Fractional CO2 laser for genitourinary syndrome of menopause in breast cancer survivors: clinical, immunological, and microbiological aspects

Becorpi, Angelamaria; Campisciano, Giuseppina; Zanotta, Nunzia; Tredici, Zelinda; Guaschino, Secondo; Petraglia, Felice; Pieralli, Annalisa; Sisti, Giovanni; Seta, Francesco De; Comar, Manola

doi:10.1007/s10103-018-2471-3

Cited by 59 publications

(86 citation statements)

References 36 publications

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“…Becorpi at al studied the vaginal microbiome in 20 breast cancer survivors treated with two sessions of CO 2 LASER. The study reported an almost unchanged microbiome following treatment.…”

Section: Basic Science Evidencementioning

confidence: 99%

The clinical role of LASER for vulvar and vaginal treatments in gynecology and female urology: An ICS/ISSVD best practice consensus document

Preti¹,

Vieira‐Baptista

Digesu³

et al. 2019

Neurourology and Urodynamics

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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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“…Becorpi at al studied the vaginal microbiome in 20 breast cancer survivors treated with two sessions of CO 2 LASER. The study reported an almost unchanged microbiome following treatment.…”

Section: Basic Science Evidencementioning

confidence: 99%

The clinical role of LASER for vulvar and vaginal treatments in gynecology and female urology: An ICS/ISSVD best practice consensus document

Preti¹,

Vieira‐Baptista

Digesu³

et al. 2019

Neurourology and Urodynamics

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“…All reported an improvement compared to baseline. Sexual function was reported to improve in thirteen studies . Improvement increased in proportion to the number of treatments and results lasted 6 months following the first treatment .…”

Section: Discussionmentioning

confidence: 99%

“…Sixteen studies used the VHIS . All reported a statistically significant improvement, regardless of whether it was one or up to three laser treatments.…”

Section: Discussionmentioning

confidence: 99%

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Review of non‐invasive vulvovaginal rejuvenation

Photiou

Lin

Dubin

et al. 2019

Acad Dermatol Venereol

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Vulvovaginal atrophy (VVA) or genitourinary syndrome of menopause (GSM) may affect up to 90% of menopausal women. Features include vulvovaginal atrophy, vulvovaginal laxity, vulvovaginal dryness and irritation, dyspareunia, anorgasmia and urinary symptoms. The vulva, vagina and bladder are oestrogen‐responsive tissues, but oestrogen replacement therapy is not possible in women who have hormone‐responsive cancers or normal oestrogen levels. Therefore, there is a role for alternative treatments. To date, three non‐surgical energy‐based therapies have been proposed: fractional microablative CO2 laser, erbium:YAG laser and temperature‐controlled radiofrequency (RF). Our objective was to assess the available evidence for the safety and efficacy of erbium:YAG laser, microablative fractional CO2 laser and RF in the treatment of VVA/GSM. The authors reviewed the current published literature evaluating these therapies. All three therapies appear safe; however, all the studies were uncontrolled and used different protocols and outcome measurements. Therefore, comparison of treatments is difficult. It appears that there is more evidence in favour of the CO2 laser than the erbium:YAG laser. Both lasers have more evidence than RF. In conclusion, microablative CO2 laser, erbium:YAG laser and RF may be offered to patients suffering from VVA/GSM as an alternative or adjunct to conventional therapies. Further well‐conducted controlled studies are needed.

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“…Further high-quality studies are currently being undertaken. In some women for whom estrogen is contraindicated, vaginal laser treatment may have a definite role; several small studies have demonstrated efficacy in breast cancer survivors, [10][11][12][13][14][15] but the quality of the evidence remains poor.…”

Section: Genitourinary Syndrome Of the Menopausementioning

confidence: 99%

Energy devices in vaginal therapy

Hillard

2019

The Obstetric & Gynaecologis

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Fractional CO2 laser for genitourinary syndrome of menopause in breast cancer survivors: clinical, immunological, and microbiological aspects

Cited by 59 publications

References 36 publications

The clinical role of LASER for vulvar and vaginal treatments in gynecology and female urology: An ICS/ISSVD best practice consensus document

The clinical role of LASER for vulvar and vaginal treatments in gynecology and female urology: An ICS/ISSVD best practice consensus document

Review of non‐invasive vulvovaginal rejuvenation

Energy devices in vaginal therapy

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