Three-month treatment with ulipristal acetate prior to laparoscopic myomectomy of large uterine myomas: a retrospective study

Objective: To assess the usefulness of 3-month treatment with ulipristal acetate (UPA) before laparoscopic myomectomy of large uterine myomas. Study design: 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 >= 10 cm; number of myomas <= 3; largest diameters of the other myomas <= 5 cm (second myoma) and <= 3 cm (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 +/- 214.9 ml) than in group S (684.2 +/- 316.8; p= 0.012). The total operative time was lower in group UPA (137.6 +/- 26.8 min) than in group S (159.7 +/- 26.8 min; 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 +/- 0.5 g/dl) than in group S (1.3 +/- 0.7 g/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 +/- 1.6 g/dl) compared with baseline (9.1 +/- 1.1 g/dl; p <0.001). Conclusion: 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. (C) 2016 Elsevier Ireland Ltd. All rights reserved.