Short-term and long-term results of resectoscopic myomectomy with and without pretreatment with GnRH analogs in premenopausal women.

OBJECTIVE: The aim of this study was to analyze the safety and efficacy of resectoscopic myomectomy and to evaluate the influence of GnRH analog pretreatment on short- and long-term surgery outcome.

METHODS: Data were collected from 80 consecutive resectoscopic myomectomies performed on premenopausal women. Forty-two patients (52.5%) had not received any preoperative medical treatment and in their case surgery was performed during the early proliferative phase (group A), whereas 38 patients (47.5%) had been treated with 2 months of intramuscular GnRH analog (triptorelin, Decapeptyl 3.75 mg) (group B). Myomas were classified according to the Wamsteker classification. The surgical time, recovery time, and complications were considered as short-term results. A 24-month follow-up was performed in order to assess long-term results, such as abnormal uterine bleeding recurrence, myomas recurrence, and need of repeat surgery.

RESULTS: Patients' mean age was 38.8 +/- 5.39 years (range: 24-47) in group A and 38.97 +/- 7.46 years (range: 20-49) in group B. Forty-eight myomas were excised in group A (1.1 +/- 0.53 myoma per patient; mean diameter: 28.72 +/- 11.57 mm) and 42 in group B (1.09 +/- 0.29; mean diameter: 29.73 +/- 14.47 mm). Myoma type distribution was similar in both groups. Surgical time of the pretreated patients (group B) was significantly longer than that of untreated patients (group A 40 +/- 18.06 versus group B 57.65 +/- 29.61 min; P = 0.002). No significant difference was found between the two groups in the length of postoperative stay (group A 1.05 +/- 0.22 days versus group B 1.15 +/- 0.44). Only one complication occurred, represented by a uterine perforation. Histopathology revealed the presence of cellular myomas, without atypia, in three patients of each group. At follow-up, abnormal uterine bleeding occurred in 36.3% of group A patients and in 26.6% of group B patients, but the difference showed no statistical significance (P = 0.57). Five patients of myoma recurrence were observed, three in group A and two in group B. Only two patients, one from each group, required repeat hysteroscopic surgery.

CONCLUSIONS: GnRH analog pretreatment, even if extremely beneficial in anemic patients, does not seem to improve short- and long-term outcome following resectoscopic myomectomy. Surgical time of pretreated patients is significantly longer, maybe because of difficulty in cervical dilatation, although further study is needed in order to confirm this hypothesis.