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Filippini M, Angioli R, Luvero D, Sammarini M, De Felice G, Latella S, de Góis Speck NM, Farinelli M, Martire FG, Gulino FA, Incognito GG, Capriglione S. The Utility of CO 2 Laser Treatment of Pelvic Symptoms in Women with Previous Perineal Trauma during Delivery. J Pers Med 2023; 14:60. [PMID: 38248761 PMCID: PMC10817595 DOI: 10.3390/jpm14010060] [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: 12/04/2023] [Revised: 12/27/2023] [Accepted: 12/29/2023] [Indexed: 01/23/2024] Open
Abstract
This study aimed to examine the impact of fractional CO2 laser treatment of pelvic symptoms in women who have undergone perineal trauma from vaginal delivery. It was a retrospective, monocentric analysis that encompassed all women assessed for pelvic discomfort or signs of vulvovaginal atrophy following vaginal delivery between 2013 and 2018. The severity of symptoms was assessed using the Visual Analogue Scale (VAS). Twenty-seven patients met the inclusion criteria and were sorted into two groups: (1) women who had undergone episiotomies during labor (n = 11); and (2) women who had experienced spontaneous tears during vaginal delivery (n = 16). For women with episiotomies, each treatment and subsequent evaluation consistently showed a significant reduction in dyspareunia intensity. A similar positive trend was observed regarding pain at the introitus (7.5 vs. 6.5 after the first treatment, p = 0.03; 6.5 vs. 3 after the second treatment, p = 0.01; 3 vs. 1 after the third treatment, p = 0.01). Among women experiencing spontaneous perineal tears during delivery, there was a notable decrease in dyspareunia following all treatments (8 vs. 7 after the first treatment, p = 0.01; 8 vs. 4 after the second treatment, p = 0.02; 3 vs. 1 after the third treatment, p = 0.03). The impact of laser treatment did not exhibit significant differences between women who underwent episiotomies and those who experienced spontaneous perineal tears. In conclusion, fractional CO2 laser can be regarded as a non-pharmacological option for managing pelvic floor symptoms in women who encountered perineal trauma during delivery, independently from the nature, spontaneity, or iatrogenesis of the perineal laceration.
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Affiliation(s)
- Maurizio Filippini
- Department of Obstetrics and Gynecology, Hospital State of Republic of San Marino, 47893 Borgo Maggiore, San Marino; (M.F.); (M.S.); (G.D.F.); (S.L.); (M.F.)
| | - Roberto Angioli
- Department of Obstetrics and Gynecology, Campus Bio-Medico University, 00128 Rome, Italy; (R.A.); (D.L.)
| | - Daniela Luvero
- Department of Obstetrics and Gynecology, Campus Bio-Medico University, 00128 Rome, Italy; (R.A.); (D.L.)
| | - Margaret Sammarini
- Department of Obstetrics and Gynecology, Hospital State of Republic of San Marino, 47893 Borgo Maggiore, San Marino; (M.F.); (M.S.); (G.D.F.); (S.L.); (M.F.)
| | - Giovanna De Felice
- Department of Obstetrics and Gynecology, Hospital State of Republic of San Marino, 47893 Borgo Maggiore, San Marino; (M.F.); (M.S.); (G.D.F.); (S.L.); (M.F.)
| | - Silvia Latella
- Department of Obstetrics and Gynecology, Hospital State of Republic of San Marino, 47893 Borgo Maggiore, San Marino; (M.F.); (M.S.); (G.D.F.); (S.L.); (M.F.)
| | - Neila Maria de Góis Speck
- Gynecological Disease Prevention Nucleus (NUPREV), Department of Gynecology, Paulista Medical School (UNIFESP/EPM), Federal University of São Paulo, São Paulo 04023-062, Brazil;
| | - Miriam Farinelli
- Department of Obstetrics and Gynecology, Hospital State of Republic of San Marino, 47893 Borgo Maggiore, San Marino; (M.F.); (M.S.); (G.D.F.); (S.L.); (M.F.)
