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Bayraktar E, Erel CT, Akturk H, Erkan IBO, Hamid R, Alper E, Adaletli I, Urfalioglu M. A novel objective evaluation method, shear wave elastography, in the treatment of atrophic vaginitis by nonablative intravaginal Er:YAG laser, a randomized-sham controlled pilot study. Menopause 2024; 31:716-723. [PMID: 38860935 DOI: 10.1097/gme.0000000000002380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2024]
Abstract
OBJECTIVE The aim of the study was to investigate the effectiveness of intravaginal Er:YAG laser for treating atrophic vaginitis in postmenopausal women utilizing shear wave elastography. METHODS In this prospective randomized sham-controlled double-blind pilot study, 20 participants were included (laser group [n = 12] / sham-control group [n = 8]). A nonablative (Smooth mode) Er:YAG laser with a wavelength of 2,940 nm was used. Objective evaluation of laser treatment efficacy was conducted using a special ultrasonic technique: shear wave elastography. Ultrasonic velocity measurements were taken from the anterior and posterior vaginal walls. Mean elasticity (E mean ) was expressed in kilopascals (kPa). Additional outcome parameters were vaginal pH, Vaginal Health Index (VHI), Female Sexual Function Index (FSFI), and visual analog scale (VAS) scores for dyspareunia. RESULTS Baseline clinical characteristics, vaginal pH, VHI, VAS and FSFI scores, and E mean values were comparable between the laser and sham-control groups. Statistically significant differences were observed in the final E mean values of the anterior vaginal wall (13.1 ± 6.3 vs 20.0 ± 3.3 kPA, P = 0.01) and posterior vaginal wall (12.7 ± 10.3 vs 19.4 ± 6.9 kPA, P = 0.04) between the laser and sham-control group. Despite comparable baseline E mean values, significant differences in vaginal wall stiffness posttreatment indicated a notable increase in tissue elasticity following laser treatment. Statistically significant differences were also observed in final vaginal pH values, VHI, VAS scores, and FSFI score improvement in favor of laser treatment. CONCLUSIONS Shear wave elastography may be considered as a reliable and objective technique for evaluating the efficacy of Er:YAG laser treatment in women with atrophic vaginitis. However, additional studies with larger sample sizes are necessary to establish conclusive evidence.
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Affiliation(s)
- Elif Bayraktar
- From the Department of Obstetrics and Gynecology, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - C Tamer Erel
- From the Department of Obstetrics and Gynecology, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Hayedeh Akturk
- Department of Radiology, American Hospital, Istanbul, Turkey
| | - Ipek Betul Ozcivit Erkan
- From the Department of Obstetrics and Gynecology, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Rauf Hamid
- Department of Radiology, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Ebru Alper
- Department of Obstetrics and Gynecology, American Hospital, Istanbul, Turkey
| | - Ibrahim Adaletli
- Department of Radiology, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Mert Urfalioglu
- From the Department of Obstetrics and Gynecology, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, Turkey
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Luvero D, Silvagni A, Angioli AM, Filippini M, Plotti F, Montera R, De Cicco Nardone C, Notaro E, Branda F, Angioli R. The Efficacy of CO 2 Vaginal Laser in the Treatment of Recurrent, Post-Coital and Interstitial Cystitis: A Multicentric Prospective Study. J Clin Med 2024; 13:3550. [PMID: 38930079 PMCID: PMC11204505 DOI: 10.3390/jcm13123550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Revised: 06/05/2024] [Accepted: 06/07/2024] [Indexed: 06/28/2024] Open
Abstract
Background: This multicentric prospective study was carried out at Fondazione Policlinico Universitario Campus Bio Medico and Ospedale di Stato of St. Marino Republic. Between 1 January 2019, and 31 December 2022, all pre- and post-menopausal women diagnosed with recurrent, post-coital, and interstitial cystitis at both centers were included in the study. The main aim of the study was to assess the effectiveness of vaginal CO2 laser treatment, alone or combined with intravesical hyaluronic acid instillations, in managing cystitis symptoms, such as dysuria, pollakiuria, and urgency, across the entire patient cohort. The secondary objective was to investigate the reduction in number of annual cystitis episodes post-treatment. Methods: Each woman underwent three to four sessions of micro-ablative CO2 vaginal laser treatment. A follow-up examination was conducted 12 months after the final laser session (up to December 2023), during which a post-treatment VAS assessment evaluated dysuria, daily pollakiuria, and urgency. The enrolled patients recorded the number of cystitis episodes experienced during the 12-month pre- and post-treatment period. Results: Results indicated the laser's efficacy in reducing the total number of cystitis episodes per year and an improvement in symptoms up to one year post-treatment. Greater efficacy of the CO2 laser treatment, particularly when combined with intravesical hyaluronic acid instillation, was observed in both pre- and post- menopausal women. Conclusions: Fractional CO2 laser therapy represents a safe and efficacious, non-hormonal approach for pre- and post-menopausal women diagnosed with recurrent, post-coital, and interstitial cystitis.
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Affiliation(s)
- Daniela Luvero
- Unit of Gynecology, Fondazione Policlinico Universitario Campus Bio Medico, Via Alvaro del Portillo 200, 00128 Roma, Italy
| | - Adele Silvagni
- Unit of Gynecology, Fondazione Policlinico Universitario Campus Bio Medico, Via Alvaro del Portillo 200, 00128 Roma, Italy
| | - Anna Maria Angioli
- Research Unit of Gynecology, Department of Medicine and Surgery, Università Campus Bio Medico, Via Alvaro del Portillo 21, 00128 Roma, Italy
| | - Maurizio Filippini
- Department of Obstetrics and Gynecology, Hospital State of Republic of San Marino, 47893 Borgo Maggiore, San Marino
| | - Francesco Plotti
- Unit of Gynecology, Fondazione Policlinico Universitario Campus Bio Medico, Via Alvaro del Portillo 200, 00128 Roma, Italy
| | - Roberto Montera
- Unit of Gynecology, Fondazione Policlinico Universitario Campus Bio Medico, Via Alvaro del Portillo 200, 00128 Roma, Italy
| | - Carlo De Cicco Nardone
- Unit of Gynecology, Fondazione Policlinico Universitario Campus Bio Medico, Via Alvaro del Portillo 200, 00128 Roma, Italy
| | - Erika Notaro
- Unit of Gynecology, Fondazione Policlinico Universitario Campus Bio Medico, Via Alvaro del Portillo 200, 00128 Roma, Italy
| | - Francesco Branda
- Unit of Medical Statistics and Molecular Epidemiology, Università Campus Bio Medico, Via Alvaro del Portillo 21, 00128 Roma, Italy
| | - Roberto Angioli
- Unit of Gynecology, Fondazione Policlinico Universitario Campus Bio Medico, Via Alvaro del Portillo 200, 00128 Roma, Italy
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Alper E, Aksoy S. Impact of Subablative Erb:Yag Laser Applications on Vaginal Resting and Contraction Pressures. HASEKI TIP BÜLTENI 2023. [DOI: 10.4274/haseki.galenos.2023.8841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
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Tjokroprawiro B, Setyaningrum T, Listiawan MY, Santoso B, Prakoeswa CS. Treating vaginal relaxation syndrome using erbium: Yttrium aluminum garnet fractional laser: A retrospective study. Gynecol Minim Invasive Ther 2022; 11:23-27. [PMID: 35310128 PMCID: PMC8926051 DOI: 10.4103/gmit.gmit_141_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 04/20/2021] [Accepted: 05/06/2021] [Indexed: 11/04/2022] Open
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Bretas TLB, Issa MCA, Fialho SCAV, Villar EAG, Velarde LGC, Pérez-López FR. Vaginal collagen I and III changes after carbon dioxide laser application in postmenopausal women with the genitourinary syndrome: a pilot study. Climacteric 2021; 25:186-194. [PMID: 34291703 DOI: 10.1080/13697137.2021.1941850] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The aim of the study was to evaluate the clinical response and collagen remodeling in the vaginal wall after three sessions of carbon dioxide (CO2) laser application. METHODS Fourteen postmenopausal women with vulvovaginal atrophy, aged 45-65 years and sexually active, were evaluated with clinical questionnaires, gynecological examinations and histological techniques before and after 20 weeks of treatment (ClinicalTrials.gov NCT03939078). Treatment consisted of 3-monthly sessions of the CO2 laser. Clinical questionnaires included the Vaginal Health Index, the Female Sexual Function Index and the International Consultation on Incontinence Questionnaires Short Form. Biopsies were taken from the lateral vaginal wall at week 0 (left wall) and week 20 (right wall). Tissue samples were stained with hematoxylin and eosin, Periodic Acid-Schiff, Picrosirius Red Stain and Orcein dyes. Immunohistochemical study was used to quantify collagens I and III in the samples. RESULTS The mean age was 54.4 ± 4.5 years, and the average time of amenorrhea was 7.6 ± 5.1 years. The Female Sexual Function Index and the Vaginal Health Index Score values increased while the International Consultation on Incontinence Questionnaire Short Form score decreased after the programmed treatment. There was no significant change in vaginal pH. Histological studies showed increases in the total and superficial epithelial cell layers, and type III collagen fibers (from 10.86 ± 7.66 to 16.87 ± 3.96, p < 0.05), and immunohistochemical studies confirmed the significant increase in collagen III. CONCLUSION Histological findings revealed epithelial atrophy reversal and collagen remodeling of the vaginal wall. Immunohistochemical analysis showed an increase in collagen type III fibers.
