Preoperative preparation of anemic patients before myomectomy and surgery for adenomyosis


Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access

Abstract

Objective. To study the efficacy of esmya in eliminating anemia in the preoperative preparation of patients with uterine myoma and adenomyosis. Subject and methods. Forty-five reproductive-aged women with multiple uterine myoma and adenomyosis who needed organ-sparing surgery (myomectomy, Osada operations) participated in the investigation. All the patients took one esmya tablet daily for 60 or 90 days before surgical treatment. Preoperative preparation with the agent was performed to reduce blood supply and myoma nodular sizes and to eliminate anemia. Results. There was a change in the sizes of myoma nodules; the most significant effect was seen in solitary nodules. With the use of esmya, the mean nodular volume reduction was 32±8%, which was greater than that in multiple nodules. In isolated adenomyosis, there was a statistically significant change in the volume of the corpus uteri, which was 24 to 29% (p < 0.05); there was also a clear separation of a glandular invasion area from the intact endometrium. The concentration of hemoglobin was increased by almost 60% in all the patients. Conclusion. A 3-month esmya cycle would suffice to reduce the volume of the uterus and fibroma. Increasing the concentration of hemoglobin assists in avoiding the need for intraoperative blood transfusion. This treatment may be useful before Osada surgery or myomectomy especially in case of large fibromas and severe anemia in women.

Full Text

Restricted Access

About the authors

Nikolay Nikolaevich Rukhlyada

I.I. Dzhanelidze Saint Petersburg Research Institute of Emergence Care

Email: nickolasr@mail.ru
Doctor of Medicine, Professor, Head of gynecology clinic

Dzhamala Mashkyur-kyzy Gasymova

I.I. Dzhanelidze Saint Petersburg Research Institute of Emergence Care

Email: jemaliya@mail.ru
postgraduate student of the Department of obstetrics, gynecology and reproduction SPBSU, obstetrician-gynecologist in the Department of gynaecology № 2

References

  1. Hudecek R., Ivanova Z., Smerdova M., Pankova S., Krajcovicova R. Effect of GnRH analogues pre-treatment on myomectomy outcomes in reproductive age women. Ceska Gynecol. 2012; 77(2): 109-17.
  2. Kiltz R.J., Rutgers J., Phillips J., Murugesapillai M.L., Kletzky O.A. Absence of a dose-response effect of leuprolide acetate on leiomyomata uteri size. Fertil. Steril. 1994; 61(6): 1021-6.
  3. Szamatowicz M., Kotarski J. Selective progesterone receptor modular (ulipristal acetate- a new option in the pharmacological treatment of uterine fibroids in women. Ginekol. Pol. 2013; 84(3): 219-22.
  4. Buttram V.C., Reiter R.C. Uterine leiomyomata: etiology, symptomatology and management. Fertil. Steril. 1981; 36(4): 433-45.
  5. Murillo E.O., Cano A. GnRH analogues for treatment of fibroids. Med. Clin. (Barc). 2013; 141(Suppl. 1): 35-9.
  6. Schlaff W.D., Zerhouni E.A., Huth J.A., Chen J., Damewood M.D., Rock J.A. A placebo-controlled trial of a depot gonadotropin-releasing hormone analogue (leuprolide) in the treatment of uterine leiomyomata. Obstet. Gynecol. 1989; 74(6): 856-62.
  7. Van Leusden H.A. Symptom-free interval after triptorelin treatment of uterine fibroids: long-term results. Gynecol. Endocrinol. 1992; 6(3): 189-98.
  8. Andreyko J.L., Blumenfeld Z., Marshall L.A., Monroe S.E., Hricak H., Jaffe R.B. Use of an agonistic analog of gonadotropin-releasing hormone (nafarelin) to treat leiomyomas: assessment by magnetic resonance imaging. Am. J. Obstet. Gynecol. 1988; 158(4): 903-10.
  9. Friedman A.J., Daly M., Juneau-Norcross M., Fine C., Rein M.S. Recurrence of myomas after myomectomy in women pretreated with leuprolide acetate depot or placebo. Fertil. Steril. 1991; 58: 205-8.
  10. Grigoriadis C., Papaconstantinou E. Clinicopathological chnges of uterine leiomyomas after GnRH agonist therapy. Clin. Exp. Obstet. Gynecol. 2012; 39(2): 191-4.
  11. George M., Lhomme C., Lefort J., Gras C., Comaru-Schally A.M., Schally A.V. Long-term use of an LH-RH agonist in the management of uterine leiomyomas: a study of 17 cases. Int. J. Fertil. 1989; 34(1): 19-24.
  12. Liu C.H., Lin Y.S., Lin C.C., Tzeng C.C., Chou C.Y. Medical treatment of uterine myoma with long-acting gonadotropin-releasing hormone agonist prior to myomectomy. J. Formos. Med. Assoc. 1993; 92(6): 536-9.
  13. West C.P, Lumsden M.A., Lawson S., Williamson J., Baird D.T. Shrinkage of uterine fibroids during therapy with goserelin (Zoladex): a luteinizing hormone-releasing hormone agonist administered as a monthly subcutaneous depot. Fertil. Steril. 1987; 48(1): 45-51.
  14. Van Leusden H.A., Dogterom A.A. Rapid reduction of uterine leiomyomas with monthly injections of D-Trp-6-GnRH. Gynecol. Endocrinol. 1988; 2(1): 45-51.
  15. McClelland H.R., Quinn A.J. Shrinkage of uterine fibroids by preoperative LHRH analogue injection. Ulster Med. J. 1992; 61(1): 51-5.
  16. Friedman A.J., Harrison-Atlas D., Barbieri R.L., Benacerraf B., Gleason R., Schiff I. A randomized placebo-controlled double-blind study evaluating the efficacy of leuprolide acetat depot in the treatment of uterine leiomyomata. Fertil. Steril. 1989; 51(6): 251-6.
  17. Osada H., Silber S., Kakinuma T., Nagaishi M., Kato K., Kato O. Surgical procedure to conserve the uterus for future pregnancy in patients suffering from massive adenomyosis. Reprod. Biomed. Online. 2011; 22(1): 94-9.
  18. Nishida M., Takano K., Arai Y., Ozone H., Ichikawa R. Conservative surgical management for diffuse uterine adenomyosis. Fertil. Steril. 2010; 94(2): 715-9.
  19. Perl V., Marquez J., Schally A.V., Comaru-Schally A.M., Leal G., Zacharias S., Gomez-Lira C. Treatment of leiomyomata uteri D-Trp-6-luteinizing hormone-releasing hormone. Fertil. Steril. 1987; 48(3): 383-9.
  20. Matta W.H., Stabile I., Shaw R.W., Campbell S. Doppler assessment of uterine blood flow changes in patients with fibroids receiving the gonadotropin-releasing hormone agonist Buserelin. Fertil. Steril. 1988; 49(6): 1083-5.
  21. Golan A., Bukovsky I., Schneider D., Ronel R., Herman A., Caspi E. D-Trp-6-luteinizing hormone-releasing hormone microcapsules in the treatment of uterine leiomyomas. Fertil. Steril. 1989; 52(3): 406-11.

Supplementary files

Supplementary Files
Action
1. JATS XML

Copyright (c) 2014 Bionika Media

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies