Gonadotropin-releasing hormone agonist use before hysterectomy.
OBJECTIVE
Our purpose was to compare the effects of leuprolide acetate in patients with symptomatic uterine leiomyoma before hysterectomy.


METHODS
Group I (n = 90) included patients with a pretreatment uterine size of 14 to 18 gestational weeks and group II (n = 60) included patients with uteri > 18 weeks' gestational size. Patients in both groups were randomized to either immediate hysterectomy or 2 months of preoperative gonadotropin-releasing hormone agonist.


RESULTS
All patients in the two groups with a pretreatment hemoglobin < 11.0 gm/dl randomized to agonist had a significant (p < 0.05) increase (> or = 1.5 gm/dl) in hemoglobin level. Patients in group I who received preoperative agonist were more likely to undergo vaginal hysterectomy (80% vs 13%, p < 0.05) than were patients who did not receive preoperative agonist. Patients undergoing vaginal hysterectomy had a shorter hospital stay, decreased operative blood loss, and a shorter convalescence period than did those undergoing abdominal hysterectomy. In group II, in spite of a mean uterine volume reduction of 51.3%, intraoperative morbidity, operative blood loss, hospital stay, and postoperative convalescence period did not differ between treatment arms.


CONCLUSIONS
The preoperative administration of gonadotropin-releasing hormone agonist in patients with a uterus of 14 to 18 weeks' size increases the use of vaginal hysterectomy, decreases intraoperative blood loss, and shortens hospital stay and convalescence. Preoperative gonadotropin-releasing hormone agonist for patients with a preoperative hemoglobin < 11.0 gm/dl reduces the risk of preoperative transfusion. Preoperative gonadotropin-releasing hormone use in the nonanemic patient with a uterine size > or = 18 weeks' gestational size doses not appear to lower operative morbidity.
Stovall
T G
TG
Department of Obstetrics and Gynecology, Bowman Gray School of Medicine, Wake Forest University, Winston-Salem, NC 27157-1066.
Summit
R L
RL
Washburn
S A
SA
Ling
F W
FW
D000328:Adult; D016063:Blood Loss, Surgical; D001803:Blood Transfusion; D001810:Blood Volume; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007044:Hysterectomy; D007045:Hysterectomy, Vaginal; D007889:Leiomyoma / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D007902:Length of Stay; D016729:Leuprolide / Q000494:pharmacology / Q000627:therapeutic use*; D008875:Middle Aged; D009929:Organ Size / Q000187:drug effects; D014594:Uterine Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D014599:Uterus / Q000473:pathology
D016729:Leuprolide