| | - Francesco Giuseppe Martire
- Gynecological Unit, Department of Surgical Sciences, University of Rome “Tor Vergata”, 00133 Rome, Italy;
| | - Ferdinando Antonio Gulino
- Unit of Gynecology and Obstetrics, Department of Human Pathology of Adults and Developmental Age, “G. Martino” University Hospital, 98122 Messina, Italy
| | - Giosuè Giordano Incognito
- Department of General Surgery and Medical Surgical Specialties, University of Catania, 95123 Catania, Italy;
| | - Stella Capriglione
- Department of Obstetrics and Gynecology, “Santa Maria alla Gruccia” Hospital, 52025 Montevarchi, Italy;
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Mejia-Gomez J, Bouteaud J, Philippopoulos E, Wolfman W, Brezden-Masley C. Use of a vaginal CO 2 laser for the management of genitourinary syndrome of menopause in gynecological cancer survivors: a systematic review. Climacteric 2021; 25:228-234. [PMID: 34694948 DOI: 10.1080/13697137.2021.1990258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Genitourinary syndrome of menopause (GSM) may arise from the hypoestrogenism caused by ovarian function destruction following gynecological cancer treatments. GSM may also be present in menopausal women and its symptoms might be exacerbated by cancer treatments. Historically, patients with hormone-dependent gynecological cancer and physicians have been less comfortable using vaginal estrogen due to fear of recurrence. CO2 vaginal laser therapies have demonstrated efficacy as a non-hormonal alternative for GSM treatment in healthy menopausal patients. The objective of this study was to evaluate the data on the effect of a CO2 vaginal laser for the management of GSM in gynecological cancer patients. Databases searched included MEDLINE, Embase, PubMed, Cochrane and Google Scholar. Selected studies assessed use of a CO2 vaginal laser in gynecological cancer patients with GSM. A total of 269 studies were retrieved. Four studies met the inclusion criteria. Each study followed a different type of CO2 vaginal laser protocol for the management of GSM in gynecological cancer patients. There are no randomized controlled trials that assess the use of a CO2 vaginal laser in gynecologic cancer patients. The number of published gynecological cancer patients treated with a CO2 laser for the management of GSM is extremely limited (N < 100). There is a lack of literature on the impact and safety of vaginal CO2 laser use to manage GSM in gynecologic cancer patients.
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Affiliation(s)
- J Mejia-Gomez
- Department of Obstetrics & Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - J Bouteaud
- Department of Obstetrics & Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - E Philippopoulos
- Department of Obstetrics & Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - W Wolfman
- Department of Obstetrics & Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - C Brezden-Masley
- Department of Medical Oncology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
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Carbon Dioxide Laser Vulvovaginal Rejuvenation: A Systematic Review. COSMETICS 2021. [DOI: 10.3390/cosmetics8030056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Genitourinary syndrome of menopause (GSM) causes significant symptomatic aggravation that affects the quality of life (QoL). Vulvovaginal atrophy (VVA), the hallmark of GSM, is managed with topical non-hormonal therapy, including moisturizers and lubricants, and topical estrogen application. Patients not responding/being unsatisfied with previous local estrogen therapies are candidates for a noninvasive modality. Carbon dioxide (CO2) laser therapy, especially the fractionated type (FrCO2), has drawn considerable attention over the past two decades as a non-invasive treatment for GSM. This systematic review describes the accumulated evidence from 40 FrCO2 laser studies (3466 participants) in GSM/VVA. MEDLINE, Scopus and Cochrane databases were searched through April 2021. We analyze the effects of FrCO2 laser therapy on symptoms, sexual function, and QoL of patients with GSM/VVA. As shown in this review, FrCO2 laser therapy for GSM shows good efficacy and safety. This modality has the potential to advance female sexual wellness. Patient satisfaction was high in the studies included in this systematic review. However, there is a lack of level I evidence, and more randomized sham-controlled trials are required. Furthermore, several clinical questions, such as the number of sessions required that determine cost-effectiveness, should be addressed. Also, whether FrCO2 laser therapy may exert a synergistic effect with systemic and/or local hormonal/non-hormonal treatments, energy-based devices, and other modalities to treat GMS requires further investigation. Lastly, studies are required to compare FrCO2 laser therapy with other energy-based devices such as erbium:YAG laser and radiofrequency.
