Three-month treatment with triptorelin, letrozole and ulipristal acetate before hysteroscopic resection of uterine myomas: prospective comparative pilot study

Bizzarri, Nicolò; Ghirardi, Valentina; Remorgida, Valentino; Venturini, Pier Luigi; Ferrero, Simone

doi:10.1016/j.ejogrb.2015.06.018

Cited by 64 publications

(32 citation statements)

References 19 publications

(29 reference statements)

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“…Several trials showed that the effect of UPA on the endometrium does not increase the technical difficulty during hysteroscopic myomectomy [17][18][19][20]. Anyway, it is still debated whether the Progesterone Receptor Modulator Associated Endometrial Changes may negatively affect the intrauterine visualization of myomas when performing hysteroscopic myomectomy [8].…”

Section: Discussionmentioning

confidence: 99%

“…In general, direct hysteroscopic myomectomy can usually be considered in women with single FIGO type 0 or 1 myomas without a necessity to prescribe any preoperative treatment [17]. The preoperative administration of UPA for myomas should be considered in the case of complex surgical procedures because it offers the advantage of a higher chance of complete primary resection without increasing the difficulty of surgery [19].…”

Section: Discussionmentioning

confidence: 99%

“…Among these, 22 studies were excluded for the inappropriate population, intervention or outcomes (n = 17), and because they were case reports or series without highly valuable information (n = 3), letter to the editor or abstract (n = 2). In the end, 6 studies (2 prospective studies [17,18] and 4 retrospective studies [19][20][21][22]) were included in the present review. Two studies evaluated UPA use before hysteroscopic myomectomy [17,19,20], 2 studies evaluated it before laparoscopic myomectomy [21,22], and 1 study before both surgical techniques [18].…”

Section: Study Selection and Study Characteristicsmentioning

confidence: 99%

“…The first study was an Italian single-center prospective nonrandomized comparative pilot trial [17]. It compared Characteristics of the studies evaluating UPA prior hysteroscopy included in the systematic review Author Bizzarri et al [17] Sancho et al [20] Ferrero et al [19] Murji et al [ Sancho et al [20] Ferrero et al [19] Murji et al [18] Secondary [23]; in this study, the myomas were also classified according to the size, topography, extension, penetration, wall (STEPW) classification [24,25]. A total of 61 women underwent either direct surgery (n = 23) or received a 3-month preoperative therapy with triptorelin (a GnRHa, 3.75 mg intra-muscular injection every 28 days; n = 20), letrozole (an aromatase inhibitor, 2.5 mg/day; n = 11), or UPA (5 mg oral daily; n = 7).…”

Section: Upa Prior To Hysteroscopymentioning

confidence: 99%

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Ulipristal Acetate before Hysteroscopic and Laparoscopic Surgery for Uterine Myomas: Help or Hindrance?

Ferrero

Vellone

Barra

et al. 2018

Gynecol Obstet Invest

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Background/aims: Ulipristal acetate ([UPA], Esmya®) is an orally active selective progesterone-receptor modulator that has been approved as preoperative treatment for uterine myomas. This systematic review aims to summarize the available data on surgical outcomes of patients undergoing myomectomy by hysteroscopy or by laparoscopy after preoperative treatment with UPA. Methods: this review was performed following PRISMA guidelines and was registered in PROSPERO (CRD42018092201). PubMed, EMBASE, and Medline databases were systematically searched electronically until March 2018 for keywords concerning this topic. There were included only peer-reviewed, English language journal articles. Results: two prospective studies and 4 retrospective studies were included. The effect of UPA on the endometrium does not increase the technical difficulty during hysteroscopic myomectomy, but it increases the chance of complete primary resection in complex hysteroscopic myomectomies. Moreover, UPA does not increase the overall technical difficulty of laparoscopic myomectomy. Contradictory results have been reported on the impact of UPA on the separation of the myoma from the myometrium and on the consistency of the myomas. Conclusion: current results support the use of UPA prior to both surgical procedures. Further studies should confirm these preliminary findings and to assess the long-term outcomes of myomectomies following UPA treatment.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Study Selection and Study Characteristicsmentioning

confidence: 99%

Section: Upa Prior To Hysteroscopymentioning

confidence: 99%

See 2 more Smart Citations

Ulipristal Acetate before Hysteroscopic and Laparoscopic Surgery for Uterine Myomas: Help or Hindrance?