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Affiliation(s)
- T L B Bretas
- Department of Clinical Medicine, Federal Fluminense University Faculty of Medicine, Niteroi, Brazil
| | - M C A Issa
- Department of Clinical Medicine, Federal Fluminense University Faculty of Medicine, Niteroi, Brazil
| | - S C A V Fialho
- Maternal and Child Department, Federal Fluminense University Faculty of Medicine, Niteroi, Brazil
| | - E A G Villar
- Department of Pathology, Federal Fluminense University Faculty of Medicine, Niteroi, Brazil
| | - L G C Velarde
- Department of Statistics, Federal Fluminense University, Niteroi, Brazil
| | - F R Pérez-López
- Department of Obstetrics and Gynecology, University of Zaragoza Faculty of Medicine, Zaragoza, Spain
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Gambacciani M, Cervigni M, Gaspar A, Novakov Mikić A, Gaviria J, Koron N, Vizintin Z. Safety of vaginal erbium laser: A review of 113,000 patients treated in the past 8 years. Climacteric 2021; 23:S28-S32. [PMID: 33124457 DOI: 10.1080/13697137.2020.1813098] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Background: Energy-based devices are becoming a popular option for minimally invasive vaginal procedures. The aim of this study was to obtain information on the frequency of occurrence of adverse effects (AEs) related to vaginal erbium laser (VEL™) treatment.Materials and methods: The global survey was conducted among practitioners using the non-ablative VEL™ (Fotona, Ljubljana, Slovenia). Users were invited to provide the number of patients treated with VEL™ and the number of observed laser-related AEs.Results: The survey was conducted from August 2018 to April 2019. Responses from 535 practitioners were collected, with a total of 113,174 patients treated in the period from 2012 to 2019. Out of 535 respondents, 160 (30%) shared detailed information about the indications they treated in a population of 62,727 patients, whereas 188 (35%) respondents provided information on the frequency of AEs observed in their treated population of 43,095 patients. All observed AEs were mild to moderate, transient and appeared with low frequencies.Conclusions: Minimally invasive thermal-only laser treatment using the non-ablative VEL™ procedures appears to be safe and the incidence of AEs is low.
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Affiliation(s)
- M Gambacciani
- Department of Obstetrics and Gynecology, University Hospital, Pisa, Italy
| | - M Cervigni
- 'La Sapienza', University Polo Pontino, ICOT-Latina, Italy
| | - A Gaspar
- Espacio Clinica Gaspar, Mendoza, Argentina
| | | | | | - N Koron
- Fotona d.o.o., Ljubljana, Slovenia
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Klap J, Campagne-Loiseau S, Berrogain N, Bosset PO, Cardot V, Charles T, Deffieux X, Donon L, Girard F, Peyrat L, Roulette P, Thuillier C, Tibi B, Vidart A, Wagner L, Hermieu JF, Cornu JN. [Vaginal LASER therapy for genito-urinary disorders: A systematic review and statement from the Committee for Female Urology and Pelviperineology of the French Association of Urology]. Prog Urol 2021; 31:634-650. [PMID: 33516611 DOI: 10.1016/j.purol.2020.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 11/08/2020] [Accepted: 11/09/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Vaginal LASER therapy is increasingly used in the field of urogynecology, but several points remain unclear. Our goal was to produce a systematic review of available evidence and provide a critical appraisal of available data. METHODS A systematic review until march 2020 was conducted using PubMed/MEDLINE, Cochrane and Embase databases. All studies about vaginal LASER use in the field of urogynecology were included. RESULTS Forty studies have been included (8 for genitourinary syndrome of menopause, 19 for stress urinary incontinence, 3 for overactive bladder, 7 for urogenital prolapse, 3 for other indications). Data were heterogeneous, and level of evidence was weak or very weak. Few studies were comparative, and only 3 were randomized). Mild improvement of symptoms and quality of life and limited satisfaction were seen for genitourinary syndrome, stress urinary incontinence, overactive bladder and prolapse. Few adverse events were reported. However, major methodological biases were noted regarding efficacy and safety evaluation. No long-term results were available. CONCLUSIONS While Vaginal LASER therapy seem to provide encouraging results, the level of evidence supporting its use was weak, especially regarding long-term outcomes. Studies of better quality are warranted before any recommendation can be made. Current use should be limited to clinical research.
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Affiliation(s)
- J Klap
- Service d'urologie, hôpital privé Claude-Galien, 91480 Quincy-sous-Senart, France
| | - S Campagne-Loiseau
- Service de gynécologie-obstétrique, CHU d'Estaing, Clermont-Ferrand, France
| | - N Berrogain
- Clinique Ambroise-Paré, 31100 Toulouse, France
| | - P O Bosset
- Service d'urologie, hôpital Foch, 40, rue Worth, 92150 Suresnes, France
| | - V Cardot
- Clinique de Meudon-Clamart, 3, avenue de Villacoublay, 92360 Meudon, France
| | - T Charles
- Service d'urologie, CHU de La-Miletrie, 86000 Poitiers, France
| | - X Deffieux
- Service de gynécologie-obstétrique, hôpital Antoine-Béclère, AP-HP, 92140 Clamart, France
| | - L Donon
- Clinique de la Côte Basque, 64100 Bayonne, France
| | - F Girard
- Service d'urologie, clinique Oudinot fondation Cognac-Jay, 2, rue Rousselet, 75007 Paris, France
| | - L Peyrat
- Service d'urologie, clinique Turin, 75008 Paris, France
| | - P Roulette
- Service d'urologie, centre hospitalier de Cahors, 335, rue Wilson, 46005 Cahors cedex, France
| | - C Thuillier
- Service d'urologie, CHU de Grenoble-Alpes, 38000 Grenoble, France
| | - B Tibi
- Service d'urologie, hôpital Pasteur 2, CHU de Nice, 30, voie Romaine - CS 51069, 06001 Nice cedex 1, France
| | - A Vidart
- Service d'urologie, hôpital Foch, 40, rue Worth, 92150 Suresnes, France
| | - L Wagner
- Service d'urologie, CHU de Nîmes, place du Pr-Robert-Debré, 30029 Nîmes cedex 9, France
| | - J-F Hermieu
- Service d'urologie, hôpital Bichat, AP-HP, Paris, France
| | - J-N Cornu
- Service d'urologie, hôpital Charles-Nicolle, université de Rouen, 76000 Rouen, France.
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Efficacy of fractional CO2 laser treatment in postmenopausal women with genitourinary syndrome: a multicenter study. ACTA ACUST UNITED AC 2021; 27:43-49. [PMID: 31794500 DOI: 10.1097/gme.0000000000001428] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE Genitourinary syndrome of menopause (GSM), especially vulvovaginal atrophy (VVA), is one of the most common conditions among women in either natural (4%-47%) or medically induced (23.4%-61.5%) menopause. The aims of this study are to assess the efficacy and effectiveness of CO2 laser in postmenopausal women with clinical signs and symptoms of GSM, in particular VVA, and to evaluate both possible early and late side effects related to this kind of treatment. METHODS This retrospective, multicenter study was conducted after collecting data from a pre-existing database. We performed three to four CO2 laser treatments on all the women enrolled in this protocol. We used a fractional CO2 laser system (SmartXide VLR, Deka m.e.l.a., Florence, Italy) with a VulvoVaginal Laser Reshaping (VLR) scanning system and appropriate handpieces for the vaginal area. All women before and after the treatment were assessed. The pre- and post-treatment averages of the symptoms, the standard deviation, and the P values were calculated. RESULTS Six hundred forty-five women who met the inclusion criteria were considered. In all the parameters examined (dyspareunia, vaginal orifice pain, dryness/atrophy, itching, burning, pH) statistically significant data were found between the pretreatment and the post-treatment (dryness: before = 8.30, after = 2.97 [P < 0.0001], dyspareunia: before = 8.70, after = 3.51 [P < 0.0001]; burning: before = 6.12, after = 1.78 [P < 0.0001]; vaginal orifice pain: before = 8.07, after = 2.94 [P < 0.0001]; itching: before = 6.09, after = 1.32 [P < 0.0001]). CONCLUSIONS Our results show the effectiveness and a good degree of tolerance of treatment with the CO2 laser system in postmenopausal women with GSM.
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Shim S, Park KM, Chung YJ, Kim MR. Updates on Therapeutic Alternatives for Genitourinary Syndrome of Menopause: Hormonal and Non-Hormonal Managements. J Menopausal Med 2021; 27:1-7. [PMID: 33942583 PMCID: PMC8102810 DOI: 10.6118/jmm.20034] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 01/12/2021] [Accepted: 01/28/2021] [Indexed: 11/23/2022] Open
Abstract
Postmenopausal atrophic vaginitis, along with vasomotor symptoms and sleep disorders, is one of the most troublesome symptoms of menopause. However, many women do not manage this symptom properly due to insufficient knowledge of the symptoms or sexual embarrassment. With appropriate treatment, many postmenopausal women can experience relief from discomforts, including burning sensation or dryness of the vagina and dyspareunia. Topical lubricants and moisturizers, systemic and local estrogens, testosterones, intravaginal dehydroepiandrosterones (DHEAs), selective estrogen receptor modulators, and energy-based therapies are possible treatment modalities. Systemic and local estrogen therapies effectively treat genitourinary syndrome of menopause (GSM), but they are contraindicated in patients with breast cancer, for whom lubricants and moisturizers must be considered as the primary treatment. Intravaginal DHEA and ospemifene can be recommended for moderate to severe GSM; however, there is insufficient data on the use of intravaginal DHEA or ospemifene in patients with breast cancer, and further studies are needed. Energy-based devices such as vaginal laser therapy reportedly alleviate GSM symptoms; however, the U.S. Food and Drug Administration warning has recently been issued because of complications such as chronic pain and burning sensations of the vagina. To summarize, clinicians should provide appropriate individualized treatment options depending on women's past history, symptom severity, and chief complaints.
