablation has been reported to increase the success rate, as well as to reduce the menstrual blood flow, accounting for a significantly higher postoperative amenorrhea rate (42% in pretreated patients vs. 24% in those receiving no pretreatment). The aim of pretreatment is not only to obtain a thin endometrium but also to reduce the size and vascularization of myomas being treated. In our study, GnRH-a administration prior to endometrial ablation was shown to have the following advantages: improved hysteroscopic view, reduced blood loss, absorption of uterine distending fluid and higher postoperative amenorrhea rates. Prior to hysteroscopic myoma resection, pretreatment with GnRH-a may be particularly indicated for all myomas with a diameter of more than 3 cm and/or with an intramural portion, or for patients suffering from secondary anemia. GnRH-a pretreatment is thus indicated before endometrial ablation, and in most cases, before hysteroscopic resection of submucous myomas, and combined medical and surgical therapy has clear benefits in the treatment of bleeding disorders.

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“…Despite these theoretical advantages, until recently there had been no randomized clinical trials comparing TCRF with or without GnRHa pre-treatment. One non-randomized trial [24] reported that operating time is reduced, but another [25] suggested that the operations may actually take longer to complete. The year 2010 saw the publication of two randomized clinical trials of GnRHa pre-treatment, one from the United Kingdom [26] and the other from Italy [27].…”

Section: There Is Conflicting Evidence For the Benefits Of Gnrha Usedmentioning

confidence: 99%

GnRH Agonists: Do They Have a Place in the Modern Management of Fibroid Disease?

Talaulikar

Belli

Manyonda

2012

J Obstet Gynecol India

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In the management of women with fibroid disease, GnRH agonists (GnRHa) are frequently used to reduce volume and vascularity before myomectomy, apparently to render the operation easier and reduce operative blood loss, and to enable a transverse supra-pubic incision instead of a midline vertical one. They induce amenorrhoea and thus aid in the correction of pre-operative anaemia. Other gynaecologists use GnRHa to shrink sub mucous fibroids greater than 5 cm in diameter to facilitate access and reduce blood loss and operating time at transcervical resection. GnRHa are also occasionally used as a temporizing measure in women with symptomatic fibroids within the climacteric. We argue against the use of GnRHa in the management of fibroid disease because they are not cost effective, render myomectomy more difficult to apply because they destroy tissue planes, the more difficult enucleation in fact increasing rather than reducing perioperative blood loss and operating time. When used before myomectomy, they increase the risk of 'recurrence' because they obscure smaller fibroids that 'recur' when the effects of the GnRHa wear off, and are associated with side effects in situations where they confer no benefits, or where alternative cheaper drugs with fewer side effects are available.

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Role of leuprolide acetate depot in hysteroscopic surgery: a controlled study

Cited by 75 publications

References 14 publications

Hysteroscopic Myomectomy: Is There a Place for Pretreatment with GnRH Agonist?

Hysteroscopic Myomectomy: Is There a Place for Pretreatment with GnRH Agonist?

Benefit of GnRH Analogue Pretreatment for Hysteroscopic Surgery in Patients with Bleeding Disorders

GnRH Agonists: Do They Have a Place in the Modern Management of Fibroid Disease?

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