Clinical Consensus Statement: Vaginal Energy-Based Devices

Alshiek, Jonia; Garcia, Bobby; Minassian, Vatché A.; Iglesia, Cheryl B.; Clark, Amanda; Sokol, Eric R.; Murphy, Miles; Malik, Shazia; Kimble, Alexis; Shobeiri, S. Abbas

doi:10.1097/spv.0000000000001241

UROGC

2022

DOI: 10.1097/spv.0000000000001241

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Clinical Consensus Statement: Vaginal Energy-Based Devices

Jonia Alshiek¹,

Bobby Garcia

Vatché A. Minassian

et al.

Abstract: This clinical consensus statement on vaginal energy-based devices (EBDs) reflects an update by content experts from the American Urogynecologic Society’s EBD writing group. In 2019, the American Urogynecologic Society’s EBD writing group used a modified Delphi process to assess statements that were evaluated for consensus after a structured literature search. A total of 40 statements were assessed and divided into 5 categories: (1) patient criteria, (2) health care provider criteria, (3) efficacy, (4) safety, … Show more

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Cited by 3 publications

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Lasers in Gynecology

Iglesia,

Choi,

Tadir

2024

Obstetrics &Amp; Gynecology

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The first published reports on the use of laser for cervical pathology date back to 1973. Technical advancements in flexible and rigid laser fibers revolutionized video laser laparoscopy in the 1990s. Fractionated lasers have been used to treat vulvovaginal symptoms associated with genitourinary syndrome of menopause, lichen sclerosus, and urinary incontinence. Review of available data suggests that fractionated lasers can improve both subjective and objective signs of vaginal atrophy and lichen sclerosus, but the evidence is weak because most of the trials are underpowered, are at risk for bias, and lack long-term follow-up. There is no strong evidence to support fractionated laser therapy for urinary incontinence or low-level laser therapy for chronic pelvic pain. Although short-term, single-arm trials suggest benefit of fractionated laser therapy for genitourinary syndrome of menopause, lichen sclerosus, and urinary incontinence, additional adequately powered, prospective, randomized, and longer-term comparative trials are needed before lasers can be recommended for these specific conditions. The purpose of this Clinical Expert Series is to review basic laser biophysics and the mechanism of action for modern fractionated lasers as relevant to the gynecologist. We also summarize safety and effectiveness data for lasers used for some of the most commonly studied gynecologic conditions: the vulvovaginal atrophy component of genitourinary syndrome of menopause, lichen sclerosus, and urinary incontinence.

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Lasers in Gynecology

Iglesia,

Choi,

Tadir

2024

Obstetrics &Amp; Gynecology

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CO₂laser therapy for management of stress urinary incontinence in women: a systematic review and meta-analysis