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Affiliation(s)
- Suhyun Shim
- Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kyung Min Park
- Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Youn Jee Chung
- Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Mee Ran Kim
- Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
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Li J, Li H, Zhou Y, Xie M, Miao Y, Wang L, Zhao Y, Ying T, Hu Y, Chen Y, Chen Y, Sun X, Wang J. The Fractional CO 2 Laser for the Treatment of Genitourinary Syndrome of Menopause: A Prospective Multicenter Cohort Study. Lasers Surg Med 2020; 53:647-653. [PMID: 33211334 PMCID: PMC8246931 DOI: 10.1002/lsm.23346] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 10/10/2020] [Accepted: 10/15/2020] [Indexed: 11/25/2022]
Abstract
Background and Objectives Genitourinary syndrome of menopause (GSM) is a common condition affecting of most postmenopausal women, which greatly impacks the quality of life,and need to treat. This prospective multicenter cohort study aimed to compare the efficacy and safety of the fractional carbon dioxide (CO2) laser with that of topical estrogen for vaginal treatment and relieving symptoms of genitourinary syndrome of menopause (GSM). Study Design/Materials and Methods This study included 162 postmenopausal patients who received vaginal laser or topical Estriol cream therapy between January 2017 and May 2019 at eight study centers in China. The degree of GSM‐related symptoms (vaginal burning, dryness, and dyspareunia) was evaluated using the Vaginal Health Index score (VHIS) and Visual Analog Scale (VAS) at baseline, 1, 3, 6, and 12 months posttreatment. The primary endpoint was the improvement in vaginal burning, dryness, and dyspareunia at 6 months after treatment. Multivariate logistic regression was used to compare the rate of improvement in the two groups. Results At baseline, the laser and control groups showed no significant difference in the mean age, time after menopause, and the VHIS (all P > 0.05). In the laser group, compared with baseline, significant differences were seen in the VHIS after the first or second treatment session and at 1, 3, 6, and 12 months posttreatment (P < 0.01). In the control group, compared with baseline, the VHIS showed significant differences after 1, 3, and 6 months of treatment (P < 0.05). However, there was no significant difference after 3 and 6 months of follow‐up between the two groups (P > 0.05). The VHIS scores were significantly higher after 1 month (16.63 ± 2.79 vs. 15.57 ± 2.43) and 12 months (15.72 ± 2.59 vs. 12.12 ± 4.08) of treatment in both the groups (P < 0.05). At 6 months after treatment, both groups showed improvement in vaginal burning, vaginal dryness, and dyspareunia (P > 0.05). The VAS findings at 6 months posttreatment were significantly different when compared with the pretreatment findings (P < 0.001). There were no significant adverse effects in the two groups. Conclusions Fractional CO2 laser vaginal treatment could be a safe and effective option for treating symptoms of GSM, including vaginal burning, dryness, and dyspareunia. The improvement in symptoms was comparable with that seen with topical estrogen therapy and lasted for at least 6–12 months posttreatment. Lasers Surg. Med. © 2020 Wiley Periodicals LLC
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Affiliation(s)
- Jingran Li
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Xizhimen, South Street, Beijing, Beijing, 100044, China
| | - Huan Li
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Lianhua Road, Shenzhen, Guangdong, 518036, China
| | - Yanfei Zhou
- Department of Obstetrics and Gynecology, Changsha Hospital for Maternity and Child Healthcare, Chengnan East Road, Changsha, Hunan, 410007, China
| | - Meiqing Xie
- Department of Obstetrics and Gynecology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Yanjiang West Road, Guangzhou, Guangdong, 510120, China
| | - Yali Miao
- Department of Obstetrics and Gynecology, West China Second University Hospital, Renmin South Road, Chengdu, Sichuan, 610041, China
| | - Luwen Wang
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Zhengzhou University, Kangfuqian Street, Zhengzhou, Henan, 450008, China
| | - Yan Zhao
- Department of Obstetrics and Gynecology, Puyang Oilfield General Hospital, Daqing Road, Puyang, Henan, 457000, China
| | - Ting Ying
- Department of Obstetrics and Gynecology, Liuzhou Maternity and Child Healthcare Hospital, Sanzhong Road, Liuzhou, Guangxi, 545001, China
| | - Yan Hu
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Lianhua Road, Shenzhen, Guangdong, 518036, China
| | - Yu Chen
- Department of Obstetrics and Gynecology, Changsha Hospital for Maternity and Child Healthcare, Chengnan East Road, Changsha, Hunan, 410007, China
| | - Yaxiao Chen
- Department of Obstetrics and Gynecology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Yanjiang West Road, Guangzhou, Guangdong, 510120, China
| | - Xiuli Sun
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Xizhimen, South Street, Beijing, Beijing, 100044, China
| | - Jianliu Wang
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Xizhimen, South Street, Beijing, Beijing, 100044, China
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A Systematic Review of Nonsurgical Vulvovaginal Restoration Devices: An Evidence-Based Examination of Safety and Efficacy. Plast Reconstr Surg 2020; 146:552e-564e. [PMID: 33141529 DOI: 10.1097/prs.0000000000007236] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The efficacy and safety of vulvovaginal restoration devices were called into question in a U.S. Food and Drug Administration statement on July 30, 2018, claiming that women are being harmed by laser and other energy-based devices. The goal of this systematic literature review was to assess existing data, determine gaps in evidence, and propose opportunities for continued investigation pertaining to laser and energy-based vaginal restoration techniques. METHODS A review of literature using PubMed, Cochrane Library databases, Embase, MEDLINE, and the Cumulative Index to Nursing and Allied Health Literature was conducted on January 9, 2019, and articles up to this point were considered. For inclusion, studies had to be available or translated in English and relate to clinical medicine, direct patient care, and nonsurgical energy-based vulvovaginal procedures. RESULTS The authors found five level I studies, 19 level II studies, four level III studies, and 46 level IV studies that used 15 different devices. Various degrees of improvement of symptoms were reported in all studies. Adverse events/side effects were noted in two of the 13 radiofrequency device studies, 15 of the 23 erbium:yttrium-aluminum-garnet device studies, and 17 of the 37 carbon dioxide device studies. The majority of adverse events were considered mild. CONCLUSIONS The majority of studies resulted in mild to no adverse side effects. However, there is a large gap in level I evidence. As a result, the authors emphasize the necessity of supplemental data surrounding this subject and suggest that additional randomized sham-controlled studies be conducted to further investigate vulvovaginal restoration devices in an effort to address women's health issues.
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Erel CT, Fistonić I, Gambacciani M, Oner Y, Fistonić N. Er:YAG laser in hysterectomized women with stress urinary incontinence: a VELA retrospective cohort, non-inferiority study. Climacteric 2020; 23:S18-S23. [PMID: 33124456 DOI: 10.1080/13697137.2020.1814728] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Objective: To test whether the erbium-doped yttrium aluminum garnet (Er:YAG) SMOOTH® laser treatment efficacy on stress urinary incontinence (SUI) in hysterectomized patients is non-inferior to its efficacy in non-hysterectomized patients.Methods: In this real-world, retrospective cohort study performed in Turkey, Croatia and Italy, we enrolled a consecutive sample of 35 hysterectomized and 34 non-hysterectomized patients with SUI. We used the Er:YAG SMOOTH® laser (Fotona, Slovenia) with a wave length of 2940 nm. The primary outcome was median reduction of SUI symptoms measured by the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short-Form (ICIQ-SF) with the non-inferiority margin defined as the minimum clinically important difference of ICIQ-SF (δ < 2.52 points).Results: In hysterectomized patients, the ICIQ-SF was reduced by 5 points (95% confidence interval 3-8; p < 0.001), a reduction of 45% (95% confidence interval 36-67%). After adjustment for baseline ICIQ-SF and five covariates, the reduction of symptoms in the hysterectomized group was not inferior to the reduction in the non-hysterectomized group.Conclusion: The Er:YAG SMOOTH® laser treatment seems to improve the symptoms of SUI in hysterectomized women not clinically relevantly less than in non-hysterectomized women. It seems that the beneficial effect of Er:YAG SMOOTH® laser treatment for SUI in hysterectomized women is time-limited.