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Abstract
BACKGROUND Vaginal rejuvenation is a topic of interest to multiple specialties, including dermatologists, plastic and reconstructive surgeons, urologists, and gynecologists. Evidence suggests that minimally invasive, energy-based devices-radiofrequency and laser therapy-are effective at vaginal tightening and decreasing symptoms of genitourinary syndrome of menopause (GSM) and/or vulvovaginal atrophy (VVA). MATERIALS AND METHODS A systematic review was completed using PubMed in November 2018 with search terms "vaginal" or "vagina" and "rejuvenation" or "tightening" or "laxity" or "radiofrequency" or "laser," as well as "genitourinary syndrome of menopause," "pelvic prolapse," "atrophic vaginitis," "vulvovaginal atrophy," "sexual function," "urinary incontinence," and "radiofrequency" or "laser." Inclusion criteria were articles written in English and clinical trials or case reports/series dealing with human subjects. RESULTS We identified 59 studies (3,609 women) treated for vaginal rejuvenation using either radiofrequency or fractional ablative laser therapy. Studies report improvement in symptoms of GSM/VVA and sexual function, high patient satisfaction, and minor adverse events, including treatment-associated pain, swelling, or vaginal discharge. CONCLUSION This review demonstrates radiofrequency and laser are efficacious for the treatment of vaginal laxity and/or atrophy. Further research needs to be completed to determine which specific pathologies can be treated, if maintenance treatment is necessary, and long-term safety concerns.
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D'Oria O, Giannini A, Prata G, Scudo M, Logoteta A, Mondo A, Perniola G, Palaia I, Cascialli G, Monti M, Muzii L, Benedetti Panici P, DI Donato V. Non-invasive treatment of vulvovaginal atrophy in menopause with CO2 laser. Minerva Obstet Gynecol 2021; 73:127-134. [PMID: 32720802 DOI: 10.23736/s2724-606x.20.04612-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Genitourinary syndrome of menopause (GSM) may affect up to 90% of menopausal women, including vulvovaginal atrophy (VVA), burning, pain, bleeding, irritation, dyspareunia, anorgasmia, and urinary symptoms. Vaginal symptoms from lack of estrogens can have a significant impact on the sexual health and quality of life (QoL) in as many as 50% of postmenopausal women. Several therapeutic alternatives, both hormonal and non- hormonal, have been proposed. Microablative CO<inf>2</inf> laser is one of the three non-surgical energy-based therapies, with Erbium:YAG laser and temperature-controlled radiofrequency (RF). Microablative CO<inf>2</inf> laser induces morphological changes in vaginal tissues and results of several clinical trials suggest that this type of laser improves symptoms of GSM. Moreover, this treatment seems to be safe. Given the increasingly widespread use of laser CO<inf>2</inf> as a non-hormonal alternative treatment for GSM, the authors reviewed the current published literature evaluating this therapy, to compare efficacy and safety of different protocols.
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Affiliation(s)
- Ottavia D'Oria
- Department of Maternal Child Health and Urologic Sciences, Umberto I Hospital, Sapienza University, Rome, Italy
| | - Andrea Giannini
- Department of Maternal Child Health and Urologic Sciences, Umberto I Hospital, Sapienza University, Rome, Italy
| | - Giovanni Prata
- Department of Maternal Child Health and Urologic Sciences, Umberto I Hospital, Sapienza University, Rome, Italy
| | - Maria Scudo
- Department of Maternal Child Health and Urologic Sciences, Umberto I Hospital, Sapienza University, Rome, Italy -
| | - Alessandra Logoteta
- Department of Maternal Child Health and Urologic Sciences, Umberto I Hospital, Sapienza University, Rome, Italy
| | - Alessandro Mondo
- Department of Maternal Child Health and Urologic Sciences, Umberto I Hospital, Sapienza University, Rome, Italy
| | - Giorgia Perniola
- Department of Maternal Child Health and Urologic Sciences, Umberto I Hospital, Sapienza University, Rome, Italy
| | - Innocenza Palaia
- Department of Maternal Child Health and Urologic Sciences, Umberto I Hospital, Sapienza University, Rome, Italy
| | - Gianluca Cascialli
- Department of Maternal Child Health and Urologic Sciences, Umberto I Hospital, Sapienza University, Rome, Italy
| | - Marco Monti