Hafidh,

Baradwan,

Latifah

et al. 2023

Therapeutic Advances in Urology

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Background: Carbon dioxide (CO2) laser therapy is an emerging treatment for women with stress urinary incontinence (SUI). Objectives: To examine the efficacy of CO2 laser therapy for management of SUI-related symptoms in women. Design: A systematic review and meta-analysis of randomized controlled trials and cohort studies. Data sources and methods: Four databases were screened until January 2023. All efficacy continuous endpoints were assessed via subtraction of the posttreatment from pretreatment values. The data were summarized as mean difference (MD) with 95% confidence interval (CI) using the random-effects model. Results: A total of 15 studies with 700 patients were analyzed. CO2 laser therapy significantly decreased the 1-h pad weights at 3 months [ n = 5 studies, MD = −3.656 g, 95% CI (−5.198, −2.113), p < 0.001], 6 months [ n = 6 studies, MD = −6.583 g, 95% CI (−11.158, −2.008), p = 0.005], and 12 months [ n = 6 studies, MD = −3.726 g, 95% CI (−6.347, −1.106), p = 0.005]. Moreover, CO2 laser therapy significantly decreased the International Consultation of Incontinence Questionnaire-Urinary Incontinence Short Form Scores at 3 months [ n = 10 studies, MD = −4.805, 95% CI (−5.985, −3.626), p < 0.001] and 12-months [ n = 6 studies, MD = −3.726, 95% CI (−6.347, −1.106), p = 0.005]. Additionally, CO2 laser therapy significantly decreased the Pelvic Floor Impact Questionnaire scores at 6 months [ n = 2 studies, MD = −11.268, 95% CI (−18.671, −3.865), p = 0.002] and 12 months [ n = 2 studies, MD = −10.624, 95% CI (−18.145, −3.103), p = 0.006]. Besides, CO2 laser therapy significantly decreased the Urogenital Distress Inventory-6 scores at 3 months [ n = 2 studies, MD = −21.997, 95% CI (−32.294, −11.699), p < 0.001], but not at 6 months [ n = 3 studies, MD = −3.034, 95% CI (−7.357, 1.259), p = 0.169]. Lastly, CO2 laser therapy significantly increased the Vaginal Health Index Score at 6 months [ n = 2 studies, MD = 2.826, 95% CI (0.013, 5.638), p = 0.047] and 12 months [MD = 1.553, 95% CI (0.173, 2.934), p = 0.027]. Conclusion: CO2 laser therapy improved the SUI-related symptoms in women. To obtain solid conclusions, future studies should be well-designed with standardized settings, consistent therapeutic protocols, and long-term follow-up periods.

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Is Erbium/Neodymium Laser Combination Therapy an Effective Treatment Option for Interstitial Cystitis/Bladder Pain Syndrome With Vulvodynia?

Okui¹,

Okui²,

Gambacciani³

2022

Cureus

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Interstitial cystitis/bladder pain syndrome (IC/BPS) is often associated with vulvodynia and poor vaginal health. IC/BPS causes pelvic and bladder pain and urinary symptoms, which considerably reduce the quality of life. To date, this condition has no definitive cure. Local estrogen therapy (LET) has been proposed as a treatment for vulvodynia and poor vaginal health to improve the symptoms of IC/BPS. However, chronic LET could be contraindicated or not desired in some patients. The present study reports the case of a 55-year-old postmenopausal woman with IC/BPS who was successfully treated with combined vaginal erbium (VEL)/neodymium (Nd:YAG) laser (VEL+Nd:YAG) therapy. The patient presented with a five-year history of pelvic pain and urinary frequency. Direct approaches for the bladder (such as hydrodistension, anticholinergic drugs, and transurethral Hunner lesion ablation/cauterization) were conducted with inconsistent results. Immediately prior to the patient's presentation, LET was administered for 12 weeks; however, this therapy resulted in mild improvement and poor patient satisfaction. After presentation, VEL+Nd:YAG therapy was conducted once a month for three months. The patient reported considerable decrease in pain during urination. The improved symptoms were maintained for six months after the last therapy session. These results suggest that VEL+Nd:YAG therapy is an effective method for improving symptoms in patients with IC/BPS.

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Clinical Consensus Statement: Vaginal Energy-Based Devices

Cited by 3 publications

References 77 publications

Lasers in Gynecology

Lasers in Gynecology

CO₂laser therapy for management of stress urinary incontinence in women: a systematic review and meta-analysis

Is Erbium/Neodymium Laser Combination Therapy an Effective Treatment Option for Interstitial Cystitis/Bladder Pain Syndrome With Vulvodynia?

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Clinical Consensus Statement: Vaginal Energy-Based Devices

Cited by 3 publications

References 77 publications

Lasers in Gynecology

Lasers in Gynecology

CO2laser therapy for management of stress urinary incontinence in women: a systematic review and meta-analysis

Is Erbium/Neodymium Laser Combination Therapy an Effective Treatment Option for Interstitial Cystitis/Bladder Pain Syndrome With Vulvodynia?

Contact Info

Product

Resources

About

CO₂laser therapy for management of stress urinary incontinence in women: a systematic review and meta-analysis