Ultrasonographic prediction of the efficacy of GnRH agonist therapy before laparoscopic myomectomy.
OBJECTIVE
To assess ultrasonographic prediction of the efficacy of administration of a gonadotropin-releasing hormone (GnRH) analog before laparoscopic myomectomy.


METHODS
Prospective, randomized study of women treated consecutively from September 1994 to July 1996 (Canadian Task Force classification I).


METHODS
Endogyn Service, Private Endoscopic Associates, Naples, and Department of Gynecologic and Pediatric Sciences, Reggio Calabria University, Catanzaro, Italy.


METHODS
Sixty-seven infertile women with symptomatic uterine myomata, mainly intramural, undergoing laparoscopic myomectomy.


METHODS
Patients were prospectively randomized in two groups. Group A received preoperative administration of two injections of a depot formulation of leuprolide acetate 28 days apart, and group B underwent direct surgery. In each group we studied the number, diameter, and echogenicity of larger fibroids; resistance index of uterine arteries and myoma vessels; operating time; and blood loss.


RESULTS
The two groups did not significantly differ in baseline ultrasonographic parameters. Both blood loss (p <0.01) and operating time (p <0.05) were significantly lower in group A. However, operating time was significantly longer when the main myoma was markedly hypoechoic.


CONCLUSIONS
Our data confirm the therapeutic efficacy of administration of a GnRH analog before laparoscopic myomectomy in reducing blood loss and decreasing operating time in all cases except those with markedly hypoechoic fibroids.
Department of Gynecologic and Pediatric Sciences, Reggio Calabria University, Catanzaro, Italy.
F
F
Zullo
M
M
Pellicano
C
C
Di Carlo
R
R
De Stefano
D
D
Marconi
E
E
Zupi
D018931:Antineoplastic Agents, Hormonal / Q000008:administration & dosage / Q000627:therapeutic use*; D016063:Blood Loss, Surgical / Q000517:prevention & control; D003692:Delayed-Action Preparations; D005260:Female; D006801:Humans; D010535:Laparoscopy; D007889:Leiomyoma / Q000000981:diagnostic imaging / Q000601:surgery*; D016729:Leuprolide / Q000008:administration & dosage / Q000627:therapeutic use*; D009215:Myometrium / Q000000981:diagnostic imaging / Q000601:surgery*; D011300:Preoperative Care; D011446:Prospective Studies; D016896:Treatment Outcome; D014463:Ultrasonography; D014594:Uterine Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D014599:Uterus / Q000098:blood supply; D014655:Vascular Resistance
D018931:Antineoplastic Agents, Hormonal; D003692:Delayed-Action Preparations; D016729:Leuprolide