- Department of Maternal Child Health and Urologic Sciences, Umberto I Hospital, Sapienza University, Rome, Italy
| | - Ludovico Muzii
- Department of Maternal Child Health and Urologic Sciences, Umberto I Hospital, Sapienza University, Rome, Italy
| | - Pierluigi Benedetti Panici
- Department of Maternal Child Health and Urologic Sciences, Umberto I Hospital, Sapienza University, Rome, Italy
| | - Violante DI Donato
- Department of Maternal Child Health and Urologic Sciences, Umberto I Hospital, Sapienza University, Rome, Italy
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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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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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Hersant B, Werkoff G, Sawan D, Sidahmed-Mezi M, Bosc R, La Padula S, Kalsoum S, Ouidir N, Meningaud JP, Belkacemi Y. Carbon dioxide laser treatment for vulvovaginal atrophy in women treated for breast cancer: Preliminary results of the feasibility EPIONE trial. ANN CHIR PLAST ESTH 2020; 65:e23-e31. [PMID: 32513482 DOI: 10.1016/j.anplas.2020.05.002] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 04/28/2020] [Accepted: 05/10/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND AND OBJECTIVE Quality of life preservation after anti-cancer therapy is a major challenge for breast cancer survivors. Approximately 42-70% of patients who receive systemic therapy for breast cancer, including endocrine therapy, will develop vulvovaginal atrophy (VVA). For these patients, the commonly proposed gel-based treatments for topical applications are restrictive. Recently, innovative, non-hormonal therapeutic approaches, such as laser therapy, have emerged. The purpose of this feasibility study is to investigate the safety and efficacy of CO2 laser therapy in women with a history of breast cancer. MATERIAL AND METHODS This prospective monocentric study included 20 patients with vulvovaginal atrophy who were treated at Henri Mondor University Hospital between 2017 and 2018. We included patients with a vaginal health index (VHI) score<15 and a contraindication for hormone administration due to a history of breast cancer. Two carbon dioxide laser sessions were used. The treatment was delivered using the following settings: vaginal tightening, FinePulse (pulse width 0.9ms), and energy density of 11.5J/cm2 that allows coverage of 70% of the targeted vaginal area to be treated. All patients had their follow-up visit at one (M1), three (M3), and six (M6) months after the first treatment to evaluate efficacy of the treatment on vulvovaginal atrophy. Vaginal health index score and female sexual distress (FSD) score were used to assess treatment efficacy and its impact on sexual quality of life. A score≥11 was associated with sexual dysfunction. The vaginal health index and female sexual distress scores were evaluated at baseline, M1, M3, and M6 of follow-up. RESULTS The mean age of the patients was 56.1±8.8 years (range, 27-69 years). Seventeen of the 20 patients had experienced menopause (mean menopausal age, 51.25±1.5 years). At inclusion, the mean vaginal health index and the female sexual distress scores were 10.58±1.71 and 21.36±15.10, respectively. Fourteen out of 20 patients (70%) had FSD scores≥11 at the baseline. At M1, the mean vaginal health index score increased significantly to 13.42±2.3 (P=0.03), which represented an improvement of 21% from the baseline. A persistent and significant improvement in the vaginal health index score was observed at M6, with the score increasing to 16.75±4.23 post-treatment (P<0.0001), representing a 34% improvement from the mean baseline score. The mean female sexual distress at M1 was 19.83±13.57, representing a 7% decrease compared to the baseline scores (P<0.01). At M3, the female sexual distress significantly decreased to 13.88±15.58, representing an improvement of 35% (P=0.006). It increased to 10.35±14.7 at M6, representing an improvement of 52% (P=0.001). At M3, 35% of the patients had a female sexual distress score>11, and at M6, only 15% had a female sexual distress score>11. No side effects were reported during follow-up. CONCLUSION This pilot feasibility study showed that carbon dioxide laser treatment appears to be an effective and safe method to improve the trophicity and decrease vaginal mucosal dryness in women with vulvovaginal atrophy that developed after systemic breast cancer therapy.
