THE DEGREE OF FLUID ABSORPTION DURING HYSTEROSCOPIC SURGERY IN PATIENTS PRETREATED WITH GOSERELIN

Study Objective. To assess the effects of pretreatment with the gonado tropin-releasing hormone analog goserelin on fluid absorption in patie nts undergoing hysteroscopic endometrial ablation. Design. Prospective , randomized, placebo-controlled study. Setting. A university-based cl inic. Patients. Thirteen women with dysfunctional uterine bleeding who were scheduled for electrosurgical hysteroscopic ablation. interventi ons. Seven women were randomized to receive luteal phase goserelin 3.7 5 mg and six saline in the menstrual cycle approximately 10 weeks befo re surgery. Operative hysteroscopy was carried out with glycine 1.5% m ixed with 2% alcohol medium under constant pressure as an irrigant. Th e amount of irrigant used, irrigant deficit, blood levels of albumin a nd ethanol, hematocrit, hemoglobin, changes in sodium levels, and cent ral venous pressure were compared between the groups. Measurements and Main Results. All of the patients had an unsuccessful course of medic al therapy for at least 3 months and a normal endometrial biopsy. The age, weight, and uterine size were similar between the groups. The mea n volume of irrigant used and operating time were similar in both grou ps (4.18 +/- 0.2 vs 4.5 +/- 0.5 L, and 33.7 +/- 1.5 vs 37 +/- 2.1 min) . Although operating time, volume deficit, decrease in protein level, and hematocrit were less in the goserelin than in the saline group, th e differences were not statistically significant (p >0.05). The ethano l levels in blood, decrease in Na+, and irrigant deficit were signific antly lower in the goserelin than in the saline group (17.4 +/- 3.8 vs 25.3 +/- 4.2 mg/ml, 6.7 +/- 1.2 vs 9.1 +/- 0.9 mEq/L, and 0.49 +/- 0. 08 vs 0.66 +/- 0.05 L, respectively; p <0.05). Conclusion. Based on th ese results we conclude that in women undergoing hysteroscopic endomet rial ablation, pretreatment with goserelin may decrease the absorption of hysteroscopic medium, prevent fluid overload, and improve the outc ome possibly by causing hypovascularity and decreased endometrial grow th.