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Affiliation(s)
- C T Erel
- Department of Obstetrics and Gynecology, İstanbul Cerrahpaşa University, İstanbul, Turkey
| | - I Fistonić
- Institute for Women's Health, Zagreb, Croatia
| | - M Gambacciani
- Department of Obstetrics and Gynecology, Pisa University Hospital, Pisa, Italy
| | - Y Oner
- Department of Obstetrics and Gynecology, İstanbul Cerrahpaşa University, İstanbul, Turkey
| | - N Fistonić
- Department of Obstetrics and Gynecology, University Hospital Merkur, Zagreb, Croatia
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13
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Grassiri G, Cervigni M, Bracco GL, Gambacciani M. The VELA experience: a strategic format. Climacteric 2020; 23:S4-S5. [PMID: 33124453 DOI: 10.1080/13697137.2020.1827863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- G Grassiri
- President and CEO of Santec Srl, Livorno, Italy
| | | | | | - M Gambacciani
- Department of Obstetrics and Gynecology, Pisa University Hospital, Pisa, Italy
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14
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Elia D, Gambiacciani M, Ayoubi JM, Berreni N, Bohbot JM, Descamps P, Druckmann R, Geoffrion H, Haab F, Heiss N, Rygaloff N, Russo E. Female urine incontinence: vaginal erbium laser (VEL) effectiveness and safety. Horm Mol Biol Clin Investig 2020; 41:/j/hmbci.ahead-of-print/hmbci-2020-0012/hmbci-2020-0012.xml. [PMID: 33119542 DOI: 10.1515/hmbci-2020-0012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 05/06/2020] [Indexed: 11/15/2022]
Abstract
Urinary incontinence is a common health problem that impacts the quality of life of women at different ages. Its physiopathology is not unequivocal, and it is necessary to consider the stress urinary incontinence (SUI), the overactive bladder syndrome and the mixed incontinence (MUI). According to the type of incontinence, its impact on the quality of life and age of the patients, therapeutic strategies are currently summarized in physiotherapy, surgery and drug treatments. We already know the benefit/risk ratio of each of these strategies. Our objective is to evaluate the potential effectiveness and safety of the VEL, an innovative vaginal laser technique (VEL - Vaginal Erbium Laser, erbium yttrium-aluminum-garnet -Er: YAG) a non-invasive laser proposed as a treatment for SUI, overactive bladder syndrome and MUI. The mechanisms of action of lasers are discussed in general and those of VEL in particular with the description of the Smooth® mode. To do this, we have collected the 21 published studies including the first randomized vs. placebo and two pilot studies of intra-urethral VEL. In conclusion: VEL procedures already have their place between the rehabilitation of the perineal floor and surgery. Further properly sized, randomized studies are needed to evaluate the laser treatments in comparison with other therapies, as well as to assess the duration of the therapeutic effects and the safety of repeated applications.
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Affiliation(s)
- David Elia
- Vaginal Erbium Laser Academy France, Paris, France
| | | | | | | | | | | | | | | | | | - Niko Heiss
- Vaginal Erbium Laser Academy France, Paris, France
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15
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Gambacciani M, Albertin E, Torelli MG, Bracco GL, Casagrande AC, Martella L, Baiocchi G, Alfieri S, Russo N, Cervigni M. Sexual function after vaginal erbium laser: the results of a large, multicentric, prospective study. Climacteric 2020; 23:S24-S27. [DOI: 10.1080/13697137.2020.1804544] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- M. Gambacciani
- Department of Obstetrics and Gynecology, University Hospital, Pisa, Italy
| | - E. Albertin
- Gynecological Clinic Elysium, Albignasego (Padova), Italy
| | | | | | | | - L. Martella
- Centro Medico Radiologico 3P, Noventa di Piave, Italy
| | - G. Baiocchi
- Department of Obstetrics and Gynecology, University of Perugia, Italy
| | | | - N. Russo
- Centro Medico Demetra, Grottaferrata, Italy
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16
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Cañadas Molina A, Sanz Baro R. The first major complication due to laser treatment for stress urinary incontinence: a short report. Climacteric 2020; 24:206-209. [PMID: 32990051 DOI: 10.1080/13697137.2020.1816958] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AIM Stress urinary incontinence (SUI) is a common benign disease causing a markedly negative impact on quality of life. Vaginal laser is a minimally invasive treatment and no major complications of this technique have been published to date. The purpose of the article is to present the first major adverse event related to this treatment. MATERIALS AND METHODS We present the case of a 48-year-old woman with an important complication after vaginal laser for SUI. RESULTS The patient presented a transverse vaginal septum and shortening of vaginal length after two sessions of vaginal erbium:yttrium aluminum garnet laser treatment. She required two surgical interventions, local injections, and pelvic floor physiotherapy, although currently the patient has not experienced complete resolution of symptoms. DISCUSSION AND CONCLUSIONS Vaginal laser use can lead to serious adverse events. Selection of patients and treatment must be carried out with caution.
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Affiliation(s)
- A Cañadas Molina
- Department of Gynecology and Obstetrics, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - R Sanz Baro
- Department of Gynecology and Obstetrics, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
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17
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Erel CT, Fernandez LDC, Inan D, Makul M. Er:YAG laser treatment of urinary incontinence after failed TOT/TVT procedures. Eur J Obstet Gynecol Reprod Biol 2020; 252:399-403. [PMID: 32711294 DOI: 10.1016/j.ejogrb.2020.07.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 06/26/2020] [Accepted: 07/02/2020] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To determine if the Er:YAG laser can improve the symptoms of SUI patients after previously failed TOT/TVT procedures. STUDY DESIGN This retrospective study includes the data of patients who were recruited from two different out-patient clinics of Obstetrics and Gynecology Department. 25 women with persistent SUI after failed TOT/TVT operations and 25 women who previously did not receive either any type of surgical treatment procedure or non-invasive treatment modalities for SUI. Er:YAG laser with 2940 nm was used in the treatment procedure for SUI setting. The patients were evaluated on the basis of ICIQ-SF before and after the procedure. The severity of SUI symptoms was graded. According to the differences in the ICIQ-SF between before and after the procedure, the percentage of improvement was graded as good responders (≥50 %) or poor responders (<50 %).The duration of the treatment effect was evaluated in follow-ups with relation to maximum improvement time (MIT) and total improvement time (TIT). RESULTS The SUI patients who previously had failed TOT/TVT operations, had significantly higher initial ICIQ-SF score (p = 0.013). Non-ablative Er:YAG laser treatment significantly and similarly improved the severity of SUI symptoms in both groups (p = 0.000 for failed TOT/TVT group and p = 0.001 for non-TOT/TVT group, respectively). The women who were good responders, were younger (p = 0.012) and had less number of years in menopause (p = 0.011). The effect of Er:YAG laser treatment lasted longer among the SUI women in the good responders group (p = 0.000 for MIT and p = 0.000 for TIT, respectively). CONCLUSIONS Non-ablative Er:YAG smooth mode laser is an alternative choice of treatment for the SUI patients who previously had failed TOT/TVT procedures. Its effect lasts longer especially in younger and early postmenopausal women.
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Affiliation(s)
- C Tamer Erel
- Istanbul University, Cerrahpaşa School of Medicine, Department of Obstetrics and Gynecology, Istanbul, Turkey.
| | | | - Deniz Inan
- Marmara University, Department of Statistics, Istanbul, Turkey
| | - Melike Makul
- Istanbul University, Cerrahpaşa School of Medicine, Department of Obstetrics and Gynecology, Istanbul, Turkey
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18
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Erel CT, Inan D, Mut A. Predictive factors for the efficacy of Er:YAG laser treatment of urinary incontinence. Maturitas 2020; 132:1-6. [DOI: 10.1016/j.maturitas.2019.11.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 09/24/2019] [Accepted: 11/08/2019] [Indexed: 12/11/2022]
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19
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Elia D, Gambacciani M, Berreni N, Bohbot JM, Druckmann R, Geoffrion H, Haab F, Heiss N, Rygaloff N, Russo E. Genitourinary syndrome of menopause (GSM) and laser VEL: a review. Horm Mol Biol Clin Investig 2019; 41:/j/hmbci.ahead-of-print/hmbci-2019-0024/hmbci-2019-0024.xml. [PMID: 31855563 DOI: 10.1515/hmbci-2019-0024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 10/24/2019] [Indexed: 11/15/2022]
Abstract
The purpose of this publication is to summarize the results of the vaginal erbium:yttrium-aluminum-garnet (Er:YAG) Smooth® laser (VEL) on the vaginal atrophy component of the genitourinary syndrome of menopause (GSM). GSM has two categories of clinical signs related to estrogen deficiency: symptoms of vulvovaginal atrophy (VVA) and urinary symptoms. This symptomatology is chronic, progressive over the years and affects a majority of women concerned by natural menopause but not exclusively: we must also consider the growing number of survivors of gynecological or non-gynecological cancers (breast, cervix, uterus, vagina, anus, etc.). At a time when hormonal treatment of menopause is contested as is the installation of under urethra prosthesis, the innovation provided by the VEL technology has the merit of offering the women concerned an effective therapeutic alternative with the security of a patent. The VEL technology has an original and unique process: acting only by thermal effect and not by ablation on tissue, VEL is a safe solution in terms of side effects and potential complications. Studies have been increasing since 2012 and all demonstrate a significant improvement in the GSM signs and symptoms, as well as an improved sexual life after VEL treatment. Double-blind, placebo-controlled, randomized studies are expected in order to ultimately confirm the safety and effectiveness of VEL.
