Comparing the Use of Uterine Artery Embolization to Gonadotropin-Releasing Hormone Agonists in Shrinking Fibroid Size: A Pilot Study in Kazakhstan

Balkenzhe Imankulova, Alibek Mereke, Nazira Kamzaeva, Talshyn Ukybassova

Abstract


Introduction: Uterine fibroids are the most common benign tumor in women in Kazakhstan. In the past two decades, endoscopic surgery has played an important role in the development of gynecologic surgery, particularly in the treatment of uterine fibroids. The goal of this paper is to evaluate whether uterine artery embolization (UAE) or gonadotropin-releasing hormone agonists (GnRHa) prior to myomectomy was more effective in decreasing fibroid size and improving surgical outcomes in a pilot study of women in Kazakhstan.

Methods: This pilot investigation included 24 patients separated into 2 groups: medication group (pre-treatment with GnRHa – 13 patients) and embolization group (pre-treatment with UAE – 11 patients). All patients had uterine fibroids, 3-10 cm in diameter, and were treated with myomectomy at the National Research Center for Maternal and Child Health, Astana, Kazakhstan. All patient data were obtained by a retrospective medical records review. Descriptive statistics were utilized to characterize participant demographics data. Independent t-tests were used to analyze continuous variables, and Chi-square and Fisher’s exact tests were used where appropriate for count data.

Results: The group treated with GnRHa had an operating time of 40±10 minutes longer than the group treated with UAE, due to the peri-operative difficulties encountered by surgeons in detecting the layer between the myometrium and fibroid capsule. The group treated with UAE experienced better patient outcomes (less blood loss, less surgical time, and reduced use of anesthesia) and was a technically easier surgery due to visible differences in uterine layers.

Conclusions: Despite the fact that both treatments (GnRHa and UAE) were effective for fibroid shrinking, embolization resulted in more optimal surgical time and improved patient outcomes. Results of this pilot study need to be confirmed in a randomized clinical trial, specifically focused on Kazakhstan and the Central Asian Region. 


Keywords


fibroids; Kazakhstan; GnRHa; uterine artery embolization

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References


Mahmoud MS, Desai K, Nezhat FR. Leiomyomas beyond the uterus; benign metastasizing leiomyomatosis with paraaortic metastasizing endometriosis and intravenous leiomyomatosis: a case series and review of the literature. Arch Gynecol Obstet. 2015;291(1):223-230.

Szamatowicz M, Kotarski J. [Selective progesterone receptor modulator (ulipristal acetate--a new option in the pharmacological treatment of uterine fibroids in women]. Ginekol Pol. 2013;84(3):219-222.

Gupta JK, Sinha A, Lumsden MA, Hickey M. Uterine artery embolization for symptomatic uterine fibroids. Cochrane database of systematic reviews (Online). 2014;12:CD005073.

Kamath MS, Kalampokas EE, Kalampokas TE. Use of GnRH analogues pre-operatively for hysteroscopic resection of submucous fibroids: a systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol. 2014;177:11-18.

Sankaran S, Manyonda IT. Medical management of fibroids. Best Pract Res Clin Obstet Gynaecol. 2008;22(4):655-676.

Nasser F, Affonso BB, de Jesus-Silva SG, et al. [Uterine fibroid embolization in women with giant fibroids]. Revista brasileira de ginecologia e obstetricia : revista da Federacao Brasileira das Sociedades de Ginecologia e Obstetricia. 2010;32(11):530-535.

Bernardo A, Gomes MT, Castro RA, Girao MJ, Bonduki CE, Yokoyama CA. [Impact of the myoma arterial embolization by uterine volume, diameter myoma greater and in the ovarian function]. Revista brasileira de ginecologia e obstetricia : revista da Federacao Brasileira das Sociedades de Ginecologia e Obstetricia. 2011;33(8):201-206.

Zhang Y, Sun L, Guo Y, et al. The impact of preoperative gonadotropin-releasing hormone agonist treatment on women with uterine fibroids: a meta-analysis. Obstet Gynecol Surv. 2014;69(2):100-108.

Yu YH, Gong SP, Wan SM. [Clinical application of GnRHa before uterine myomectomy: report of 20 cases]. Di 1 jun yi da xue xue bao = Academic journal of the first medical college of PLA. 2004;24(3):317-319.

Higashijima T, Kataoka A, Nishida T, Yakushiji M. Gonadotropin-releasing hormone agonist therapy induces apoptosis in uterine leiomyoma. Eur J Obstet Gynecol Reprod Biol. 1996;68(1-2):169-173.

Uemura T, Mori J, Yoshimura Y, Minaguchi H. Treatment effects of GnRH agonist on the binding of estrogen and progesterone, and the histological findings of uterine leiomyomas. Asia-Oceania journal of obstetrics and gynaecology / AOFOG. 1991;17(4):315-320.




DOI: https://doi.org/10.5195/cajgh.2015.232

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