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Revista Brasileira de Ginecologia e Obstetrícia. 2020;42(10):649-658
, , , Gonadotropin-releasing hormone analogues (GnRH-a) have been used preoperatively before hysteroscopic myomectomy to decrease the size and vascularization of the myomas, but evidence to support this practice is weak. Our objective was to analyze the use of GnRH-a in the reduction of submucous fibroid as a facilitator for surgical hysteroscopy from published clinical trials.
Studies from electronic databases (Pubmed, Scielo, EMBASE, Scopus, PROSPERO), published between 1980 and December 2018. The keywords used were fibroid, GnRH analogue, submucous, histeroscopy, histeroscopic resection and their correspondents in Portuguese.
The inclusion criteria were controlled trials that evaluated the GnRH-a treatment before hysteroscopic resection of submucous myomas. Four clinical trials were included in the meta-analysis.
Two review authors extracted the data without modification of the original data, using the agreed form. We resolved discrepancies through discussion or, if required, we consulted a third person.
The present meta-analysis included a total of 213 women and showed no statistically significant differences in the use of GnRH-a compared with the control group for complete resection of submucous myoma (relative risk [RR]: 0.94; 95%; confidence interval [CI]: 0.80-1.11); operative time (mean difference [MD]: - 3.81; 95%;CI : - 3.81-2.13); fluid absorption (MD: - 65.90; 95%;CI: - 9.75-2.13); or complications (RR 0.92; 95%;CI: 0.18-4.82).
The present review did not support the routine preoperative use of GnRH-a prior to hysteroscopic myomectomy. However, it is not possible to determine its inferiority when compared with the other methods due to the heterogeneity of existing studies and the small sample size.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2020;42(10):649-658
, , , Gonadotropin-releasing hormone analogues (GnRH-a) have been used preoperatively before hysteroscopic myomectomy to decrease the size and vascularization of the myomas, but evidence to support this practice is weak. Our objective was to analyze the use of GnRH-a in the reduction of submucous fibroid as a facilitator for surgical hysteroscopy from published clinical trials.
Studies from electronic databases (Pubmed, Scielo, EMBASE, Scopus, PROSPERO), published between 1980 and December 2018. The keywords used were fibroid, GnRH analogue, submucous, histeroscopy, histeroscopic resection and their correspondents in Portuguese.
The inclusion criteria were controlled trials that evaluated the GnRH-a treatment before hysteroscopic resection of submucous myomas. Four clinical trials were included in the meta-analysis.
Two review authors extracted the data without modification of the original data, using the agreed form. We resolved discrepancies through discussion or, if required, we consulted a third person.
The present meta-analysis included a total of 213 women and showed no statistically significant differences in the use of GnRH-a compared with the control group for complete resection of submucous myoma (relative risk [RR]: 0.94; 95%; confidence interval [CI]: 0.80-1.11); operative time (mean difference [MD]: - 3.81; 95%;CI : - 3.81-2.13); fluid absorption (MD: - 65.90; 95%;CI: - 9.75-2.13); or complications (RR 0.92; 95%;CI: 0.18-4.82).
The present review did not support the routine preoperative use of GnRH-a prior to hysteroscopic myomectomy. However, it is not possible to determine its inferiority when compared with the other methods due to the heterogeneity of existing studies and the small sample size.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2004;26(5):411-416
DOI 10.1590/S0100-72032004000500011
OBJECTIVE: to evaluate the incidence of non-gynecological surgical procedures used in the treatment of ovarian cancer, as well to describe their complications. METHODS: eighty-two patients with ages from 22 to 89 (mean = 54.1 ± 15.1 years), submitted to laparotomy for surgical treatment of ovarian cancer from February 1999 to October 2003 were retrospectively evaluated. This study included only patients with epithelial ovary carcinoma. The patients were divided into 2 groups, patients submitted exclusively to gynecological procedures and patients submitted to non-gynecological procedures. Statistical analysis was made with the Student's t-test or the chi-square test. RESULTS: 5 patients (6.1%) were in stage (FIGO) I, 18 (21.9%) in stage II, 40 (48.8%) in stage III, and 19 (23.2%) in stage IV. Non-gynecological procedures were done in 35 cases (42.7%), including: 17 colostomies, 16 enterectomies, 8 peritonectomies, 7 colectomies, 5 partial diaphragm resections, 4 partial cystectomies, 4 splenectomies, 2 ileostomies, and 1 hepatectomy. All patients submitted to non-gynecological procedures were included in stages III and IV. This group of patients underwent longer-lasting surgeries (5.3 ± 1.4 versus 3.1 + 0,0 h; p < 0.001). There was no significant difference between these two groups regarding hemotransfusion requirement (42,2 versus 40%; p = 0.512) and hospitalization time (11.5 ± 7.2 versus 10 ± 9.9 days; p = 0.454). Patients submitted to non-gynecological surgeries developed higher rates of postoperative complications (37 versus 17.1%; p = 0.042), and two of them (2.4%) died. CONCLUSION: non-gynecological surgical procedures are frequently used in the treatment of patients with ovarian cancer. These procedures are associated with a longer-lasting surgery and higher rates of postoperative complications.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2004;26(5):411-416
