Ulipristal Acetate before Hysteroscopic and Laparoscopic Surgery for Uterine Myomas: Help or Hindrance?

Simone Ferrero, Valerio Gaetano Vellone, Fabio Barra, Carolina Scala

Research output: Contribution to journalReview articlepeer-review

Abstract

Background/aims: Ulipristal acetate ([UPA], Esmya®) is an orally active selective progesterone-receptor modulator that has been approved as preoperative treatment for uterine myomas. This systematic review aims to summarize the available data on surgical outcomes of patients undergoing myomectomy by hysteroscopy or by laparoscopy after preoperative treatment with UPA. Methods: this review was performed following PRISMA guidelines and was registered in PROSPERO (CRD42018092201). PubMed, EMBASE, and Medline databases were systematically searched electronically until March 2018 for keywords concerning this topic. There were included only peer-reviewed, English language journal articles. Results: two prospective studies and 4 retrospective studies were included. The effect of UPA on the endometrium does not increase the technical difficulty during hysteroscopic myomectomy, but it increases the chance of complete primary resection in complex hysteroscopic myomectomies. Moreover, UPA does not increase the overall technical difficulty of laparoscopic myomectomy. Contradictory results have been reported on the impact of UPA on the separation of the myoma from the myometrium and on the consistency of the myomas. Conclusion: current results support the use of UPA prior to both surgical procedures. Further studies should confirm these preliminary findings and to assess the long-term outcomes of myomectomies following UPA treatment.

Original languageEnglish
Pages (from-to)313-325
Number of pages13
JournalGynecologic and Obstetric Investigation
Volume84
Issue number4
DOIs
Publication statusPublished - Jul 1 2019

Keywords

  • Hysteroscopy
  • Laparoscopy
  • Myoma
  • Myomectomy
  • Ulipristal acetate

ASJC Scopus subject areas

  • Reproductive Medicine
  • Obstetrics and Gynaecology

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