Optical coherence tomography evaluation of vaginal epithelial thickness during CO₂ laser treatment: A pilot study

Abstract

Genitourinary syndrome of menopause (GSM) negatively affects more than half of postmenopausal women. Energy-based therapy has been explored as a minimally invasive treatment for GSM; however, its mechanism of action and efficacy is controversial. Here, we report on a pilot imaging study conducted on a small group of menopause patients undergoing laser treatment. Intravaginal optical coherence tomography (OCT) endoscope was used to quantitatively monitor the changes in the vaginal epithelial thickness (VET) during fractional-pixel CO 2 laser treatment. Eleven patients with natural menopause and one surgically induced menopause patient were recruited in this clinical study. Following the laser treatment, 6 out of 11 natural menopause patient showed increase in both proximal and distal VET, while two natural menopause patient showed increase in VET in only one side of vaginal tract.Furthermore, the patient group that showed increased VET had thinner baseline VET compared to the patients that showed decrease in VET after laser treatment.These results demonstrate the potential utility of intravaginal OCT endoscope in evaluating the vaginal tissue integrity and tailoring vaginal laser treatment on a perperson basis, with the potential to monitor other treatment procedures.

Light and energy‐based therapeutics for genitourinary applications: Consensus on protocols and best practices

“…Data generated in similar treatment protocols may offer meaningful and comparable data. Future application of scientific tools with absolute parameters such as the new approach of noninvasive optical biopsy dedicated to the vaginal wall may reduce the number of subjects tested and increase the scientific merit of the generated data 58 …”

“…Future application of scientific tools with absolute parameters such as the new approach of noninvasive optical biopsy dedicated to the vaginal wall may reduce the number of subjects tested and increase the scientific merit of the generated data. 58 Cost can be compared to other treatment modalities only if safety and efficacy are confirmed, and treatment protocols are optimized. Cost may vary in different parts of the world, based on reimbursement and governing body policies.…”

Depth-Resolved Attenuation Mapping of the Vaginal Wall under Prolapse and after Laser Treatment Using Cross-Polarization Optical Coherence Tomography: A Pilot Study

“…Moreover, given the likelihood of heterogeneous areas of connective tissue remodeling in the early stages after restoration of the anisotropic properties, at later dates, such differences will probably not be so noticeable. Therefore, in the early stages of monitoring the effectiveness of treatment in the future, it will be more appropriate to use an intravaginal OCT probe [36], which could enable examination of several different sections of the vaginal wall tissue and accordingly exclude the need for invasive (punch or excision biopsy) manipulations in such patients. Current efforts are underway for the construction and implementation of a circumferential-scanning intravaginal CP OCT probe for in vivo imaging of the vaginal wall.…”

“…In earlier studies, conventional OCT has been successfully used to quickly identify vaginal epithelial damage [31], for monitoring its treatment with nonoxynol-9 vaginal gel [32] and for analysis of human ovarian tissue [33,34]. The first encouraging results of using OCT in vivo for tracking vaginal tissue changes after treatment with fractional-pixel CO 2 laser therapy for genitourinary syndrome of post-menopausal women have also been obtained [35,36]. The emerging OCT modalities, such as polarization-sensitive (PS) OCT, OCT-angiography and OCT-elastography, as well as endoscopic and handheld scanning probes, significantly extend the prospects and possibilities of the application of OCT techniques to various types of tissues and organs [37][38][39].…”

OCT angiography in the monitoring of vaginal health

“…Our group has previously published work on 3D scanning of in vivo human vaginal canals using a rotated OCT imaging probe to measure the epithelial thickness. 22 Furthermore, we conducted a pilot study demonstrating the feasibility of using OCT to provide an optical biopsy of the vaginal lamina propria and epithelium. 23 However, in addition to vaginal tissue structure change, vaginal vascular change is also an important indication of vagina health.…”