Vaginal erbium laser: the second-generation thermotherapy for the genitourinary syndrome of menopause

M Gambacciani, M Levancini, M Cervigni, M Gambacciani, M Levancini, M Cervigni

Abstract

Aim To evaluate the effects of the vaginal erbium laser (VEL) in the treatment of postmenopausal women suffering from genitourinary syndrome of menopause (GSM). Method GSM was assessed in postmenopausal women before and after VEL (one treatment every 30 days, for 3 months; n = 45); the results were compared with the effects of a standard treatment for GSM (1 g of vaginal gel containing 50 μg of estriol, twice weekly for 3 months; n = 25). GSM was evaluated with subjective (visual analog scale, VAS) and objective (Vaginal Health Index Score, VHIS) measures. In addition, in 19 of these postmenopausal women suffering from stress urinary incontinence (SUI), the degree of incontinence was evaluated with the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) before and after VEL treatments. Results VEL treatment induced a significant decrease of VAS of both vaginal dryness and dyspareunia (p < 0.01), with a significant (p < 0.01) increase of VHIS. In postmenopausal women suffering from mild to moderate SUI, VEL treatment was associated with a significant (p < 0.01) improvement of ICIQ-SF scores. The effects were rapid and long lasting, up to the 24th week of the observation period. VEL was well tolerated with less than 3% of patients discontinuing treatment due to adverse events. Conclusion This pilot study demonstrates that VEL induces a significant improvement of GSM, including vaginal dryness, dyspareunia and mild to moderate SUI. Further studies are needed to explore the role of laser treatments in the management of GSM.

Keywords: DYSPAREUNIA; ERBIUM LASER; GENITOURINARY SYNDROME OF MENOPAUSE; MENOPAUSE; STRESS URINARY INCONTINENCE; VAGINAL ATROPHY.

Figures

Figure 1. Effect of second-generation laser thermotherapy…
Figure 1. Effect of second-generation laser thermotherapy on vaginal dryness (upper panel) and dyspareunia (lower panel) using the visual analog score (VAS) on a 10-point scale for the women receiving laser treatment (n = 43) and the women receiving estriol (n = 19). See text for details. *, p < 0.01 vs. corresponding basal values in both groups; **, p < 0.05 vs. estriol basal values and corresponding laser group values
Figure 2. Effect of second-generation laser thermotherapy…
Figure 2. Effect of second-generation laser thermotherapy on the Vaginal Health Score Index (VHIS) for the women receiving laser treatment (n = 43) and the women receiving estriol (n = 19). See text for details. *, p < 0.01 vs. corresponding basal values in both groups; **, p < 0.05 vs. estriol basal values and corresponding laser group values
Figure 3. Effect of second-generation laser thermotherapy…
Figure 3. Effect of second-generation laser thermotherapy on International Consultation on Incontinence Questionnaire (ICIQ-SF) score in 19 postmenopausal women suffering from stress urinary incontinence. *, p < 0.01 vs. corresponding basal values. See text for details