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Affiliation(s)
- B Hersant
- Henri-Mondor Breast Center, hôpitaux universitaires Henri-Mondor, 51, avenue Marechal de Lattre de Tassigny, 94010 Créteil, France; Department of Maxillofacial Surgery, Plastic and Reconstructive, hôpitaux universitaires Henri-Mondor, 51, avenue Marechal de Lattre de Tassigny, 94010 Créteil, France; University of Paris East Creteil (UPEC), Créteil, France.
| | - G Werkoff
- Henri-Mondor Breast Center, hôpitaux universitaires Henri-Mondor, 51, avenue Marechal de Lattre de Tassigny, 94010 Créteil, France; Gynecological Surgery Department, Bégin Army Teaching Hospital, 69, avenue de Paris, 94160 Saint-Mandé, France
| | - D Sawan
- Department of Maxillofacial Surgery, Plastic and Reconstructive, hôpitaux universitaires Henri-Mondor, 51, avenue Marechal de Lattre de Tassigny, 94010 Créteil, France
| | - M Sidahmed-Mezi
- Department of Maxillofacial Surgery, Plastic and Reconstructive, hôpitaux universitaires Henri-Mondor, 51, avenue Marechal de Lattre de Tassigny, 94010 Créteil, France
| | - R Bosc
- Henri-Mondor Breast Center, hôpitaux universitaires Henri-Mondor, 51, avenue Marechal de Lattre de Tassigny, 94010 Créteil, France; Department of Maxillofacial Surgery, Plastic and Reconstructive, hôpitaux universitaires Henri-Mondor, 51, avenue Marechal de Lattre de Tassigny, 94010 Créteil, France; University of Paris East Creteil (UPEC), Créteil, France
| | - S La Padula
- Department of Maxillofacial Surgery, Plastic and Reconstructive, hôpitaux universitaires Henri-Mondor, 51, avenue Marechal de Lattre de Tassigny, 94010 Créteil, France
| | - S Kalsoum
- Department of Pathology, hôpitaux universitaires Henri-Mondor, 51, avenue Marechal de Lattre de Tassigny, 94010 Créteil, France
| | - N Ouidir
- Department of Pathology, hôpitaux universitaires Henri-Mondor, 51, avenue Marechal de Lattre de Tassigny, 94010 Créteil, France
| | - J-P Meningaud
- Henri-Mondor Breast Center, hôpitaux universitaires Henri-Mondor, 51, avenue Marechal de Lattre de Tassigny, 94010 Créteil, France; Department of Maxillofacial Surgery, Plastic and Reconstructive, hôpitaux universitaires Henri-Mondor, 51, avenue Marechal de Lattre de Tassigny, 94010 Créteil, France; University of Paris East Creteil (UPEC), Créteil, France
| | - Y Belkacemi
- Henri-Mondor Breast Center, hôpitaux universitaires Henri-Mondor, 51, avenue Marechal de Lattre de Tassigny, 94010 Créteil, France; Department of Radiation Oncology, hôpitaux universitaires Henri-Mondor, 51, avenue Marechal de Lattre de Tassigny, 94010 Créteil, France; Inserm Unit 955, Team 21, IMRB, Créteil, France; University of Paris East Creteil (UPEC), Créteil, France
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Mackova K, Van daele L, Page A, Geraerts I, Krofta L, Deprest J. Laser therapy for urinary incontinence and pelvic organ prolapse: a systematic review. BJOG 2020; 127:1338-1346. [DOI: 10.1111/1471-0528.16273] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2020] [Indexed: 01/09/2023]
Affiliation(s)
- K Mackova
- Cluster Urogenital and Abdominal Surgery Department of Development and Regeneration KU Leuven Leuven Belgium
- Third Faculty of Medicine Institute for the Care of Mother and Child Charles University Prague Czech Republic
| | - L Van daele
- Faculty of Medicine KU Leuven Leuven Belgium
| | - A‐S Page
- Department Obstetrics and Gynaecology University Hospitals KU Leuven Leuven Belgium
| | - I Geraerts
- Department of Physical Medicine and Rehabilitation University Hospitals, KU Leuven Leuven Belgium