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Affiliation(s)
- David Elia
- Vela-France (Vaginal Erbium Laser Academy France), Paris, France
| | | | - Nicolas Berreni
- Vela-France (Vaginal Erbium Laser Academy France), Paris, France
| | - Jean Marc Bohbot
- Vela-France (Vaginal Erbium Laser Academy France), Paris, France
| | - René Druckmann
- Vela-France (Vaginal Erbium Laser Academy France), Paris, France
| | - Hugues Geoffrion
- Vela-France (Vaginal Erbium Laser Academy France), Paris, France
| | - François Haab
- Vela-France (Vaginal Erbium Laser Academy France), Paris, France
| | - Niko Heiss
- Vela-France (Vaginal Erbium Laser Academy France), Paris, France
| | - Nicolas Rygaloff
- Vela-France (Vaginal Erbium Laser Academy France), Paris, France
| | - Eleonora Russo
- Vela-Italia (Vaginal Erbium Laser Academy Italia), Pisa, Italy
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20
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Erbium:YAG laser treatment of female stress urinary incontinence: midterm data. Int Urogynecol J 2019; 31:1859-1866. [DOI: 10.1007/s00192-019-04148-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 10/01/2019] [Indexed: 11/25/2022]
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21
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Affiliation(s)
- Swati Jha
- Consultant Gynaecologist Subspecialist in Urogynaecology Sheffield Teaching Hospitals NHS Foundation Trust Level 4, Jessop Wing, Tree Root Walk Sheffield S10 2SF UK
| | - Tim Hillard
- Consultant Gynaecologist and Urogynaecologist Department of Obstetrics and Gynaecology Poole Hospital NHS Foundation Trust Longfleet Road Poole Dorset BH15 2JB UK
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22
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Scavello I, Maseroli E, Di Stasi V, Vignozzi L. Sexual Health in Menopause. MEDICINA (KAUNAS, LITHUANIA) 2019; 55:E559. [PMID: 31480774 PMCID: PMC6780739 DOI: 10.3390/medicina55090559] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 08/28/2019] [Accepted: 08/29/2019] [Indexed: 02/07/2023]
Abstract
Sexual function worsens with advancing menopause status. The most frequently reported symptoms include low sexual desire (40-55%), poor lubrication (25-30%) and dyspareunia (12-45%), one of the complications of genitourinary syndrome of menopause (GSM). Declining levels of sex steroids (estrogens and androgens) play a major role in the impairment of sexual response; however, psychological and relational changes related with aging and an increase in metabolic and cardiovascular comorbidities should also be taken into account. Although first-line therapeutic strategies for menopause-related sexual dysfunction aim at addressing modifiable factors, many hormonal and non-hormonal, local and systemic treatment options are currently available. Treatment should be individualized, taking into account the severity of symptoms, potential adverse effects and personal preferences.
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Affiliation(s)
- Irene Scavello
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Department of Experimental, Clinical, and Biomedical Sciences "Mario Serio", University of Florence, 50139 Florence, Italy
| | - Elisa Maseroli
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Department of Experimental, Clinical, and Biomedical Sciences "Mario Serio", University of Florence, 50139 Florence, Italy
| | - Vincenza Di Stasi
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Department of Experimental, Clinical, and Biomedical Sciences "Mario Serio", University of Florence, 50139 Florence, Italy
| | - Linda Vignozzi
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Department of Experimental, Clinical, and Biomedical Sciences "Mario Serio", University of Florence, 50139 Florence, Italy.
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23
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Arêas F, Valadares ALR, Conde DM, Costa-Paiva L. The effect of vaginal erbium laser treatment on sexual function and vaginal health in women with a history of breast cancer and symptoms of the genitourinary syndrome of menopause: a prospective study. Menopause 2019; 26:1052-1058. [PMID: 31453969 DOI: 10.1097/gme.0000000000001353] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To assess the effects of vaginal erbium laser treatment on the vaginal health and sexual function of postmenopausal women with a history of breast cancer. METHODS An open, prospective, therapeutic intervention study was conducted with 24 postmenopausal women with a history of breast cancer and vaginal dryness, and/or dyspareunia, who had not used vaginal hormone therapy for at least 6 months. The women were treated using a 2,940-nm Erbium: YAG laser (Etherea-MX, Athena, São Carlos, São Paulo, Brazil), with 90 and 360 scanning scopes, between August, 2017 and October, 2017 in a private clinic in a city of southeastern Brazil. Vaginal erbium laser treatment was performed at three sessions with a 30-day interval between each session. Sexual function was assessed before and 1 month after treatment using the Short Personal Experiences Questionnaire. Questions related to genitourinary symptoms were also applied. Vaginal health was assessed before each laser session using the Vaginal Health Index Score. RESULTS Mean age was 53.7 years. Vaginal health improved, as shown by an increased overall score (P < 0.001). The effect size was large between pretreatment and post-treatment scores for vaginal elasticity, fluid volume, epithelial integrity, and moisture. The effect size was also significant for the overall sexual function score and for the score in the dyspareunia domain between pretreatment and 1 month after the final treatment session. CONCLUSION Vaginal erbium laser may represent a novel therapeutic option for improving vaginal health and sexual function in postmenopausal women with a history of breast cancer.
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Affiliation(s)
- Fernanda Arêas
- Department of Gynecology and Obstetrics, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Ana L R Valadares
- Department of Gynecology and Obstetrics, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Délio Marques Conde
- Department of Gynecology and Obstetrics, Federal University of Goiás, Goiânia, Goiás, Brazil
| | - Lúcia Costa-Paiva
- Department of Gynecology and Obstetrics, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
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24
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Laser Therapy in the Treatment of Female Urinary Incontinence and Genitourinary Syndrome of Menopause: An Update. BIOMED RESEARCH INTERNATIONAL 2019; 2019:1576359. [PMID: 31275962 PMCID: PMC6582847 DOI: 10.1155/2019/1576359] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Revised: 04/05/2019] [Accepted: 05/10/2019] [Indexed: 11/18/2022]
Abstract
Vaginal birth trauma is the leading cause of stress urinary incontinence (SUI) in women. Also, the process of ageing and hormonal deprivation in postmenopause alters the metabolism of connective tissues and decreases collagen production leading to pelvic floor dysfunction. Noninvasive treatment is recommended as first-line management of urinary incontinence (UI) in women. Surgical procedures are more likely to be implemented to cure UI but are associated with more adverse events. Sex hormone deficiency affects changes also in the lower urinary tract where estrogens are the main regulators of physiological functions of the vagina. In the last decade, laser treatment of SUI and of the genitourinary syndrome of menopause (GSM) has been shown a promising treatment method in peer-reviewed literature. This review's aim is to present the evidence-based medical data and laser treatment of SUI and GSM in an outpatient setting to be a good treatment option, regarding short-term as well as long-term follow-ups. Long-term follow-up studies are needed to confirm that laser treatment is a good, painless outpatient procedure with no side effects in postmenopausal women.
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25
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Preti M, Vieira-Baptista P, Digesu GA, Bretschneider CE, Damaser M, Demirkesen O, Heller DS, Mangir N, Marchitelli C, Mourad S, Moyal-Barracco M, Peremateu S, Tailor V, Tarcan T, De EJB, Stockdale CK. The Clinical Role of LASER for Vulvar and Vaginal Treatments in Gynecology and Female Urology: An ICS/ISSVD Best Practice Consensus Document. J Low Genit Tract Dis 2019; 23:151-160. [PMID: 30789385 PMCID: PMC6462818 DOI: 10.1097/lgt.0000000000000462] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
In this best practice document, we propose recommendations for the use of LASER for gynecologic and urologic conditions such as vulvovaginal atrophy, urinary incontinence, vulvodynia, and lichen sclerosus based on a thorough literature review. Most of the available studies are limited by their design; for example, they lack a control group, patients are not randomized, follow-up is short term, series are small, LASER is not compared with standard treatments, and most studies are industry sponsored. Because of these limitations, the level of evidence for the use of LASER in the treatment of these conditions remains low and does not allow for definitive recommendations for its use in routine clinical practice. Histological evidence is commonly reported as proof of tissue regeneration after LASER treatment. However, the histological changes noted can also be consistent with reparative changes after a thermal injury rather than necessarily representing regeneration or restoration of function. The use of LASER in women with vulvodynia or lichen sclerosus should not be recommended in routine clinical practice. There is no biological plausibility or safety data on its use on this population of women. The available clinical studies do not present convincing data regarding the efficacy of LASER for the treatment of vaginal atrophy or urinary incontinence. Also, although short-term complications seem to be uncommon, data concerning long-term outcomes are lacking. Therefore, at this point, LASER is not recommended for routine treatment of the aforementioned conditions unless part of well-designed clinical trials or with special arrangements for clinical governance, consent, and audit.
