Study of Proliferative Activity of Vaginal Epithelium in Women with Stress Urinary Incontinence Treated by Er:YAG Laser

Abstract

The expression of Ki-67 proliferation marker was studied in vaginal biopsy specimens from women with stress urinary incontinence treated using a Fotona nonablative erbium laser. Cells expressing Ki-67 were located in all cases in the parabasal and basal levels of stratified squamous epithelium, the index of labeled nuclei before Er:YAG laser exposure was 19.05±2.86%. After 1-2 months of laser therapy, the index of labeled nuclei in the epithelium increased significantly and reached 31.79±2.25%. These changes were interpreted as a result of epithelial-stromal interactions. Presumably, the increase in proliferative activity of the vaginal epithelium after exposure to Er:YAG laser was due to the presence of an appreciable level of synthetically active fibroblasts in the subepithelial stroma.

Female urinary incontinence: is laser treatment effective? a systematic review

“…Seventeen studies counting more than 892 female patients with UI were included in the review. 4,8,10,[14][15][16][17][18][19][20][21][22][23][24][25][26][27] The search of MEDLINE and SCOPUS provided a total of 878 records. After removing duplicates, 526 studies were excluded because they did not meet the criteria.…”

“…Additionally, studies comprising histopathological investigation found increased proliferative activity, remodelling of the stromal components of vaginal mucosa, higher synthesis of collagen and neoangiogenesis. 25,26 The majority of the patients tolerated treatments well; few of them reported minor symptoms during laser sessions, which ranged from mild discomfort to warmth sensation. Only one patient quitted treatment due to intolerance.…”

“…Four studies demonstrated changes in vaginal epithelium after laser treatment. 8,[25][26][27] There was significant increase in the thickness and staining of type III collagen of the epithelium, with higher population of intermediate and shedding superficial cells. 8,27 Lappi et al quantified these changes, revealing significant increase in epithelium thickness (114.19±17.31µm to 187.83±15.35µm); volume density (1.8±0.2% to 2.9±0.3%) and number of capillary profiles per test area (8.5±0.63 to 12.1±1.07) as well as increase proliferative activity based on Ki67 expression (19.05±2.86% to 31.79±2.25%).…”

“…8,27 Lappi et al quantified these changes, revealing significant increase in epithelium thickness (114.19±17.31µm to 187.83±15.35µm); volume density (1.8±0.2% to 2.9±0.3%) and number of capillary profiles per test area (8.5±0.63 to 12.1±1.07) as well as increase proliferative activity based on Ki67 expression (19.05±2.86% to 31.79±2.25%). 25,26…”

Lasers and energy‐based devices marketed for vaginal rejuvenation: A cross‐sectional analysis of the MAUDE database

“…In human soft tissue, the 2940 nm erbium yttrium‐aluminum‐garnet medium (Er:YAG) laser in the non‐ablative thermal mode has been shown to stimulate deep collagen remodeling and improve tightness and elasticity of the treated area . This non‐ablative treatment modality has been evaluated in several studies . A study evaluating Er:YAG laser treatment compared with topical estrogen therapy for GSM‐related symptoms demonstrated greater improvement in symptoms (irritation, dyspareunia, dryness, chronic leukorrhea) of the laser‐treated group up to 18 months of follow‐up after treatment.…”