- Department Rehabilitation Sciences Group Biomedical Sciences KU Leuven Leuven Belgium
| | - L Krofta
- Third Faculty of Medicine Institute for the Care of Mother and Child Charles University Prague Czech Republic
| | - J Deprest
- Cluster Urogenital and Abdominal Surgery Department of Development and Regeneration KU Leuven Leuven Belgium
- Department Obstetrics and Gynaecology University Hospitals KU Leuven Leuven Belgium
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Alexiades MR. Fractional Co 2 Laser Treatment of the Vulva and Vagina and the Effect of Postmenopausal Duration on Efficacy. Lasers Surg Med 2020; 53:185-198. [PMID: 32329093 PMCID: PMC7984360 DOI: 10.1002/lsm.23247] [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: 02/02/2020] [Revised: 03/27/2020] [Accepted: 03/30/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND OBJECTIVES More studies are needed to assess the long-term safety profile and clinical outcomes of lasers and energy-based devices to treat the symptoms associated with vulvovaginal atrophy. This study evaluated a series of three fractional CO2 laser treatments to the vulva and vagina with a 1-year follow-up in a postmenopausal population. STUDY DESIGN/MATERIALS AND METHODS In this prospective, self-controlled, open-label clinical study, 18 postmenopausal females with atrophic vaginitis received 3 monthly treatments to the vulva and vagina with a fractional CO2 laser system and 1-, 3-, 6-, and 12-month follow-up. Investigators used the Vaginal Health Index (VHI) to assess changes in vaginal elasticity, fluid volume, vaginal pH, epithelial integrity, and moisture. Sexual function at each timepoint was subject-reported, using the validated Female Sexual Function Index (FSFI). RESULTS Treatment of the vulva and vagina in postmenopausal women with fractional CO2 laser resurfacing resulted in statistically significant improvements as compared with baseline at all post-treatment and follow-up intervals to 12 months in VHI and FSFI (P ≤ 0.003 and P ≤ 0.03, respectively). Mean total VHI score increased from a baseline of 11.8-22.8 (93.2% improved) at 6-month follow-up (P = 0.0002) slightly decreasing to 21.4 (81.4% improved) at 12-month follow-up post-treatment (P = 0.0003). Mean FSFI Scores increased from a baseline of 17.9-26.3 (46.9% improvement) at 12-month follow-up post-treatment (P ≤ 0.0048). Cohort analysis revealed restoration of normal or near-normal (23-25) VHI following laser treatment in the recently menopausal (1-3 years) greatly exceeded that of the >3 years postmenopausal population and the difference was statistically significant (P ≤ 0.05). Normal/near-normal VHI at 3-, 6-, and 12-month post-treatment was 88%, 88%, and 63% in the recently postmenopausal cohort, as compared with 30%, 40%, and 10% of the >3 years postmenopausal group (P ≤ 0.05). Patient satisfaction following treatment was rated as high at 94% at 12-month follow-up. Safety findings demonstrated no-to-slight discomfort in the majority of subjects and transient erythema and edema, with no adverse events associated with treatment. CONCLUSION Fractional CO2 laser treatment of the vulva and vagina resulted in statistically significant improvements in VHI and FSFI compared with baseline in postmenopausal population that were sustained to 12-month follow-up. Restoration of normal VHI was observed in a statistically significant greater percentage in the recently postmenopausal cohort (1-3 years) as compared with postmenopausal cohort of >3 years, suggesting that early intervention is correlated with improved outcomes. Lasers Surg. Med. © 2020 Wiley Periodicals, Inc.