Ferrero

Vellone

Barra

et al. 2018

Gynecol Obstet Invest

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View full text Add to dashboard Cite

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“…32 To date, there have been a number of studies looking at the effect of UPA on surgery. In a prospective nonrandomised trial, Bizzari et al 51 showed that letrozole, triptorelin and UPA decreased the size of fibroids when given for 3 months prior to hysteroscopic resection of fibroids, but there was no difference in operating time between patients given UPA and those who were not given any pre-treatment. In a retrospective analysis, Ferrero et al 52 reported an increased ability to perform complicated hysteroscopic myomectomy after pre-treatment with UPA for 3 months.…”

Section: Upa and Surgerymentioning

confidence: 99%

Is ulipristal acetate the new drug of choice for the medical management of uterine fibroids? Res ipsa loquitur?

Odejinmi

Oliver

Mallick

2017

Womens Health (Lond Engl)

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Ulipristal acetate (Esmya © ) has been hailed the new wonder drug with regard to the medical management of uterine fibroids, and many postulate that it will remove the need for surgical treatment in the future. While the results from the PEARL studies are certainly promising and its amenorrhoeic rates and reduction in fibroid size are unquestionable, there is still a paucity of data with regard to its long-term effects, the effects on its usage prior to surgery and its variable efficacy in different ethnic populations. To facilitate our knowledge further, independent studies with clear outcome measures evaluating the long-term effects of the drug in a wider, more representative, ethnic minority population as well as assessing its true cost-effectiveness compared to surgery are needed. The aim of this article is to review the historical aspects with regard to the management of uterine fibroids to gain an understanding of where we are now and to evaluate the wider use of ulipristal acetate, both its benefits and limitations and postulate where to go in the future in order to allow our women to make safe and informed choices regarding their treatment options.

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Preoperative medical therapy before surgery for uterine fibroids

Lethaby

Puşcaşiu

Vollenhoven

2017

Cochrane Database of Systematic Reviews

103

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Background Uterine fibroids occur in up to 40% of women aged over 35 years. Some are asymptomatic, but up to 50% cause symptoms that warrant therapy. Symptoms include anaemia caused by heavy menstrual bleeding, pelvic pain, dysmenorrhoea, infertility and low quality of life. Surgery is the first choice of treatment. In recent years, medical therapies have been used before surgery to improve intraoperative and postoperative outcomes. However, such therapies tend to be expensive. Fibroid growth is stimulated by oestrogen. Gonadotropin-hormone releasing analogues (GnRHa) induce a state of hypo-oestrogenism that shrinks fibroids , but has unacceptable side effects if used long-term. Other potential hormonal treatments, include progestins and selective progesterone-receptor modulators (SPRMs). This is an update of a Cochrane Review published in 2000 and 2001; the scope has been broadened to include all preoperative medical treatments. Objectives To assess the effectiveness and safety of medical treatments prior to surgery for uterine fibroids. Search methods We searched the Cochrane Gynaecology and Fertility Group specialised register, CENTRAL, MEDLINE, Embase, PsycINFO and CINAHL in June 2017. We also searched trials registers (ClinicalTrials.com; WHO ICTRP), theses and dissertations and the grey literature, handsearched reference lists of retrieved articles and contacted pharmaceutical companies for additional trials. Selection criteria We included randomised comparisons of medical therapy versus placebo, no treatment, or other medical therapy before surgery, myomectomy, hysterectomy or endometrial resection, for uterine fibroids. Data collection and analysis We used standard methodological procedures expected by The Cochrane Collaboration.

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Three-month treatment with triptorelin, letrozole and ulipristal acetate before hysteroscopic resection of uterine myomas: prospective comparative pilot study

Cited by 64 publications

References 19 publications

Ulipristal Acetate before Hysteroscopic and Laparoscopic Surgery for Uterine Myomas: Help or Hindrance?

Ulipristal Acetate before Hysteroscopic and Laparoscopic Surgery for Uterine Myomas: Help or Hindrance?

Is ulipristal acetate the new drug of choice for the medical management of uterine fibroids? Res ipsa loquitur?

Preoperative medical therapy before surgery for uterine fibroids

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