Comparison of surgery alone and combined surgical-medical treatment in the management of symptomatic uterine adenomyoma.
OBJECTIVE
To compare the efficacy of surgical-medical treatment and surgery alone in the treatment of uterine symptomatic adenomyoma.


METHODS
Prospective nonrandomized study.


METHODS
Medical centers.


METHODS
One hundred sixty-five women treated with conservative adenomyomectomy.


METHODS
Surgery followed by six-course treatment (n = 114, surgical-medical group) or no treatment (n = 51, surgery-alone group) with a gonadotropin-releasing hormone (GnRH) agonist regimen.


METHODS
Symptom relief (scale: 0, no symptoms, to 5, worst symptoms) and relapse (when any one scale was > or =2 after treatment) during the 2-year follow-up period.


RESULTS
The general characteristics of the patients were similar in both groups, except for the diameter of the adenomyoma and age. Patients in both groups had statistically significant symptom relief, and all symptom scores declined from a mean of 3 or 4 to a mean of 1 or less at the end of the 2-year follow-up period. The symptom-relapse rates in the surgical-medical group were statistically significantly lower than those in the surgery alone group (n = 32, 28.1% vs. n = 25, 49.0%, respectively).


CONCLUSIONS
Conservative surgery, regardless of GnRH agonist treatment, may be acceptable for management of a selected population with severe symptomatic adenomyoma. However, surgical-medical treatment provided more effective symptom control (a lower symptom relapse rate) than surgery alone during the 2-year follow-up period.
Wang
Peng-Hui
PH
Department of Obstetrics and Gynecology, Taipei Veterans General Hospital and National Yang-Ming University School of Medicine, Taipei, Taiwan. Electronic address: phwang@vghtpe.gov.tw.
Liu
Wei-Min
WM
Department of Obstetrics and Gynecology, Taipei Medical University Hospital and Taipei Medical University, Taipei, Taiwan.
Fuh
Jong-Ling
JL
Neurological Institute, Taipei Veterans General Hospital and National Yang-Ming University Schools of Medicine, Taipei, Taiwan.
Cheng
Ming-Huei
MH
Department of Obstetrics and Gynecology, Taipei Veterans General Hospital and National Yang-Ming University School of Medicine, Taipei, Taiwan.
Chao
Hsiang-Tai
HT
Department of Obstetrics and Gynecology, Taipei Veterans General Hospital and National Yang-Ming University School of Medicine, Taipei, Taiwan.
D018194:Adenomyoma / Q000188:drug therapy* / Q000601:surgery*; D000328:Adult; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists*; D013509:Gynecologic Surgical Procedures / Q000379:methods; D006801:Humans; D016729:Leuprolide / Q000627:therapeutic use; D008875:Middle Aged; D011446:Prospective Studies; D055502:Secondary Prevention; D016896:Treatment Outcome; D014594:Uterine Neoplasms / Q000188:drug therapy* / Q000601:surgery*
D007987:Gonadotropin-Releasing Hormone; D016729:Leuprolide