Effects of non-ablative Er:YAG laser on the skin and the vaginal wall: systematic review of the clinical and experimental literature

Hympánová, Lucie; Mackova, Katerina; El‐Domyati, Moetaz; Vodegel, Eva V.; Roovers, Jan‐Paul; Bosteels, Jan; Krofta, Ladislav; Deprest, Jan

doi:10.1007/s00192-020-04452-9

Cited by 9 publications

(14 citation statements)

References 45 publications

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“…The need for this was previously demonstrated by the overzealous introduction of vaginal mesh, which led to their eventual withdrawal from the market 41 . Laser treatment remains controversial as there is no experimental basis to prove its effects 28,42 . Preclinical experimentation can provide information about the mechanisms of actions as well as the potential adverse effects 42,43 .…”

Section: Discussionmentioning

confidence: 99%

“…41 Laser treatment remains controversial as there is no experimental basis to prove its effects. 28,42 Preclinical experimentation can provide information about the mechanisms of actions as well as the potential adverse effects. 42,43 Herein we measured the effects of Er:YAG laser application in menopausal sheep.…”

Section: Discussionmentioning

confidence: 99%

“…28,42 Preclinical experimentation can provide information about the mechanisms of actions as well as the potential adverse effects. 42,43 Herein we measured the effects of Er:YAG laser application in menopausal sheep. Ovariectomised sheep display changes similar to menopausal women, including osteoporosis, 44 hot flushes, 45 atherosclerosis 22 and, for our purposes, also vaginal atrophy.…”

Section: Discussionmentioning

confidence: 99%

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Vaginal Er:YAG laser application in the menopausal ewe model: a randomised estrogen and sham‐controlled trial

Mackova

Mazzer

Cunha

et al. 2020

BJOG

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Objective To describe effects of non‐ablative erbium‐doped:yttrium‐aluminium‐garnet (Er:YAG) laser on vaginal atrophy induced by iatrogenic menopause in the ewe. Design Animal experimental, randomised, sham and estrogen‐treatment controlled study with blinding for primary outcome. Setting KU Leuven, Belgium. Sample Twenty‐four ewes. Methods Menopause was surgically induced, after which the ewes were randomised to three groups receiving vaginal Er:YAG laser application three times, with a 1‐month interval; three sham manipulations with a 1‐month interval; or estrogen replacement and sham manipulations. At given intervals, ewes were clinically examined and vaginal wall biopsies were taken. Vaginal compliance was determined by passive biomechanical testing from explants taken at autopsy. Main outcome measures Vaginal epithelial thickness (primary), composition of the lamina propria (collagen, elastin, glycogen and vessel content), vaginal compliance, clinical signs. Results Animals exposed to Er:YAG laser application and sham manipulation, but not to estrogens, displayed a significant and comparable increase in vaginal epithelial thickness between baseline and 7 days after the third application (69% and 67%, respectively, both P < 0.0008). In laser‐treated ewes, temporary vaginal discharge and limited thermal injury were observed. Estrogen‐substituted ewes displayed a more prominent increase in epithelial thickness (202%; P < 0.0001) and higher vaginal compliance (P < 0.05). None of the interventions induced changes in the lamina propria. Conclusions Vaginal Er:YAG laser has comparable effect to sham manipulation in menopausal ewes. Tweetable abstract Vaginal Er:YAG laser has comparable effect to sham manipulation in menopausal ewes #LASER #GSM #RCT.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Vaginal Er:YAG laser application in the menopausal ewe model: a randomised estrogen and sham‐controlled trial

Mackova

Mazzer

Cunha

et al. 2020

BJOG

Self Cite

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“…Additionally, as the Er:YAG laser wavelength is limited to its very shallow optical penetration depth, it has been hypothesized that instead of having to rely on the pulse sequence heat‐pumping technique, devices with a deeper penetration depth and longer pulse durations may represent a more suitable means for deep thermal remodeling [ 58 ]. However, the published clinical results using the smooth‐resurfacing technique [ 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 ], suggest that the superficial heat shocking resulting from individual short laser pulses within a SMOOTH sequence may represent an additional, indirect mechanism of action for regenerating epithelial and deeper‐lying connective tissues [ 36 , 37 , 38 , 39 , 40 , 41 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 ], which is complementary to the conventional direct slow stimulation of fibroblasts [ 68 ].…”

Section: Discussionmentioning

confidence: 99%

“…To explain the observed clinical results using smooth‐resurfacing, it has been suggested that other indirect mechanisms in addition to the direct heat injury to the deeper‐lying connective tissues may play a role in regeneration and remodeling, including vascular damage, recruitment of inflammatory cells, and release of mediators [ 36 ]. An additional indirect triggering of tissue regeneration through short‐exposure intense heat shocking of epithelia has been proposed [ 37 ], based on stimulating signal transduction processes for transcription factor activation, gene expression, and fibroblast growth, leading to new collagen and extracellular matrix formation [ 38 , 39 , 40 , 41 ].…”

Section: Introductionmentioning

confidence: 99%

Characteristics of Non‐Ablative Resurfacing of Soft Tissues by Repetitive Er:YAG Laser Pulse Irradiation