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Affiliation(s)
- Mario Preti
- Department of Obstetrics and Gynecology, University of Torino, Torino, Italy
| | - Pedro Vieira-Baptista
- Hospital Lusíadas Porto
- Lower Genital Tract Unit, Centro Hospitalar de São João, Porto, Portugal
| | | | - Carol Emi Bretschneider
- Center for Urogynecology and Pelvic Reconstructive Surgery, Obstetrics, Gynecology and Women's Health Institute, Cleveland Clinic
| | - Margot Damaser
- Center for Urogynecology and Pelvic Reconstructive Surgery, Obstetrics, Gynecology and Women's Health Institute, Cleveland Clinic
- Glickman Urological and Kidney Institute and Department of Biomedical Engineering Lerner Research Institute, Cleveland Clinic
- Advanced Platform Technology Center Louis Stokes Cleveland VA Medical Center, Cleveland, OH
| | - Oktay Demirkesen
- Istanbul University Cerrahpaşa Faculty of Medicine, Department of Urology, Istanbul, Turkey
| | - Debra S Heller
- Department of Pathology & Laboratory Medicine, Rutgers-New Jersey Medical School, Newark, NJ
| | - Naside Mangir
- Kroto Research Institute, Department of Material Science and Engineering, University of Sheffield
- Royal Hallamshire Hospital, Department of Urology, Sheffield, UK
| | - Claudia Marchitelli
- Department of Gynecology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Sherif Mourad
- Ain Shams University, Department of Urology, Cairo, Egypt
| | | | - Sol Peremateu
- Department of Gynecology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Visha Tailor
- Imperial College Healthcare, Department of Urogynaecology, London, UK
| | - Tufan Tarcan
- Marmara University School of Medicine, Department of Urology, Istanbul, Turkey
| | - Elise J B De
- Department of Urology, Massachusetts General Hospital-Harvard Medical School Boston, MA
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26
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Desai SA, Kroumpouzos G, Sadick N. Vaginal rejuvenation: From scalpel to wands. Int J Womens Dermatol 2019; 5:79-84. [PMID: 30997377 PMCID: PMC6451893 DOI: 10.1016/j.ijwd.2019.02.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 02/15/2019] [Accepted: 02/17/2019] [Indexed: 11/26/2022] Open
Abstract
Vaginal rejuvenation procedures are increasing in popularity in terms of types of treatment offered, number of patients undergoing them, clinical studies, and in the controversy surrounding them. Both non-invasive and invasive solutions are being developed by pharmaceutical and technological companies. Radiofrequency devices and lasers are spearheading the energy-based device space, and fillers and platelet-rich plasma are used to address several concerns surrounding vaginal health. In this review, an overview of the growing field of vaginal rejuvenation is presented, as well as the authors’ personal view and analysis of this clinical space.
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Affiliation(s)
- Sejal A Desai
- BCJ Hospital and Asha Parekh Research Centre, Mumbai, India.,NMC Hospitals, Dubai, United Arab Emirates
| | - George Kroumpouzos
- Department of Dermatology, Alpert Medical School of Brown University, Providence, Rhode Island.,Department of Dermatology, Medical School of Jundiaí, Sao Paulo, Brazil.,GK Dermatology, South Weymouth, Massachusetts
| | - Neil Sadick
- Department of Dermatology at Weill Cornell Medical College, New York, New York.,Sadick Dermatology, New York, New York
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27
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Preti M, Vieira-Baptista P, Digesu GA, Bretschneider CE, Damaser M, Demirkesen O, Heller DS, Mangir N, Marchitelli C, Mourad S, Moyal-Barracco M, Peremateu S, Tailor V, Tarcan T, De EJB, Stockdale CK. The clinical role of LASER for vulvar and vaginal treatments in gynecology and female urology: An ICS/ISSVD best practice consensus document. Neurourol Urodyn 2019; 38:1009-1023. [PMID: 30742321 DOI: 10.1002/nau.23931] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 01/03/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND The clinical role of LASER for vulvar and vaginal treatments in gynecology and female urology is controversial. AIMS In this best practice document, we propose recommendations for the use of LASER for gynecologic and urologic conditions such as vulvovaginal atrophy, urinary incontinence, vulvodynia, and lichen sclerosus based on a thorough literature review. MATERIALS & METHODS This project was developed between January and September 2018. The development of this document followed the ICS White Paper Standard Operating Procedures. RESULTS Most of the available studies are limited by their design; for example they lack a control group, patients are not randomized, follow up is short term, series are small, LASER is not compared with standard treatments, and studies are industry sponsored. Due to these limitations, the level of evidence for the use of LASER in the treatment of these conditions remains low and does not allow for definitive recommendations for its use in routine clinical practice. Histological evidence is commonly reported as proof of tissue regeneration following LASER treatment. However, the histological changes noted can also be consistent with reparative changes after a thermal injury rather than necessarily representing regeneration or restoration of function. The use of LASER in women with vulvodynia or lichen sclerosus should not be recommended in routine clinical practice. There is no biological plausibility or safety data on its use on this population of women. DISCUSSION The available clinical studies do not present convincing data regarding the efficacy of LASER for the treatment of vaginal atrophy or urinary incontinence. Also, while short-term complications seem to be uncommon, data concerning long-term outcomes are lacking. CONCLUSION At this point, LASER is not recommended for routine treatment of the aforementioned conditions unless part of well-designed clinical trials or with special arrangements for clinical governance, consent, and audit.
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Affiliation(s)
- Mario Preti
- Department of Obstetrics and Gynecology, University of Torino, Torino, Italy
| | - Pedro Vieira-Baptista
- Hospital Lusíadas Porto, Porto, Portugal.,Lower Genital Tract Unit, Centro Hospitalar de São João, Porto, Portugal
| | | | - Carol Emi Bretschneider
- Center for Urogynecology and Pelvic Reconstructive Surgery, Obstetrics, Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, Ohio
| | - Margot Damaser
- Center for Urogynecology and Pelvic Reconstructive Surgery, Obstetrics, Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, Ohio.,Glickman Urological and Kidney Institute and Department of Biomedical Engineering Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio.,Advanced Platform Technology Center, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio
| | - Oktay Demirkesen
- Faculty of Medicine, Department of Urology, Istanbul University Cerrahpaşa, Istanbul, Turkey
| | - Debra S Heller
- Department of Pathology and Laboratory Medicine, Rutgers-New Jersey Medical School, Newark, New Jersey
| | - Naside Mangir
- Kroto Research Institute, Department of Material Science and Engineering, University of Sheffield, Sheffield, UK.,Department of Urology, Royal Hallamshire Hospital, Sheffield, UK
| | - Claudia Marchitelli
- Department of Gynecology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Sherif Mourad
- Department of Urology, Massachusetts General Hospital-Harvard Medical School Boston, Boston, Massachusetts
| | | | - Sol Peremateu
- Department of Gynecology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Visha Tailor
- Department of Urogynaecology, Imperial College Healthcare, London, UK
| | - Tufan Tarcan
- Department of Urology, Ain Shams University, Cairo, Egypt
| | - Elise J B De
- Department of Urology, Marmara University School of Medicine, Istanbul, Turkey
| | - Colleen K Stockdale
- Department of Obstetrics and Gynecology, University of Iowa, Iowa City, Iowa
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Digesu GA, Tailor V, Preti M, Vieira-Baptista P, Tarcan T, Stockdale C, Mourad S. The energy based devices for vaginal "rejuvenation," urinary incontinence, vaginal cosmetic procedures, and other vulvo-vaginal disorders: An international multidisciplinary expert panel opinion. Neurourol Urodyn 2019; 38:1005-1008. [PMID: 30697814 DOI: 10.1002/nau.23927] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 12/02/2018] [Indexed: 11/10/2022]
Abstract
AIMS Energy-based devices using radiofrequency and laser technologies have gained popularity as therapies for vaginal atrophy, urinary incontinence, and vaginal prolapse. They have been promoted by cosmetic and aesthetic industries for vaginal "laxity" and vaginal "rejuvenation," both of which are undefined conditions and terms. This article aims to review the current available literature and its quality on this emerging technology. METHODS An international panel of gynaecologists, urogynaecologists, and urologists undertook a review of the available published literature, identifying articles, guidance, and society statements on the use vaginal energy-based devices. RESULTS There is currently no formal guidance for the use of vaginal energy based therapies. No randomized controlled trials have been published. No comparative studies to existing treatment has been carried out. Studies suggest that vaginal laser can be used in the treatment of vaginal prolapse or "vaginal laxity" and stress urinary incontinence with no quality evidence supporting the use of the therapy for vaginal atrophy or lichen sclerosis. CONCLUSIONS This international group propose that whilst there remains a paucity of good quality data describing the safety, benefits, and appropriate use of vaginal radiofrequency or laser treatments in gynaecology and urogynaecology, a consensus best practice document by an established scientific community needs to be developed.
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Affiliation(s)
| | - Visha Tailor
- Imperial College Healthcare, Department of Urogynaecology, London, UK
| | - Mario Preti
- Department of Obstetrics and Gynecology, University of Torino, Torino, Italy
| | - Pedro Vieira-Baptista
- Hospital Lusíadas Porto, Porto, Portugal.,Lower Genital Tract Unit, Centro Hospitalar de São João, Porto, Portugal
| | - Tufan Tarcan
- Marmara University School of Medicine, Department of Urology, Istanbul, Turkey
| | - Colleen Stockdale
- Department of Obstetrics and Gynecology, University of Iowa, Iowa City, Iowa
| | - Sherif Mourad
- Ain Shams University, Department of Urology, Cairo, Egypt
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Lukač M, Lozar A, Perhavec T, Bajd F. Variable heat shock response model for medical laser procedures. Lasers Med Sci 2019; 34:1147-1158. [DOI: 10.1007/s10103-018-02704-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 12/06/2018] [Indexed: 10/27/2022]
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Bhide AA, Khullar V, Swift S, Digesu GA. The use of laser in urogynaecology. Int Urogynecol J 2018; 30:683-692. [PMID: 30564874 PMCID: PMC6491394 DOI: 10.1007/s00192-018-3844-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 11/28/2018] [Indexed: 11/30/2022]
Abstract
Introduction The use of lasers in urogynaecology has increased in recent years. Their use has been described in pelvic organ prolapse, urinary incontinence and genito-urinary symptoms of menopause. The aim of this study was to review the published literature on CO2 and erbium:YAG laser use in urogynaecological conditions. Methods An extensive search of literature databases (PubMed, EMBASE) was performed for publications (full text and abstracts) written in English up to July 2018. Relevant trials were selected and analysed by an independent reviewer. Twenty-five studies were identified in total. Results All studies were either prospective cohort or case-control studies. The results of individual studies indicate that both CO2 and erbium lasers are effective in treating urogynaecological conditions. Most studies use a vaginal approach with only two investigations of intraurethral application. Conclusion The use of lasers to treat these conditions may seem appealing; however, the lack of good-quality evidence in the form of multi-centre randomised placebo-controlled trials is concerning. The safety and effectiveness of these laser devices have not been established. Use of lasers may lead to serious adverse events such as vaginal burns, scarring, dyspareunia and chronic pain. Randomised placebo-controlled trials in addition to formal evaluation of the laser devices are required before this treatment modality can be recommended.