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Affiliation(s)
- Macrene R Alexiades
- Dermatology and Laser Surgery Center of New York, Yale University School of Medicine, New York, New York
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Photiou L, Lin M, Dubin D, Lenskaya V, Khorasani H. Review of non‐invasive vulvovaginal rejuvenation. J Eur Acad Dermatol Venereol 2020; 34:716-726. [DOI: 10.1111/jdv.16066] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 10/17/2019] [Indexed: 02/06/2023]
Affiliation(s)
- L. Photiou
- Department of Dermatology The Alfred Hospital Melbourne Vic. Australia
| | - M.J. Lin
- Department of Dermatology Icahn School of Medicine at Mount Sinai New York NY USA
| | - D.P. Dubin
- Department of Dermatology Icahn School of Medicine at Mount Sinai New York NY USA
| | - V. Lenskaya
- Department of Pathology Icahn School of Medicine at Mount Sinai New York NY USA
| | - H. Khorasani
- Department of Dermatology Icahn School of Medicine at Mount Sinai New York NY USA
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12
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Athanasiou S, Pitsouni E, Douskos A, Salvatore S, Loutradis D, Grigoriadis T. Intravaginal energy-based devices and sexual health of female cancer survivors: a systematic review and meta-analysis. Lasers Med Sci 2019; 35:1-11. [PMID: 31396795 DOI: 10.1007/s10103-019-02855-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 07/26/2019] [Indexed: 02/07/2023]
Abstract
A systematic review and meta-analysis was undertaken to assess the efficacy and safety of intravaginal energy-based therapies (laser and radiofrequency) on sexual health of cancer survivors (CS) (breast cancer (BCS) and/or gynecological cancer (GCS)). PubMed, Scopus, Web of Science, and Cochrane Library were searched until 21/02/2019. Quality of reporting, methodology, and body of evidence were assessed using STROBE, MINORS, and GRADE. Primary outcomes were dyspareunia, dryness, and sexual health (FSFI, FSDS-R). Secondary outcomes were burning, itching, dysuria, incontinence, Vaginal Health Index Score (VHIS), microbiome-cytokine evaluation, and adverse events. Main analyses, subgroup analyses, and sensitivity analyses were performed. Eight observational studies (n = 274) were eligible for inclusion. None of the studies evaluated radiofrequency. BCS and BCS-GCS were included in 87% and 13% of studies, respectively. All primary outcomes improved significantly with the exception of FSDS-R (dyspareunia (5 studies (n = 233), standardized mean difference (StdMD) (- 1.17), 95%CI [- 1.59, - 0.75]; p < 0.001; I2 = 55%), vaginal dryness (4 studies (n = 183), StdMD (- 1.98), 95%CI [- 3.31, - 0.65]; p = 0.003; I2 = 91%), FSFI (2 studies, n = 28, MD (12.79), 95%CI [7.69, 17.89]; p < 0.001; I2 = 0%). Itching, dysuria, and VHIS increased significantly, while burning was not improved. Serious adverse events were not observed by any of the studies. Intravaginal laser therapies appear to have a positive effect on dyspareunia, vaginal dryness, and FSFI of CS. However, the quality of evidence is "very low," with no data on intravaginal radiofrequency therapy. Further research with high-quality RCTs and long-term follow-up is needed to evaluate the value of energy-based devices as a therapeutic option for CS with sexual problems.
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Affiliation(s)
- Stavros Athanasiou
- Urogynaecology Unit, 1st Department of Obstetrics and Gynecology, "Alexandra" Hospital, Medical School, National and Kapodistrian University of Athens, Vasilisis Sofias Ave. 80, 115 28, Athens, Greece.
| | - Eleni Pitsouni
- Urogynaecology Unit, 1st Department of Obstetrics and Gynecology, "Alexandra" Hospital, Medical School, National and Kapodistrian University of Athens, Vasilisis Sofias Ave. 80, 115 28, Athens, Greece
| | - Athanasios Douskos
- Urogynaecology Unit, 1st Department of Obstetrics and Gynecology, "Alexandra" Hospital, Medical School, National and Kapodistrian University of Athens, Vasilisis Sofias Ave. 80, 115 28, Athens, Greece
| | - Stefano Salvatore
- Obstetrics and Gynecology Unit, Urogynecology Unit, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Dimitrios Loutradis
- 1st Department of Obstetrics and Gynecology, "Alexandra" Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Themos Grigoriadis
- Urogynaecology Unit, 1st Department of Obstetrics and Gynecology, "Alexandra" Hospital, Medical School, National and Kapodistrian University of Athens, Vasilisis Sofias Ave. 80, 115 28, Athens, Greece
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Azaïs H. [Vaginal LASER therapy, a pragmatic option for patients after cancer]. ACTA ACUST UNITED AC 2019; 47:692-693. [PMID: 31376508 DOI: 10.1016/j.gofs.2019.07.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Indexed: 10/26/2022]
Affiliation(s)
- H Azaïs
- Service de chirurgie et oncologie gynécologique et mammaire, hôpitaux universitaires Pitié-Salpêtrière - Charles Foix, AP-HP, 47/83, boulevard de l'Hôpital, 75013 Paris, France.