DOI 10.1590/S0100-72032004000500011
OBJECTIVE: to evaluate the incidence of non-gynecological surgical procedures used in the treatment of ovarian cancer, as well to describe their complications. METHODS: eighty-two patients with ages from 22 to 89 (mean = 54.1 ± 15.1 years), submitted to laparotomy for surgical treatment of ovarian cancer from February 1999 to October 2003 were retrospectively evaluated. This study included only patients with epithelial ovary carcinoma. The patients were divided into 2 groups, patients submitted exclusively to gynecological procedures and patients submitted to non-gynecological procedures. Statistical analysis was made with the Student's t-test or the chi-square test. RESULTS: 5 patients (6.1%) were in stage (FIGO) I, 18 (21.9%) in stage II, 40 (48.8%) in stage III, and 19 (23.2%) in stage IV. Non-gynecological procedures were done in 35 cases (42.7%), including: 17 colostomies, 16 enterectomies, 8 peritonectomies, 7 colectomies, 5 partial diaphragm resections, 4 partial cystectomies, 4 splenectomies, 2 ileostomies, and 1 hepatectomy. All patients submitted to non-gynecological procedures were included in stages III and IV. This group of patients underwent longer-lasting surgeries (5.3 ± 1.4 versus 3.1 + 0,0 h; p < 0.001). There was no significant difference between these two groups regarding hemotransfusion requirement (42,2 versus 40%; p = 0.512) and hospitalization time (11.5 ± 7.2 versus 10 ± 9.9 days; p = 0.454). Patients submitted to non-gynecological surgeries developed higher rates of postoperative complications (37 versus 17.1%; p = 0.042), and two of them (2.4%) died. CONCLUSION: non-gynecological surgical procedures are frequently used in the treatment of patients with ovarian cancer. These procedures are associated with a longer-lasting surgery and higher rates of postoperative complications.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(7):525-528
DOI 10.1590/S0100-72032003000700010
PURPOSE: to evaluate the results of the use of bovine pericardium in the pubovaginal sling procedure for treatment of stress urinary incontinence. METHODS: a prospective analysis of five patients who underwent pubovaginal sling with the use of bovine pericardium strip for stress urinary incontinence in the "Hospital das Clínicas of UFMG" from October/2001 to December/2001. The mean age was 48.2±11.5 years (33 to 69 years). RESULTS: the mean surgical time was 45±35.3 min and the mean hospital stay was 36±12.4 h (24 to 48 h). Complications in the periperative or immediate postoperative period did not occur. All patients initially presented satisfactory results with normal voiding and without stress incontinence. Postoperative complications occurred in the 5 patients (100%), with dehiscence of the vaginal wound and total expulsion of the strip in 2 patients (40%) and partial expulsion in 3 patients (60%). All patients presented stress urinary incontinence and were submitted to a new sling procedure using the rectus fascia. The patients then progressed without complications and with improvement of urinary continence in 4 patients (80%). CONCLUSIONS: pubovaginal sling with the use of bovine pericardium was associated with high rates of complications. Therefore, its use is not recommended in the treatment of stress urinary incontinence.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(7):525-528
DOI 10.1590/S0100-72032003000700010
PURPOSE: to evaluate the results of the use of bovine pericardium in the pubovaginal sling procedure for treatment of stress urinary incontinence. METHODS: a prospective analysis of five patients who underwent pubovaginal sling with the use of bovine pericardium strip for stress urinary incontinence in the "Hospital das Clínicas of UFMG" from October/2001 to December/2001. The mean age was 48.2±11.5 years (33 to 69 years). RESULTS: the mean surgical time was 45±35.3 min and the mean hospital stay was 36±12.4 h (24 to 48 h). Complications in the periperative or immediate postoperative period did not occur. All patients initially presented satisfactory results with normal voiding and without stress incontinence. Postoperative complications occurred in the 5 patients (100%), with dehiscence of the vaginal wound and total expulsion of the strip in 2 patients (40%) and partial expulsion in 3 patients (60%). All patients presented stress urinary incontinence and were submitted to a new sling procedure using the rectus fascia. The patients then progressed without complications and with improvement of urinary continence in 4 patients (80%). CONCLUSIONS: pubovaginal sling with the use of bovine pericardium was associated with high rates of complications. Therefore, its use is not recommended in the treatment of stress urinary incontinence.