To evaluate the efficacy and safety of a gonadotropin-releasing hormone (GnRH) agonist for treating large-sized submucosal leiomyoma before hysteroscopic myomectomy.The data were retrospectively collected from patients who underwent a hysteroscopic myomectomy for a submucosal leiomyoma >3.5 cm in size from January 2009 to December 2018. The patients were divided into the GnRH group and the control group according to whether they were pretreated before surgery.A total of 61 patients were included in the study, 31 in the GnRH agonist group and 30 in the control group. At diagnosis, the maximum leiomyoma diameter was similar between the 2 groups (4.67 ± 0.6 cm in the GnRH agonist group vs 3.82 ± 0.6 cm in the control group, P = .061). After pretreatment with the GnRH agonist, the maximum diameter was significantly smaller in the GnRH agonist group compared to the control group (3.82 ± 0.6 vs 4.33 ± 0.8 cm, respectively, P = .004). The leiomyoma volume in the GnRH agonist group decreased by 55.6%, from 41.68 ± 15.7 to 23.19 ± 10.4 cm 3 , which led to significant differences in leiomyoma volume between the 2 groups (23.19 ± 10.4 cm 3 in the GnRH agonist group vs 33.22 ± 24.7 cm 3 in the control group, P = .042). The GnRH agonist group showed a shorter operation time (37.7 vs 43.9 minutes, P = .040) and less uterine distention media was used (6800 vs 9373.3 mL, P = .037) compared to the control group. Postoperative complications such as estimated blood loss, remnant leiomyoma, and recurrence were similar between the 2 groups.Treatment with a GnRH agonist before hysteroscopic myomectomy for large submucosal leiomyoma might decrease the volume of the leiomyoma, reduce operation time, and the amount of uterine-distension media used without surgical complications.
Objective(s):To provide additional data and to inform all women at average risk of ovarina cancer, undergoing a benign gynecological laparoscopic procedure about the Pro's and the Con's of opportunistic bilateral salpingectomy (OBS). Mechanism: Risk reducing salpingo-oophorectomy to prevent epithelial ovarian cancer (EOC) is associated with decreased quality of life and increased overall mortality. OBS has emerged as a primary prevention of ovarian cancer through a paradigm shift in which fallopian tubes are often the cause of ovarian cancer rather than the ovaries themselves. Findings in Brief: Causal relationship of salpingectomy and reduced risk of ovarian cancer has not been proven yet. There are several population-based studies that showed bilateral salpingectomy reduced risk of EOC by 42-67%, but there also is a study that suggest increased risk of ovarian cancer after salpingectomy. As for risk of surgical complications, several cohort studies have demonstrated that there was no increase in rates of hospital readmission, blood transfusion, day of hospital stay. However, recent meta-analysis stated that there were insufficient data to assess any difference in both intraoperative and postoperative complication rates. The procedure of salpingectomy can disrupt blood supply to the ovary. Data of reproductive outcome after assisted reproductive technologies such as in vitro fertilization and embryo transfer (IVF-ET) are conflicting. Some studies suggest that salpingectomy did not compromise the outcome of IVF-ET, but other studies found that salpingectomy may lead to decreased ovarian reserve after salpingectomy. For patients who do not wish fertility, data on the effect of OBS during hysterectomy suggest that changes in serum ovarian reserve markers were not different between OBS group and control group. Conclusions: Bilateral salpingectomy should be considered at the time of abdominal or pelvic for women at average risk of ovarian cancer. However, physicians should discuss the protective benefit of bilateral salpingectomy against ovarian cancer and controversial data on ovarian reserve.
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