goserelin and Postoperative-Complications

Submucous fibroids are common benign tumours responsible for menorrhagia, subfertility and miscarriage. They can be readily removed by hysteroscopic transcervical resection of myoma (TCRM). To facilitate resection, pre-operative GnRH analogues have been suggested, but the value of this treatment is uncertain. Our aim was to assess the value of pre-operative GnRH analogues for the resection of submucous fibroids.. This was a prospective, double-blind, placebo-controlled, randomized trial. Women found to have submucous fibroids on three-dimensional saline infusion sonohysterography (3D SIS) were randomized to receive GnRH or placebo. Following treatment patients underwent TCRM by a single operator blinded to the group allocation. Women were followed up 6 weeks after their operation to ascertain resolution of symptoms. The primary outcome measure of the study was completeness of fibroid resection. Secondary outcome measures included the duration of the TCRM, the fluid deficit recorded at TCRM, the resolution of symptoms post-operatively and the number of subsequent fibroid related operations.. Forty-seven women were randomized to GnRH or placebo. On the basis of intention-to-treat analysis, there was no significant difference in the number of complete fibroid resections between women who received GnRH analogues [14/24, 58.3% (95% CI 38.6-78.1)] and those who received placebo [16/23, 69.6% (50.8-88.4)] (RR 0.84, 95% CI 0.54-1.29; P = 0.43). Similarly there was no significant difference between the groups in any of the secondary outcome measures.. Our study does not support routine administration of GnRH analogues before transcervical resection of fibroid as we did not identify any benefit in such treatment.

Topics: Adult; Antineoplastic Agents, Hormonal; Blood Loss, Surgical; Blood Volume; Body Fluids; Combined Modality Therapy; Double-Blind Method; Female; Gonadotropin-Releasing Hormone; Goserelin; Humans; Leiomyoma; Middle Aged; Postoperative Complications; Premedication; Reoperation; Statistics as Topic; Time Factors; Uterine Neoplasms

To investigate the effect of the gonadotrophin releasing hormone (GnRH)-agonist goserelin, given by monthly subcutaneous injection for three months prior to total abdominal hysterectomy for uterine leiomyomata, on the pre-operative symptoms, difficulty of operation and operative blood loss.. Randomised placebo-controlled study.. Patients were recruited from the gynaecological outpatient departments from hospitals in Edinburgh, Glasgow and Newcastle.. Seventy-one premenopausal women with uterine leiomyomata who were on the waiting list for hysterectomy.. After the presence of leiomyomata was confirmed using ultrasonography, the women were randomised to receive either the GnRH-agonist goserelin by monthly subcutaneous injection or a sham injection for three months prior to operation. At the monthly visits, patients were asked about treatment related symptoms, fibroid related symptoms, and their bleeding patterns. Blood was taken for haematological assessment.. Haemoglobin concentrations at recruitment, at operation and post-operatively, pre-operative symptoms, operative difficulty and blood loss and post-operative complications.. Treatment with goserelin induced amenorrhoea in over 80% of the women, and this was associated with a significant rise in haemoglobin level. At the time of operation, fibroid related symptoms were less in the goserelin group than in the placebo group. The hysterectomy was technically easier and the median (range) operative blood loss was significantly lower in the goserelin group compared with the placebo group (187 (60-600) ml vs 308 (118-1000) ml respectively; P < 0.05, Wilcoxon signed rank test). There was no difference between the two groups in the duration of hospital stay or the frequency of post-operative complications. The fibroids were smaller at the time of operation in the goserelin group, and more women treated with goserelin were able to have their operations through a transverse incision.. This study demonstrates the benefits of goserelin in women having total abdominal hysterectomy for uterine leiomyomata.

Topics: Adult; Blood Loss, Surgical; Double-Blind Method; Female; Goserelin; Hemoglobins; Humans; Hysterectomy; Leiomyoma; Length of Stay; Postoperative Complications; Preoperative Care; Uterine Neoplasms; Uterus

We treated eleven cases of high risk surgical candidate women with prosthetic heart valves, complaining of menorrhagia, by thermal balloon ablation under local anesthesia after pharmacological endometrial thinning. Menorrhagia was documented by a validated pad scoring system. All patients were severely anemic at presentation. Nine of them had one valve replaced among these cases, two were restenosic at presentation, one had twice mitral valve replacement. Two of them had two valves replaced. All procedures were performed under local anesthesia supplemented by analgesics, no complications were observed either intraoperatively or during the follow-up of at least 24 months. After two years, thermal balloon ablation proved to be statistically significantly effective in terms of pad score reduction; two patients reported spotting and the rest was hypomenorrheic, none of the group experienced amenorrhea. This technique proved to be safe, feasible and effective under this clinical circumstances.

Topics: Adult; Anesthesia, Local; Catheterization; Endometrium; Female; Follow-Up Studies; Goserelin; Heart Valve Prosthesis Implantation; Heating; Humans; Menorrhagia; Middle Aged; Postoperative Complications; Premedication; Treatment Outcome

To evaluate the prevalence of resumption of menstruation after an interval of amenorrhea in women treated by endometrial ablation and myometrial resection.. Retrospective analysis.. Tertiary care university-affiliated teaching hospital.. One hundred fifty-seven consecutive patients treated for menorrhagia refractory to medical therapy.. Loop resection or rollerball ablation of the endometrium.. At 6 to 12 months postoperatively, 50. 6% of patients were amenorrheic and 35.1% had hypomenorrhea. Over follow-up of 13 to 30 months, 45.1% of women became amenorheic and 40.5% had satisfactory hypomenorrhea. Resumption of menstruation after any interval of amenorrhea occurred in 27.2% of amenorheic patients. We observed an increasing trend to resumption of menstruation after rollerball ablation (29.4%) compared with loop resection (26.7%) and after preoperative endometrial suppression with buserelin (37.5%) and leuprolide (27.1%) compared with danazol (12.5%) and goserelin (10.5%). Resumption of menstruation occurred in 44.4% of women who did not have preoperative endometrial suppression.. Our results suggest that resumption of menstruation does occur after a variable interval of amenorrhea following endometrial ablation and myometrial resection. It could potentially be used as a marker of failure of endometrial destruction.

Topics: Amenorrhea; Buserelin; Danazol; Electrocoagulation; Endometrium; Female; Follow-Up Studies; Goserelin; Humans; Leuprolide; Menorrhagia; Myometrium; Postoperative Complications; Preoperative Care; Retrospective Studies; Time Factors; Treatment Failure

A total of 77 men with prostatic carcinoma treated with orchiectomy or a gonadotropin releasing hormone analogue before September 1987 underwent evaluation by a questionnaire regarding vasomotor symptoms. Answers were received from 84% of the patients. Of 63 patients 43 (68%) reported hot flushes during treatment, while 30 (48%) still had flushes 5 years after treatment. Of the latter 30 patients 28 (median 7.6 years after treatment) had vasomotor symptoms at the time of the study. Only 13 of 43 men with vasomotor symptoms after the start of treatment had relief 5 years later. At the time of the study 13 of 30 patients (more than 40%) still had flushes 8 years after castration. Most men reported that the flushes presently had the same frequency and duration as when they started therapy. Contrary to the general belief that the symptoms disappear with time, our study highlighted a long persistence of hot flushes after castration.

Topics: Aged; Aged, 80 and over; Androgen Antagonists; Climacteric; Goserelin; Humans; Male; Orchiectomy; Postoperative Complications; Prevalence; Prostatic Neoplasms; Retrospective Studies; Severity of Illness Index; Time Factors