- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04868812
Histological Modifications of Postmenopausal Vaginal Mucosa After Repeated Carbon Dioxide (CO2) Laser Treatment (REPLAMOD)
Histological Modifications of Postmenopausal Vaginal Mucosa After Repeated CO2 Laser
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
The investigator propose a prospective case series of 15 postmenopausal women with bothersome symptoms of GSM treated with MonaLisa Touch CO2 laser. The investigator hypothesize that even in the long term MonaLisa Touch will significantly improve GSM histologically and clinically from baseline.
The primary outcome objective of the study is to evaluate the histological modifications of the vaginal mucosa after repeated CO2 Monalisa Touch laser treatment. The investigator shall evaluate the role of this treatment by calculating the difference in vaginal epithelial thickness between the biopsy obtained before the start of laser treatment and the biopsy obtained after treatment. In addition, the study will analyze the safety of repeated laser treatments verifying the absence of fibrosis formation in the vaginal mucosa. Secondary objectives of the study will include an evaluation of the clinical effects associated with repeated Monalisa Touch CO2 laser treatments using validated questionnaires.
All participants will be screened to ensure inclusion/exclusion criteria are met. A biopsy will be taken from each patient one month before the first laser treatment and one month after the last laser treatment. The MonaLisa treatment will be performed monthly for 3 months. MonaLisa treatment with fractional microablative laser system. For subjects with concomitant vulvar symptoms, vulvar treatment will be done. Biopsy samples will be analyzed with Hematoxylin- Eosin and Trichrome staining, Periodic acid-Schiff (PAS) reaction for glycogen and immunohistochemistry for CD34, a vessel marker. All clinical questionnaires will be assessed at baseline and at one month after the last session.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
-
-
-
Milan, Italy, 20132
- IRCCS San Raffaele Hospital
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Italian speaking and able to give informed consent.
- Menopausal females with absence of menstruation for at least 12 months.
- Presence of GSM symptoms.
- Completion of at least two cycles of three laser treatments sessions in previous years.
- Prolapse stage < II, according to the pelvic organ prolapse quantification (POP-Q) system.
- No pelvic surgery within 6 months prior to treatment.
- Understanding and acceptance to the obligation to return to all scheduled visits and follow-ups.
Exclusion Criteria:
- Inability of give informed consent
- History of vulvovaginal condyloma, vaginal intraepithelial neoplasia (VAIN), vaginal carcinoma, lichen sclerosis, lichen planus.
- History of cancers of the lower genital tract (cervix, uterus, vagina).
- History of pelvic radiotherapy.
- Personal history of genital fistula, a thin recto-vaginal septum as determined by the investigator or personal history of a fourth degree laceration during screening physical exam.
- Any other medical condition that the investigators feel would compromise the study.
- Acute or recurrent urinary tract infection (UTI), or genital infection (e.g. bacterial vaginosis, herpes genitalis, candida).
- Stage III or IV pelvic organ prolapse.
- History of any female sexual disorder.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: N/A
- Interventional Model: Single Group Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Patient
All participants will be screened to ensure inclusion/exclusion criteria are met.
A biopsy will be taken from each patient one month before the first laser treatment and one month after the last laser treatment.
The MonaLisa treatment will be performed monthly for 3 months.
A clinical evaluation will be recorded for each patient using validated questionnaires at baseline and one month after the last procedure.
|
SmartXide 2 V 2 LR, MonaLisa Touch, DEKA, Florence, Italy; MonaLisa Touch CO2 fractionated laser
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Microscopic evaluation for vaginal epithelial thickness
Time Frame: 4-5 weeks after the last treatment
|
The vaginal epithelial thickness will be measured in micrometers.
Then the difference in vaginal epithelial thickness between the biopsy obtained before and after the start of laser treatment will be calculated, considering a 20% increase as significant.
|
4-5 weeks after the last treatment
|
Microscopic evaluation of number of papillae
Time Frame: 4-5 weeks after the last treatment
|
The number of papillae in bioptic samples will be analyzed with Hematoxylin- Eosin and Trichrome staining.
|
4-5 weeks after the last treatment
|
Microscopic evaluation of glycogen amount
Time Frame: 4-5 weeks after the last treatment
|
The amount of glycogen present at the epithelial level and the ratio between the number of type I collagen fibers and type III will be evaluated with PAS reaction for glycogen.
|
4-5 weeks after the last treatment
|
Microscopic evaluation of number and size of the vessels
Time Frame: 4-5 weeks after the last treatment
|
The number and size of the vessels present in the subepithelial layer will be evaluated using immunohistochemistry for CD34, a vessel marker.
|
4-5 weeks after the last treatment
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Validated questionnaires VHI
Time Frame: 4-5 weeks after the last treatment
|
Vaginal Health Index (VHI) for evaluation of vaginal atrophy severity that is composed by the sum of 6 fields (min score 1 max score 5).
The least score (6) is the worst; the maximum score (30) is the best.
|
4-5 weeks after the last treatment
|
Validated questionnaires FSFI
Time Frame: 4-5 weeks after the last treatment
|
Female Sexual Function Index (FSFI) questionnaire which will assess female sexual function that is composed of 19 fields.
