One-Step Resection via Hysteroscopic Myomectomy and Prostaglandin F2α for Large Submucosal Myoma

Study Objective: To assess the efficacy of prostaglandin F2 alpha (PGF(2 alpha)) in hysteroscopic myomectomy of submucous myomas. Design: Single-blind, randomized clinical trial study. Setting: Teaching hospital, affiliate of Iran University of Medical Sciences, Tehran, Iran. Patients: Forty-four patients with symptomatic submucous myomas were randomly assigned to the intervention group (n= 21; 1 excluded owing to myoma not identified on pathologic examination) and the control group (n= 22). Interventions: In the intervention group, PGF(2 alpha) was injected into the cervix twice: before the beginning of the surgery and after the resection of the intrauterine portion of the submucous myoma. TIn the control group, the myomas were resected without the PGF(2 alpha) injection. The same procedure was performed in the control group without the PGF(2 alpha) injection. Measurements and Main Results: There were no differences in the demographics, size, or type of myomas among the groups at baseline. Although the proportion of complete removal of the submucous myomas in the intervention group (PGF(2 alpha)) was higher (20/23 myomas or 87%) than that in the control group (15/23 myomas or 65.2%), the difference was not significant (p=.1). The number of 1-step complete removal of large submucous myomas (> 5 cm) in the PGF(2 alpha) group was significantly higher than that in the control group (8/10 myomas [80%] vs 2/8 myomas [25%], p=.03). The mean duration of operative time was significantly longer in the intervention group than in the control group (p=.01). The intervention group experienced more days of postoperative bleeding than the control group (p=.001). There were no differences regarding the length of stay at the hospital or hemoglobin levels between the groups (p=.07). Conclusion: In the current study, injection of PGF(2 alpha) was beneficial for 1-step complete resection of large (> 5 cm) submucous myomas via hysteroscopic myomectomy. . (c) 2020 AAGL. All rights reserved.