Efficacy of Fractional CO₂ Laser, Promestriene, and Vaginal Lubricant in the Treatment of Urinary Symptoms in Postmenopausal Women: A Randomized Clinical Trial

Abstract

Background and Objectives Evaluating the efficacy of the fractional CO2 laser, promestriene, and vaginal lubricant to treat urinary symptoms in women with genitourinary syndrome of menopause. Study Design/Materials and Methods We conducted a randomized clinical trial with 72 postmenopausal women aged 50 years or older. The participants were randomized to one intervention each in three treatment groups fractional CO2 laser, promestriene, and vaginal lubricant. Urinary symptoms were assessed prior to treatment and 2 weeks after treatment completion using validated questionnaires, the International Consultation on Incontinence Questionnaire (ICIQ‐UI SF), and the International Consultation on Incontinence Questionnaire Overactive Bladder (ICIQ‐OAB). Results There was a significant reduction in the total ICIQ‐UI SF score in the intragroup comparison (baseline vs. week 14) of the CO2 laser group (P = 0.004). This group also showed a statistically significant reduction in nocturia (1.33 ± 0.87 vs. 1.00 ± 0.76, respectively; P = 0.031). In the intergroup comparison after treatment, nocturia in the lubricant group had worsened compared with that of the other two groups (P = 0.002). Regarding the total ICIQ‐OAB score, the results of the CO2 laser group were superior to those of the lubricant group in the intergroup comparison (7.76 ± 3.36, P = 0.020; analysis of variance P = 0.038). Conclusion The results were significantly different between the intravaginal fractional CO2 laser and topical estrogen groups for treating urinary symptoms related to the genitourinary syndrome of menopause. Further controlled and randomized studies are needed. Lasers Surg. Med. © 2020 Wiley Periodicals, Inc.

Fractional Microablative CO2 Laser‐Related Histological Changes on Vulvar Tissue in Patients With Genitourinary Syndrome of Menopause

“…In fact, the use of local estrogens is supported by the evidence of superiority over placebo in several trials, for both clinical and cytological outcomes [46,47]. About improvement in symptoms, few studies compared fractional CO 2 laser to local estrogens [48–51]. These studies showed similar results between the two treatments [48,51], or even better results for the fractional CO 2 laser (alone or in combination with local estrogens) [49,50].…”

“…About improvement in symptoms, few studies compared fractional CO 2 laser to local estrogens [48–51]. These studies showed similar results between the two treatments [48,51], or even better results for the fractional CO 2 laser (alone or in combination with local estrogens) [49,50]. In addition, another study showed that the fractional CO 2 laser was effective in women dissatisfied with previous local estrogens [52].…”

Vaginal laser for overactive bladder syndrome

“…A small but statistically significant improvement in ICIQ-OAB scores was described. No adverse effects were reported during the study period [10]. The results of Aguiar et al show a small but statistically significant difference between the intravaginal fractional CO 2 laser and topical oestrogen groups for treating OAB symptoms related to GSM [10].…”

“…No adverse effects were reported during the study period [10]. The results of Aguiar et al show a small but statistically significant difference between the intravaginal fractional CO 2 laser and topical oestrogen groups for treating OAB symptoms related to GSM [10]. Once more the sample size was too small to draw any long-term conclusions for the efficacy of vaginal laser use for the treatment of OAB symptoms.…”

“…In view of the lack of robust scientific evidence, to date, vaginal laser therapy should be considered an unproven option for OAB symptoms related to GSM [8][9][10][11][12]. In addition, promotion of this approach for the treatment of exclusively OAB syndrome is not advised without further research investigating the efficacy and safety of this potentially long-term treatment modality.…”