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Affiliation(s)
- Alka A Bhide
- St Mary's Hospital, Imperial College NHS Trust, London, UK.
| | - Vik Khullar
- St Mary's Hospital, Imperial College NHS Trust, London, UK
| | - Stephen Swift
- Medical University of South Carolina, Charleston, SC, USA
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Shobeiri SA, Kerkhof MH, Minassian VA, Bazi T. IUGA committee opinion: laser-based vaginal devices for treatment of stress urinary incontinence, genitourinary syndrome of menopause, and vaginal laxity. Int Urogynecol J 2018; 30:371-376. [PMID: 30523374 DOI: 10.1007/s00192-018-3830-0] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 11/14/2018] [Indexed: 11/26/2022]
Abstract
This committee opinion reviews the laser-based vaginal devices for treatment of genitourinary syndrome of menopause, vaginal laxity, and stress urinary incontinence. The United States Food and Drug Administration has issued a warning for unsubstantiated advertising and use of energy-based devices. Well-designed case-control studies are required to further investigate the potential benefits, harm, and efficacy of laser therapy in the treatment of genitourinary syndrome of menopause, vaginal laxity, and stress urinary incontinence. The therapeutic advantages of nonsurgical laser-based devices in urogynecology can only be recommended after robust clinical trials have demonstrated their long-term complication profile, safety, and efficacy.
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Affiliation(s)
- S Abbas Shobeiri
- Department of Obstetrics and Gynecology, INOVA Women's Hospital, Falls Church, VA, USA.
- Department of Biomedical Engineering, George Mason University, Fairfax, VA, USA.
| | - M H Kerkhof
- Curilion Female Health Clinic, Haralem, Netherlands
| | - Vatche A Minassian
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA, USA
| | - Tony Bazi
- Department of Obstetrics and Gynecology, The American University of Beirut, Beirut, Lebanon
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Lin HY, Tsai HW, Tsui KH, An YF, Lo CC, Lin ZH, Liou WS, Wang PH. The short-term outcome of laser in the management of female pelvic floor disorders: Focus on stress urine incontinence and sexual dysfunction. Taiwan J Obstet Gynecol 2018; 57:825-829. [DOI: 10.1016/j.tjog.2018.10.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2018] [Indexed: 12/11/2022] Open
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Vaginal erbium laser as second-generation thermotherapy for the genitourinary syndrome of menopause: a pilot study in breast cancer survivors. Menopause 2018; 24:316-319. [PMID: 28231079 DOI: 10.1097/gme.0000000000000761] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the efficacy and acceptability of a second generation of vaginal laser treatment, the vaginal erbium laser, as a nonablative photothermal therapy for the management of genitourinary syndrome of menopause in postmenopausal breast cancer survivors. METHODS The study was performed using an erbium laser crystal yttrium-aluminum-garnet (XS Fotona Smooth, Fotona, Ljubljana, Slovenia) with a wavelength of 2,940 nm. Forty-three postmenopausal breast cancer survivors were treated with three laser applications every 30 days. Symptoms were assessed before the treatment and after 1, 3, 6, 12, and 18 months, using two methods, subjective Visual Analog Scale (VAS) and objective Vaginal Health Index Score (VHIS). The procedures were performed on an outpatient basis without anesthesia or drug use before or after the intervention. RESULTS From baseline values of 8.5 ± 1.0 cm, vaginal dryness VAS scores were 4.4 ± 1.2 cm after the third treatment and 5.5 ± 1.5 cm 12 months after the treatment (P < 0.01 vs basal values), whereas they were 7.5 ± 1.8 cm after 18 months from the last laser application (NS vs basal values). From baseline values of 7.5 ± 1.5 cm, dyspareunia VAS values decreased to 4.2 ± 0.9 cm after the third treatment and 5.1 ± 1.8 cm 12 months from the last laser application (P < 0.01 vs basal values), whereas they were 6.5 ± 1.8 cm after 18 months from the last laser application (NS vs basal values). VHIS, from baseline values of 8.1 ± 1.3, was 21.0 ± 1.4 after the third treatment and 18 ± 1.8 12 months from the last laser application (P < 0.01 vs basal values), whereas they were 14.8 ± 1.5 cm after 18 months from the last laser application (NS vs basal values). No adverse events were recorded during the study. CONCLUSIONS This study suggests that the vaginal erbium laser is effective and safe for the treatment of genitourinary syndrome of menopause in breast cancer survivors.
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Gambacciani M, Levancini M, Russo E, Vacca L, Simoncini T, Cervigni M. Long-term effects of vaginal erbium laser in the treatment of genitourinary syndrome of menopause. Climacteric 2018; 21:148-152. [PMID: 29436235 DOI: 10.1080/13697137.2018.1436538] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To evaluate the long-term efficacy of a second generation of vaginal laser treatment, the vaginal erbium laser, as a non-ablative photothermal therapy for the management of genitourinary syndrome of menopause. METHODS The study was performed using an erbium laser crystal yttrium-aluminum-garnet (XS Fotona Smooth™, Fotona, Ljubljana, Slovenia) with a wavelength of 2940 nm. Postmenopausal women (n = 205) were treated with three laser applications at 30-day intervals. Symptoms were assessed before and after treatment throughout 24 months, using the subjective visual analog scale (VAS) and the objective vaginal health index score (VHIS). In addition, postmenopausal women suffering from stress urinary incontinence were evaluated with the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF). RESULTS Vaginal erbium laser treatment induced a significant (p < 0.01) decrease in VAS for both vaginal dryness and dyspareunia, as well an increase in VHIS (p < 0.01) up to the 12th month after the last laser treatment. The values returned to levels similar to the baseline after 18 and 24 months. In addition, vaginal erbium laser treatment improved mild-moderate stress urinary incontinence in 114 postmenopausal women. Less than 3% of patients discontinued treatment due to adverse events. CONCLUSIONS These results suggest that vaginal erbium laser may be effective and safe for the treatment of genitourinary syndrome of menopause.
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Affiliation(s)
- M Gambacciani
- a Department of Obstetrics and Gynecology , University Hospital of Pisa , Pisa , Italy
| | - M Levancini
- b Department of Obstetrics and Gynecology , Clinica Alemana, University of Development , Santiago , Chile
| | - E Russo
- a Department of Obstetrics and Gynecology , University Hospital of Pisa , Pisa , Italy
| | - L Vacca
- c Department of Obstetrics and Gynecology , Catholic University of the Sacred Heart , Rome , Italy
| | - T Simoncini
- a Department of Obstetrics and Gynecology , University Hospital of Pisa , Pisa , Italy
| | - M Cervigni
- c Department of Obstetrics and Gynecology , Catholic University of the Sacred Heart , Rome , Italy
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Faubion SS, Sood R, Kapoor E. Genitourinary Syndrome of Menopause: Management Strategies for the Clinician. Mayo Clin Proc 2017; 92:1842-1849. [PMID: 29202940 DOI: 10.1016/j.mayocp.2017.08.019] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 08/16/2017] [Accepted: 08/30/2017] [Indexed: 01/25/2023]
Abstract
Genitourinary syndrome of menopause (GSM), previously known as atrophic vaginitis or vulvovaginal atrophy, affects more than half of postmenopausal women. Caused by low estrogen levels after menopause, it results in bothersome symptoms, including vaginal dryness, itching, dyspareunia, urinary urgency and increased frequency, and urinary tract infections. Even though women with GSM can have sexual dysfunction that interferes with partner relationships, women are often embarrassed to seek treatment, and health care professionals do not always actively screen for GSM. As a result, GSM remains underdiagnosed and undertreated. Several effective treatments exist, but low-dose vaginal estrogen therapy is the criterion standard. It is effective and safe for most patients, but caution is suggested for survivors of hormone-sensitive cancers. Newer treatment options include selective estrogen receptor modulators, vaginal dehydroepiandrosterone, and laser therapy. Nonprescription treatments include vaginal lubricants, moisturizers, and dilators. Pelvic floor physical therapy may be indicated for some women with concomitant pelvic floor muscle dysfunction. Sex therapy may be helpful for women with sexual dysfunction. This concise review presents a practical approach to the evaluation and management of GSM for the primary care physician.