The minimum score is 2 in the worst situation; maximum score is 36 in the best situation
|
4-5 weeks after the last treatment
|
Validated questionnaires UDI-6
Time Frame: 4-5 weeks after the last treatment
|
Urinary Distress Inventory-6 (UDI-6) is a 6 fields questionnaires on voiding function.
The minimum score is 0 in absence of symptoms; 18 is the maximum score in the worst situation.
|
4-5 weeks after the last treatment
|
Validated questionnaires ICIQ-UI
Time Frame: 4-5 weeks after the last treatment
|
International Consultation on Incontinence Questionnaire - Urinary Incontinence (ICIQ-UI) which will evaluate the extent of urinary symptoms.
It is divided into two parts: questions 1, 2 and 3 are added together and the maximum score is 22, in worst condition; a score of zero is obtained in asymptomatic patients.
The last is a describing question.
|
4-5 weeks after the last treatment
|
Validated questionnaires LIKERT
Time Frame: 4-5 weeks after the last treatment
|
5-point Likert scale is made to assess the impact of GSM symptoms on quality of life (QoL).
It is a descriptive question.
|
4-5 weeks after the last treatment
|
Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Stefano Salvatore, MD, IRCCS San Raffaele Hospital
Publications and helpful links
General Publications
- Management of symptomatic vulvovaginal atrophy: 2013 position statement of The North American Menopause Society. Menopause. 2013 Sep;20(9):888-902; quiz 903-4. doi: 10.1097/GME.0b013e3182a122c2.
- Zerbinati N, Serati M, Origoni M, Candiani M, Iannitti T, Salvatore S, Marotta F, Calligaro A. Microscopic and ultrastructural modifications of postmenopausal atrophic vaginal mucosa after fractional carbon dioxide laser treatment. Lasers Med Sci. 2015 Jan;30(1):429-36. doi: 10.1007/s10103-014-1677-2. Epub 2014 Nov 20.
- Salvatore S, Nappi RE, Zerbinati N, Calligaro A, Ferrero S, Origoni M, Candiani M, Leone Roberti Maggiore U. A 12-week treatment with fractional CO2 laser for vulvovaginal atrophy: a pilot study. Climacteric. 2014 Aug;17(4):363-9. doi: 10.3109/13697137.2014.899347. Epub 2014 Jun 5.
- Cagnacci A, Xholli A, Sclauzero M, Venier M, Palma F, Gambacciani M; writing group of the ANGEL study. Vaginal atrophy across the menopausal age: results from the ANGEL study. Climacteric. 2019 Feb;22(1):85-89. doi: 10.1080/13697137.2018.1529748. Epub 2019 Jan 2.
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- REPLAMOD
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
product manufactured in and exported from the U.S.
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
Clinical Trials on Vaginal Atrophy
-
Petra LarmoTurun Gynekologikeskus Oy; Tekes - The Finnish Funding Agency for Technology...CompletedVaginal Atrophy | Vaginal Dryness | Vulvar Atrophy | Vulvar DrynessFinland
-
Rajavithi HospitalTerminatedVaginal Atrophy | Oxytocin Gel | Postmenopausal Women | Vaginal Maturation IndexThailand
-
BionovoUnknownVaginal Atrophy | Vulvar AtrophyUnited States
-
Sun Pharmaceutical Industries LimitedTerminated
-
Bitop AGCompleted
-
University of Texas Southwestern Medical CenterAmerican Society for Aesthetic Plastic SurgeryCompleted
-
Dr. August Wolff GmbH & Co. KG ArzneimittelproDERM GmbHCompleted
-
National and Kapodistrian University of AthensIRCCS San RaffaeleUnknown
-
Syneron MedicalUnknownVaginal AtrophyUnited States
-
Herbarium Laboratorio Botanico LtdaNot yet recruiting
Clinical Trials on SmartXide 2 V 2 LR, MonaLisa Touch, DEKA, Florence, Italy
-
University of AarhusNot yet recruitingGenitourinary Syndrome of MenopauseDenmark
-
National and Kapodistrian University of AthensIRCCS San RaffaeleUnknown
-
University Hospital Inselspital, BerneDeka Medical, Inc.Active, not recruitingLichen Sclerosus Et Atrophicus of the VulvaSwitzerland
-
National and Kapodistrian University of AthensCompletedOveractive Bladder (OAB)Greece
-
National and Kapodistrian University of AthensUnknownVaginal Dryness | Dyspareunia | Gynecological Cancer | Pelvic RadiotherapyGreece
-
National and Kapodistrian University of AthensUnknownBreast Cancer | Vaginal Atrophy | Dyspareunia | Genitourinary Syndrome of MenopauseGreece
-
Federal University of São PauloFundação de Amparo à Pesquisa do Estado de São PauloEnrolling by invitationGenitourinary Symptoms | Postmenopausal Symptoms | Postmenopausal Atrophic VaginitisBrazil
-
Federal University of São PauloFundação de Amparo à Pesquisa do Estado de São PauloRecruitingBreast Cancer | Vaginal Atrophy | Vulva; AtrophyBrazil