Lukač

Zorman²,

Lukač

et al. 2021

Lasers Surg Med

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Background and Objectives Recently, several minimally invasive gynecological, ENT and esthetic procedures have been introduced that are based on delivering “smooth” sequences of Er:YAG laser pulses to cutaneous or mucosal tissue at moderate cumulative fluences that are not only below the ablation threshold but typically also do not require local anesthesia. To explain the observed clinical results using “smooth‐resurfacing,” it has been suggested that in addition to the direct heat injury to deeper‐lying connective tissues, there is an additional mechanism based on indirect triggering of tissue regeneration through short‐exposure, intense heat shocking of epithelia. The goal of this study is to improve understanding of the complex dynamics of the exposure of tissues to a series of short Er:YAG laser pulses, during which the thermal exposure times transition from extremely short to long durations. Study Design/Materials and Methods A physical model of laser‐tissue interaction was used to calculate the temperature evolution at the irradiated surface and deeper within the tissue, in combination with a chemical model of tissue response based on the recently introduced variable heat shock (VHS) model, which assumes that the tissue damage represents a combined effect of two limiting Arrhenius′ processes, defining cell viability at extremely long and short exposure times. Superficial tissue temperature evolution was measured during smooth‐resurfacing of cutaneous and mucosal tissue, and compared with the model. Two modalities of non‐ablative resurfacing were explored: a standard “sub‐resurfacing” modality with cumulative fluences near the ablation threshold, and the “smooth‐resurfacing” modality with fluences below the patient′s pain threshold. An exemplary skin tightening clinical situation was explored by measuring pain tolerance threshold fluences for treatments on abdominal skin with and without topical anesthesia. The obtained temperature data and pain thresholds were then used to study the influence of Er:YAG laser sequence parameters on the superficial (triggering) and deep (coagulative) tissue response. Results The simulations show that for the sub‐resurfacing modality, the parameter range where no excessive damage to the tissue will occur is very narrow. On the other hand, using pain tolerance as an indicator, the smooth‐resurfacing treatments can be performed more safely and without sacrificing the treatment efficacy. Two preferred smooth‐resurfacing treatment modalities were identified. One involves using optimally long pulse sequence durations (≈1–3 seconds) with an optimal number of pulses ( N ≈ 10–30), resulting in a maximal short‐exposure superficial tissue response and moderate coagulation depths. And for deeper coagulation, without significant superficial heat shocking, very long pulse sequences (>5 seconds) with a large number of delivered pulses are to be used in combination with topical anesthesia...

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Vaginal erbium laser treatment for stress urinary incontinence: A multicenter randomized sham‐controlled clinical trial

O'Reilly,

Viereck,

Phillips

et al. 2023

Intl J Gynecology & Obste

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ObjectiveTo evaluate the efficacy and safety of non‐ablative vaginal Er:YAG laser device in stress urinary incontinence (SUI) treatment.MethodsWe conducted a multicenter blinded randomized sham‐controlled trial in which women with urodynamic SUI were randomization to active arm using Er:YAG laser therapy, and sham arm using sham handpiece. Patients received two treatments 1 month apart. The primary outcomes measure was 1 h pad weight test measured at 6 months. Secondary outcomes were durability of treatment success at 12 months, and questionnaires for assessment of SUI severity (ICIQ‐UI SF), sexual function (PISQ‐12) and HRQoL (KHQ), and incidence and severity of device related adverse events and pain (VAS).ResultsA total of 110 participants with SUI were recruited; 73 in the active arm and 37 in the sham arm. Two participants were excluded; one was assigned the wrong treatment and one withdrew their consent. Treatment success was observed in 36% of the sham arm and 59% of the active arm; in the latter, odds of achieving treatment success were more than three‐fold higher (OR 3.63, 95% CI: 1.3–11.2, P = 0.02). HRQoL by KHQ showed significant improvement in the active versus the sham arm (OR 0.36, 95% CI: 0.15–0.87, P = 0.003). Similarly, subjective patient assessment of general and sexual function improvement with PISQ‐12 and PGI‐I showed superior effect over sham (OR 2.8, 95% CI: 1.2–7.0, P = 0.02 and OR 0.13, 95% CI: 0.05–0.36, P < 0.001, respectively).ConclusionNon‐ablative vaginal Er:YAG laser therapy significantly improves SUI symptoms versus sham treatment. Er:YAG laser therapy should be considered as a non‐surgical treatment option for SUI patients.

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Effects of non-ablative Er:YAG laser on the skin and the vaginal wall: systematic review of the clinical and experimental literature

Cited by 9 publications

References 45 publications

Vaginal Er:YAG laser application in the menopausal ewe model: a randomised estrogen and sham‐controlled trial

Vaginal Er:YAG laser application in the menopausal ewe model: a randomised estrogen and sham‐controlled trial

Characteristics of Non‐Ablative Resurfacing of Soft Tissues by Repetitive Er:YAG Laser Pulse Irradiation

Vaginal erbium laser treatment for stress urinary incontinence: A multicenter randomized sham‐controlled clinical trial

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