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Affiliation(s)
- Stephanie S Faubion
- Women's Health Clinic, Division of General Internal Medicine, Mayo Clinic, Rochester, MN.
| | - Richa Sood
- Women's Health Clinic, Division of General Internal Medicine, Mayo Clinic, Rochester, MN
| | - Ekta Kapoor
- Women's Health Clinic, Division of General Internal Medicine, Mayo Clinic, Rochester, MN; Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN
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Tadir Y, Gaspar A, Lev-Sagie A, Alexiades M, Alinsod R, Bader A, Calligaro A, Elias JA, Gambaciani M, Gaviria JE, Iglesia CB, Selih-Martinec K, Mwesigwa PL, Ogrinc UB, Salvatore S, Scollo P, Zerbinati N, Nelson JS. Light and energy based therapeutics for genitourinary syndrome of menopause: Consensus and controversies. Lasers Surg Med 2017; 49:137-159. [PMID: 28220946 DOI: 10.1002/lsm.22637] [Citation(s) in RCA: 144] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2017] [Indexed: 11/09/2022]
Abstract
Gynecologist and plastic surgeons pioneered the application of lasers in medicine and surgery almost 5 decades ago, initially used to treat cervical and vaginal pathologies. Ever since, energy-based devices have been deployed to treat pelvic pathologies and improve fertility. Recent technological developments triggered an unprecedented wave of publications, assessing the efficacy of fractional laser, and radiofrequency on the vaginal wall in reversing natural aging processes. Studies have shown that a certain degree of thermal energy deposited on the vaginal wall stimulates proliferation of the glycogen-enriched epithelium, neovascularization, and collagen formation in the lamina propria, and improves natural lubrication and control of urination. This review aimed to review such data and to guide future research. A unique assembly of experts from around the globe, compiled and edited this manuscript based on a thorough literature review and personal experience. Lasers Surg. Med. 49:137-159, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Yona Tadir
- Beckman Laser Institute and Medical Clinic, University of California, Irvine, California
| | - Adrian Gaspar
- Department of Laser Surgery, Mendoza Hospital, Mendoza, Argentina
| | - Ahinoam Lev-Sagie
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Macrene Alexiades
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut
| | - Red Alinsod
- South Coast Urogynecology, Laguna Beach, California
| | - Alex Bader
- Reconstruction & Cosmetic Gynecology, London, UK
| | - Alberto Calligaro
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Jorge A Elias
- Urogynecology and Aesthetic Gynecology Clinic, Boenos Aires, Argentina
| | - Marco Gambaciani
- Department of Obstetrics and Gynecology, University Hospital Pisa, Pisa, Italy
| | - Jorge E Gaviria
- Aesthetics and Laser Medical Educational Center, Korpo Laser, Caracas, Venezuela
| | - Cheryl B Iglesia
- Departments of Obstetrics and Gynecology, Georgetown University, Washington, District of Columbia
| | | | - Patricia L Mwesigwa
- Departments of Obstetrics and Gynecology, Georgetown University, Washington, District of Columbia
| | | | - Stefano Salvatore
- Department of Obstetrics and Gynecology, San Raffaele University, Milan, Italy
| | - Paolo Scollo
- Department of Obstetrics and Gynecology, Cannizzaro Hospital, Catania, Italy
| | - Nicola Zerbinati
- Department of Surgical and Morphological Sciences, University of Insubria, Varese, Italy
| | - John Stuart Nelson
- Beckman Laser Institute and Medical Clinic, University of California, Irvine, California
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Gambacciani M, Palacios S. Laser therapy for the restoration of vaginal function. Maturitas 2017; 99:10-15. [PMID: 28364861 DOI: 10.1016/j.maturitas.2017.01.012] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 01/16/2017] [Accepted: 01/25/2017] [Indexed: 01/28/2023]
Abstract
Laser therapy has a therapeutic role in various medical conditions and most recently has gained interest as a non-hormonal treatment for genitourinary syndrome of menopause (GSM) and as a non-invasive option for stress urinary incontinence (SUI). Several therapies are available to alleviate GSM symptoms, including hormonal and non-hormonal products. Both microablative fractional CO2 laser and the non-ablative vaginal Er:YAG laser (VEL) induce morphological changes in the vaginal tissues, and data from non-randomized clinical trials suggest that laser therapy can alleviate vaginal dryness and dyspareunia. VEL has been reported to improve SUI as well as vaginal prolapse. Although large randomized trials have not been reported, the evidence suggests that VEL can be offered as a safe and efficacious alternative to hormone replacement therapy (HRT) for GSM, as well as a first-line treatment for mild to moderate SUI, before surgical procedures are resorted to. Randomized studies are needed to compare laser treatments with other therapies, as well as to assess the duration of the therapeutic effects and the safety of repeated applications. Research is presently evaluating both an automated robotic probe for VEL treatments and an intraurethral probe for the treatment of severe and type III SUI.
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Affiliation(s)
- Marco Gambacciani
- Department of Obstetrics and Gynaecology, Pisa University Hospital, Pisa, Italy.
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Laser therapy as a treatment modality for genitourinary syndrome of menopause: a critical appraisal of evidence. Int Urogynecol J 2017; 28:681-685. [PMID: 28154914 DOI: 10.1007/s00192-017-3282-y] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 01/19/2017] [Indexed: 12/20/2022]
Abstract
Interest in laser therapy as a nonhormonal option for the treatment of genitourinary syndrome of menopause (GSM) has increased. We conducted a systematic review of the use of laser therapy for the relief of GSM symptoms. Six electronic databases were searched and conference abstracts were searched manually from the introduction of laser therapy to the present date. The keywords used were: "genitourinary syndrome", "vulvovaginal atrophy", "postmenopausal symptoms", "laser therapy" and "fractional laser treatment". Of the 165 articles identified in the search, none was a randomized controlled trial. As a result, we included three observational studies without a control group and one case-control study that met our inclusion criteria. The total number of women included in the four studies was 220. The collated data suggest that laser therapy may be valuable as a nonhormonal therapeutic modality in the management of GSM. Higher quality of evidence from randomized controlled trials is required to establish the efficacy of laser treatment in the management of GSM.
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Baggish MS. Fractional CO2 Laser Treatment for Vaginal Atrophy and Vulvar Lichen Sclerosus. J Gynecol Surg 2016. [DOI: 10.1089/gyn.2016.0099] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Michael S. Baggish
- St. Helena Hospital, St. Helena, CA, and Department of Obstetrics and Gynecology, University of California—San Francisco, San Francisco, CA
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40
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Karcher C, Sadick N. Vaginal rejuvenation using energy-based devices. Int J Womens Dermatol 2016; 2:85-88. [PMID: 28492016 PMCID: PMC5418869 DOI: 10.1016/j.ijwd.2016.05.003] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 05/19/2016] [Accepted: 05/19/2016] [Indexed: 12/28/2022] Open
Abstract
Physiologic changes in a woman's life, such as childbirth, weight fluctuations, and hormonal changes due to aging and menopause, may alter the laxity of the vaginal canal, damage the pelvic floor, and devitalize the mucosal tone of the vaginal wall. These events often lead to the development of genitourinary conditions such as stress urinary incontinence; vaginal atrophy; dryness; and physiologic distress affecting a woman's quality of life, self-confidence, and sexuality. Various treatment modalities are currently available to manage these indications, varying from invasive vaginal surgery to more benign treatments like topical vaginal hormonal gels or hormone-replacement therapy. A new trend gaining momentum is the advent of energy-based devices for vaginal rejuvenation that apply thermal or nonthermal energy to the various layers of the vaginal tissue, stimulating collagen regeneration contracture of elastin fibers, neovascularization, and improved vaginal lubrication. This review aims to present the available technologies offering vaginal rejuvenation and the scientific evidence that underlines their safety and efficacy for this indication.
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Affiliation(s)
| | - Neil Sadick
- Clinical Professor of Dermatology, Weill Cornell Medical College, New York, New York
- President of Sadick Dermatology, New York, New York
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Bondi C, Ferrero S, Scala C, Tafi E, Racca A, Venturini PL, Leone Roberti Maggiore U. Pharmacokinetics, pharmacodynamics and clinical efficacy of ospemifene for the treatment of dyspareunia and genitourinary syndrome of menopause. Expert Opin Drug Metab Toxicol 2016; 12:1233-46. [DOI: 10.1080/17425255.2016.1218847] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Chiara Bondi
- Academic Unit of Obstetrics and Gynaecology, IRCCS AOU San Martino – IST, Genova, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genova, Genova, Italy
| | - Simone Ferrero
- Academic Unit of Obstetrics and Gynaecology, IRCCS AOU San Martino – IST, Genova, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genova, Genova, Italy
| | - Carolina Scala
- Academic Unit of Obstetrics and Gynaecology, IRCCS AOU San Martino – IST, Genova, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genova, Genova, Italy
| | - Emanuela Tafi
- Academic Unit of Obstetrics and Gynaecology, IRCCS AOU San Martino – IST, Genova, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genova, Genova, Italy
| | - Annalisa Racca
- Academic Unit of Obstetrics and Gynaecology, IRCCS AOU San Martino – IST, Genova, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genova, Genova, Italy
| | - Pier Luigi Venturini
- Academic Unit of Obstetrics and Gynaecology, IRCCS AOU San Martino – IST, Genova, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genova, Genova, Italy
| | - Umberto Leone Roberti Maggiore
- Academic Unit of Obstetrics and Gynaecology, IRCCS AOU San Martino – IST, Genova, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genova, Genova, Italy
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Gambacciani M, Cervigni M. Erbium laser in gynecology: aims, aspirations and action points. Climacteric 2015; 18 Suppl 1:2-3. [DOI: 10.3109/13697137.2015.1082258] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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