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14
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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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15
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Singh P, Chong CYL, Han HC. Effects of Vulvovaginal Laser Therapy on Postmenopausal Vaginal Atrophy: A Prospective Study. J Gynecol Surg 2019. [DOI: 10.1089/gyn.2018.0048] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- Priyanka Singh
- Department of Urogynaecology, KK Women's and Children's Hospital, Singapore, Singapore
| | | | - How Chuan Han
- Department of Urogynaecology, KK Women's and Children's Hospital, Singapore, Singapore
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16
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17
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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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18
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Ratz C. [Vaginal laser therapy for urinary incontinence and genitourinary syndrome of menopause : A review]. Urologe A 2019; 58:284-290. [PMID: 30721329 DOI: 10.1007/s00120-019-0861-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Use of vaginal laser therapy in the treatment of grade I stress urinary incontinence and genitourinary syndrome of menopause is gaining in importance across the globe. MATERIALS AND METHODS On the basis of the research that is currently available, an analysis is carried out regarding whether laser therapy is already suitable for use in the field of urology. RESULTS The research available is still limited: randomized controlled studies in particular are lacking. All the data published to date demonstrate a response to laser therapy with minimal side effects, high patient compliance and satisfaction, and a long-term response for a minimum of 12 months. CONCLUSIONS Vaginal laser therapy has shown potential and demonstrated its safety for use in urology as either a complementary or alternative treatment to existing treatment options, such as topical hormonal therapies, pelvic floor exercises or surgical procedures. It is necessary to define it as separate from aesthetic procedures.
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Affiliation(s)
- C Ratz
- Urologie Groß-Gerau, Am Sandböhl 2, 64521, Groß-Gerau, Deutschland.
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19
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Boa R, Grénman S. Psychosexual health in gynecologic cancer. Int J Gynaecol Obstet 2018; 143 Suppl 2:147-152. [DOI: 10.1002/ijgo.12623] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Rosalind Boa
- Department of Obstetrics and Gynecology; University of Cape Town; Cape Town South Africa
| | - Seija Grénman
- Department of Obstetrics and Gynecology; Turku University Hospital; Turku Finland
- University of Turku; Turku Finland
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[CO 2 LASER for the treatment of vaginal symptoms of genitourinary syndrome of menopause]. ACTA ACUST UNITED AC 2018; 46:729-734. [PMID: 30241737 DOI: 10.1016/j.gofs.2018.09.001] [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: 06/07/2018] [Indexed: 11/23/2022]
Abstract
Genitourinary syndrome of menopause (GSM) brings together a collection of signs including vaginal dryness, burning sensation and itching discomfort as well as deterioration of sexual health, dysuria, urgenturia and repeated urinary infections and may be responsible for a significant impairment of quality of life in symptomatic postmenopausal women. The management of GSM therefore represents a public health issue. Systemic or local hormonal treatments are frequently offered, as well as non-hormonal treatments. The existence of contraindications to hormonal treatments and the constraints of using local treatments lead us to propose other therapeutic options. CO2 LASER is now part of the therapeutic arsenal for the treatment of vaginal dryness in the context of GSM. There is a growing interest in this technique, especially for women who have a contraindication to hormonal therapy, as it is a globally effective, long-acting alternative with very little adverse effect. Current evidence suggests that this tool could provide a quality of life benefit to many patients with minimal side effect exposure, if used in the respect of its indications and implementation protocols. However, clinical data based on high-level therapeutic trials remain absolutely essential for this treatment to be validated and recommended by health professionals.
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Brandão P, Henriques J, Almeida A, Ramôa P. Female urinary incontinence: is laser treatment effective? a systematic review. ACTA ACUST UNITED AC 2018. [DOI: 10.15406/ogij.2018.09.00337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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