Françoise Clerckx

Neodymium: YAG laser hysteroscopy in large submucous fibroids.

The preoperative use of a potent, subcutaneously injected gonadotropin-releasing hormone agonist (GnRH-a) was evaluated in a series of 60 women with large submucosal fibroids. Myomectomy by hysteroscopy and Nd:YAG laser was easily performed. In 12 cases, the largest portion of the myoma was not inside the uterine cavity and myomectomy was carried by a two-step hysteroscopy. In women who wished to become pregnant, a pregnancy rate of 66% was achieved. Advantages of preoperative use of a GnRH-a are (1) the significant decrease of the fibroid size, (2) a lower fluid absorption, and (3) the restoration of a normal hemoglobin concentration.

Treatment of uterine fibroids with implants of gonadotropin-releasing hormone agonist: assessment by hysterography.

The effect of a potent, subcutaneously injected gonadotropin-releasing hormone (GnRH analog) (Buserelin, Hoechst, Frankfurt/Main West Germany) on the size of uterine leiomyomas and the uterine cavity area was studied in a group of 20 women. In all patients except 1, the uterine cavity area calculated by hysterosalpingography was decreased, with an average decrease of 35% (from 12.0 +/- 5.4 cm2 to 7.8 +/- 3.3 cm2) by 8 weeks of therapy. Significant decrease was observed in the group of women with initial uterine cavity area greater than 10 cm2. In patients with very large submucous fibroids, myomectomy by hysteroscopy and neodymium:YAG laser was easily performed. Rapid relief of symptoms such as menometrorrhagia permits the restoration of a normal hemoglobin concentration. In conclusion, use of GnRH analog represents an adjunct for preoperative reduction of tumor size and may permit surgical treatment by hysteroscopy.

The place of GnRH agonists in the treatment of endometriosis and fibroids by advanced endoscopic techniques

Uterine fibroids and endometriosis are common benign diseases of the female genital tract. Fibroids are commonly associated with infertility and/or menorrhagia, especially if they are submucosal. Endometriosis is diagnosed in more than 35% of patients undergoing laparoscopy for infertility. Both diseases are oestrogen-dependent, and suppression of the secretion of gonadal steroids by administration of a luteinizing hormone-releasing hormone (LHRH) agonist has therefore been proposed as a non-surgical approach to the treatment of these conditions. Because most leiomyomata and endometrial cysts return to near pretreatment size within 4 months after cessation of gonadotrophin hormone-releasing hormone agonist (GnRH agonist) therapyl4, these agents cannot be used as definitive medical therapy but must be considered as an adjuvant for the pre-operative reduction of tumour size.

Endometriosis: rationale for surgery

In this chapter, we will try to classify the different indications of surgery and/or combined (medico-surgical) therapy in 1) peritoneal endometriosis 2) ovarian endometriosis 3) deep-infiltrating endometriosis of the recto-vaginal septum 4) ureteral endometriosis 5) digestive endometriosis