Study Objective: To evaluate the efficacy of preoperative treatment with ulipristal acetate (UPA) in patients undergoing high complexity hysteroscopic myomectomy. Design: Retrospective analysis of a prospectively collected database (Canadian Task Force classification II-2). Setting: University teaching hospital. Patients: Patients of reproductive age requiring hysteroscopic myomectomy with STEPW (size, topography, extension, penetration, and wall) score 5 or 6. Interventions: Patients included in the study either underwent direct surgery (group S) or received a 3-month preoperative treatment with UPA (group UPA). Based on a power calculation, 25 patients were required in each study group. Measurements and Main Results: Myoma characteristics were similar in the 2 study groups. The 3-month UPA treatment caused a 21.9% (±10.3%) mean (±SD) percentage decrease in myoma volume. The number of complete resections (primary outcome of the study) was higher in group UPA (92.0%) than in group S (68.0%; p =034). The operative time was lower in group UPA than in group S (p =048), whereas there was no significant difference in fluid balance between the 2 study groups (p =256). The incidence of complications was similar in the 2 groups (p =609). Patient satisfaction at 3 months from surgery was higher in group UPA than in group S (p =041). Conclusion: A 3-month preoperative treatment with UPA increases the possibility of complete resection in high complexity hysteroscopic myomectomy. It decreases the operative time and improves patient satisfaction at 3 months from surgery.
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