References

    1. Portman DJ, Gass MLS. on behalf of the Vulvovaginal Atrophy Conference Panel Genitourinary syndrome of menopause: new terminology for vulvovaginal atrophy from the International Society for the Study of Women's Sexual Health and The North American Menopause Society. Climacteric. 2014;17:557–63.
    1. Sturdee DW, Panay N. Recommendations for the management of postmenopausal vaginal atrophy. Climacteric. 2010;13:509–22.
    1. Management of symptomatic vulvovaginal atrophy: 2013 position statement of The North American Menopause Society Menopause. 2013;20:888–902.
    1. Robinson D, Toozs-Hobson P, Cardozo L. The effect of hormones on the lower urinary tract. Menopause Int. 2013;19:155–62.
    1. Robinson D, Cardozo L. The pathophysiology and management of postmenopausal urogenital oestrogen deficiency. J Br Menopause Soc. 2001;7:67–73.
    1. Ettinger B, Hait H, Reape KZ, Shu H. Measuring symptom relief in studies of vaginal and vulvar atrophy: the most bothersome symptom approach. Menopause. 2008;15:885–9.
    1. Parish SJ, Nappi RE, Krychman ML, et al. Impact of vulvovaginal health on postmenopausal women: a review of surveys on symptoms of vulvovaginal atrophy. Int J Womens Health. 2013;5:437–47.
    1. Oge T, Hassa H, Aydin Y, Yalcin OT, Colak E. The relationship between urogenital symptoms and climacteric complaints. Climacteric. 2013;16:646–52.
    1. Suckling JA, Kennedy R, Lethaby A, Roberts H. Local estrogen for vaginal atrophy in postmenopausal women. Cochrane Database Syst Rev. 2006;((4)):1–104.
    1. Santoro N, Komi J. Prevalence and impact of vaginal symptoms among postmenopausal women. J Sex Med. 2009;6:2133–42.
    1. MacBride MB, Rhodes DJ, Shuster LT. Vulvovaginal atrophy. Mayo Clin Proc. 2010;85:87–94.
    1. Santen RJ, Allred DC, Ardoin SP, et al. Executive summary: Postmenopausal hormone therapy: an Endocrine Society scientific statement. J Clin Endocrinol Metab. 2010;95((Suppl 1)):s1–66.
    1. The 2012 hormone therapy position statement of the North American Menopause Society Menopause. 2012;19:257–71.
    1. de Villiers TJ, Gass MLS, Haines CJ, et al. Global Consensus Statement on Menopausal Hormone Therapy. Climacteric. 2013;16:203–4.
    1. de Villiers TJ, Pines A, Panay N, et al. on behalf of the International Menopause Society Updated 2013 International Menopause Society recommendations on menopausal hormone therapy and preventive strategies for midlife health. Climacteric. 2013;16:316–37.
    1. Giarenis I, Cardozo L. Managing urinary incontinence: what works? Climacteric. 2014;17((Suppl 2)):26–33.
    1. Cody JD, Jacobs ML, Richardson K, Moehrer B, Hextall A. Oestrogen therapy for urinary incontinence in post-menopausal women. Cochrane Database Syst Rev. 2012;10:D001405.
    1. Nelken RS, Ozel BZ, Leegant AR, Felix JC, Mishell DR. Randomized trial of estradiol vaginal ring versus oral oxybutynin for the treatment of overactive bladder. Menopause. 2011;18:962–6.
    1. Tseng LH, Wang AC, Chang YL, Soong YK, Lloyd LK, Ko YJ. Randomized comparison of tolterodine with vaginal estrogen cream versus tolterodine alone for the treatment of postmenopausal women with overactive bladder syndrome. Neurourol Urodyn. 2009;28:47–51.
    1. Salvatore S, Nappi RE, Zerbinati N, et al. A 12-week treatment with fractional CO2 laser for vulvovaginal atrophy: a pilot study. Climacteric. 2014;17:363–9.
    1. Kaufmann R, Hibst R. Pulsed Erbium: YAG laser ablation in cutaneous surgery. Lasers Surg Med. 1996;19:324–30.
    1. Reynolds N, Cawrse N, Burge T, Kenealy J. Debridement of a mixed partial and full thickness burn with an erbium: YAG laser. Burns. 2003;29:183–8.
    1. Baraldi CE, Puricelli E, Kulkes S, Martins GL. Er: YAG laser in oral soft tissue surgery. J Oral Laser Applications. 2001;1:24.
    1. Levy JL, Trelles MA. New operative technique for treatment of xanthelasma palpebrarum: laser inverted resurfacing: preliminary report. Ann Plast Surg. 2003;50:339–43.
    1. Vizintin Z, Rivera M, Fistonic I, et al. Novel minimally invasive VSP Er: YAG laser treatments in gynecology. J Laser Health Acad. 2012;1:46–58.
    1. Gaspar A. Comparison of new minimally invasive Er: YAG laser treatment and hormonal replacement therapy in the treatment of vaginal atrophy. Climacteric. 2014;17((Suppl 1)):124.
    1. Cano A, Estevez J, Usandizaga R, et al. The therapeutic effect of a new ultra low concentration estriol gel formulation (0.005% estriol vaginal gel) on symptoms and signs of postmenopausal vaginal atrophy: results from a pivotal phase III study. Menopause. 2012;19:1130–9.
    1. Bachmann GA, Notelovitz M, Kelly SJ, et al. Long-term non-hormonal treatment of vaginal dryness. Clin Pract Sexuality. 1992;8:3–8.
    1. Qaseem A, Dallas P, Forciea MA, et al. Nonsurgical management of urinary incontinence in women: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2014;161:429–40.
    1. Fistonic I. Laser treatment of early stages of stress urinary incontinence significantly improves sexual life. Presented at Annual Conference of European Society for Sexual Medicine; December 2012; Amsterdam.
    1. Fistonic I. Erbium laser treatment for early stages of stress urinary incontinence (SUI) in women. Presented at Annual Meeting of International Urogynecological Association; May 2013; Dublin.
    1. Fistonic I. Erbium laser treatment for early stages of stress urinary incontinence (SUI) and vaginal relaxation significantly improves pelvic floor function. Presented at 15th Congress of Human Reproduction; March 2013; Venice.

Source: PubMed

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