title: Three-month treatment with ulipristal acetate prior to laparoscopic myomectomy of large uterine myomas: a retrospective study.
abstract: OBJECTIVE
  To assess the usefulness of 3-month treatment with ulipristal acetate (UPA) before laparoscopic myomectomy of large uterine myomas.
  
  
  METHODS
  This retrospective analysis of a prospectively collected database included women of reproductive age requiring laparoscopic myomectomy with the following characteristics: FIGO type 3, 4 or 5 myomas; largest diameter of the main myoma ≥10cm; number of myomas ≤3; largest diameters of the other myomas ≤5cm (second myoma) and ≤3cm (third myoma). Patients either underwent direct surgery (group S) or were treated before surgery with UPA for 3 months (group UPA).
  
  
  RESULTS
  The mean (±SD) intraoperative blood loss was lower in group UPA (507.1±214.9ml) than in group S (684.2±316.8; p=0.012). The total operative time was lower in group UPA (137.6±26.8min) than in group S (159.7±26.8min; p<0.001); there was no significant difference in the suturing time between the two study groups (p=0.076). Hemoglobin drop was lower in group UPA (1.1±0.5g/dl) than in group S (1.3±0.7g/dl; p=0.034). Six patients in group S and no patient in group UPA required postoperative blood transfusions (p=0.031). Complications were not different between the two groups (p=0.726). Moreover, preoperative treatment with UPA caused a significant increase in hemoglobin levels (11.9±1.6g/dl) compared with baseline (9.1±1.1g/dl; p<0.001).
  
  
  CONCLUSIONS
  A 3-month treatment with UPA before laparoscopy for large uterine myomas decreases intraoperative blood loss, hemoglobin drop, postoperative blood transfusion and length of surgery.
authors: Academic Unit of Obstetrics and Gynecology, IRCCS AOU San Martino-IST, Largo R. Benzi 10, 16132 Genoa, Italy; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Italy. Electronic address: simone.ferrero@unige.it.
authors: Simone
authors: S
authors: Ferrero
authors: Unit of Obstetrics and Gynecology, IRCCS AOU San Martino-IST, Largo R. Benzi 10, 16132 Genoa, Italy.
authors: Franco
authors: F
authors: Alessandri
authors: Department of Surgical and Diagnostic Sciences, IRCCS San Martino Hospital and National Institute for Cancer Research, University of Genoa, Largo Rosanna Benzi 1, 16132 Genoa, Italy.
authors: Valerio Gaetano
authors: VG
authors: Vellone
authors: Academic Unit of Obstetrics and Gynecology, IRCCS AOU San Martino-IST, Largo R. Benzi 10, 16132 Genoa, Italy; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Italy.
authors: Pier Luigi
authors: PL
authors: Venturini
authors: Academic Unit of Obstetrics and Gynecology, IRCCS AOU San Martino-IST, Largo R. Benzi 10, 16132 Genoa, Italy; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Italy.
authors: Umberto
authors: U
authors: Leone Roberti Maggiore
mesh_terms: D000328:Adult; D016063:Blood Loss, Surgical; D016208:Databases, Factual; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D018231:Leiomyomatosis / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D009649:Norpregnadienes / Q000627:therapeutic use*; D061646:Operative Time; D012189:Retrospective Studies; D016896:Treatment Outcome; D063186:Uterine Myomectomy / Q000379:methods*; D014594:Uterine Neoplasms / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*
chemical_list: D009649:Norpregnadienes; C555622:ulipristal acetate
keywords: Laparoscopy; Myomectomy; Surgery; Ulipristal acetate; Uterine myoma