Endometrial resection and preoperative LH-RH agonists: a prospective 5-year trial.
OBJECTIVE
To evaluate the benefits of systematic preoperative treatment with LH-RH agonists prior to endometrial resection (ER).


METHODS
The study population was made up of 98 premenopausal women who underwent resectoscopic treatment for abnormal uterine bleeding (AUB) between January 1996 and December 1997. Only patients with endometrial polyps or dysfunctional bleeding were included. The population was divided into two groups: patients who had (group B) and those who had not (group A) received LH-RH before the surgical intervention.


RESULTS
ER was carried out as a single procedure in 66 (67.5%) of the patients. ER plus polypectomy was necessary in 32 (32.5%) patients. There were no differences between the two groups as far as the operating time and total volume of distension medium were concerned. No intraoperative complications were seen in either group. A higher negative balance of distension medium was achieved in group A (320 +/- 23 mL versus 187 +/- 16 mL; P < 0.001), and this difference was not modified when cases with polyps were excluded. The failure rate was similar in both groups both at 12 months [group A 6 (14.8%) versus group B 7 (14.9%) patients] and at 60 months [group A, 11 (21.6%) versus group B 10 (21.2%) patients]. Likewise, the amenorrhea and hypomenorrhea rates at 12 months and at 60 months were also shown to be the same in both groups. When two doses of LH-RH are used and the failure rate is taken into account the cost of an acceptable outcome increases from 843.37 Euro to 1373.49 Euro per patient, while the total cost of a hysterectomy is 1355.42 Euro.


CONCLUSIONS
Endometrial suppression with LH-RH agonists did not guarantee better results of ER, but they are strongly recommended during the learning curve to achieve a safer procedure.
Zapico
Alvaro
A
Servicio de Obstetricia y Ginecologiá, Hospital Príncipe de Asturias, School of Medicine, Universidad de Alcalá, Ctra Meco s/n. Alcalá de Henares, 28805 Madrid, Spain. azapicog@meditex.es
Grassa
Almudena
A
Martínez
Elena
E
Menéndez
Mónica
M
Cortés Prieto
Joaquín
J
D000328:Adult; D016889:Endometrial Neoplasms / Q000150:complications / Q000188:drug therapy / Q000601:surgery; D004717:Endometrium / Q000187:drug effects* / Q000601:surgery; D005260:Female; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists; D017273:Goserelin / Q000494:pharmacology*; D013509:Gynecologic Surgical Procedures; D006728:Hormones / Q000494:pharmacology*; D006801:Humans; D008875:Middle Aged; D011127:Polyps / Q000150:complications / Q000188:drug therapy / Q000601:surgery; D011300:Preoperative Care; D011446:Prospective Studies; D016896:Treatment Outcome; D014592:Uterine Hemorrhage / Q000188:drug therapy* / Q000209:etiology / Q000601:surgery
D006728:Hormones; D017273:Goserelin; D007987:Gonadotropin-Releasing Hormone