Fractional microablative CO2 laser in breast cancer survivors affected by iatrogenic vulvovaginal atrophy after failure of nonestrogenic local treatments: a retrospective study

Pagano, Tiziana; Rosa, Pasquale De; Vallone, Roberta; Schettini, Francesco; Arpino, Grazia; Giuliano, Mario; Lauria, Rossella; Santo, Irene De; Conforti, Alessandro; Gallo, Alessandra; Nazzaro, G.; Placido, Sabino De; Locci, Mariavittoria; Placido, Giuseppe De

doi:10.1097/gme.0000000000001053

Cited by 67 publications

(85 citation statements)

References 31 publications

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“…This limited study drew similar conclusions to those reached for other women and was hindered by similar study design flaws. 70,71,76 Recent developments for the use of LASER in women with GSM/VVA include an international multicenter observational study aiming to evaluate 1500 women treated with vaginal Er:YAG LASER. 77 There is also an ongoing randomized study comparing the effects of CO 2 LASER to vaginal estrogen treatment.…”

Section: Impact On the Vaginal Microbiomementioning

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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Section: Impact On the Vaginal Microbiomementioning

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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“…Ten studies included breast cancer survivors. [43][44][45][46][47][48][49][50][51][52] Below, we discuss the studies in terms of the therapeutic modality used. We present the results in terms of histological changes, physician assessment, subjective patient reports, adverse events, author recommendations and long-term outcomes.…”

Section: Resultsmentioning

confidence: 99%

“…47 Seven studies included women with a history of breast cancer. 44,45,[47][48][49][50]52 Histological changes Samuels & Garcia 59 performed biopsies in 'several' postmenopausal women immediately before the first treatment and then at 3-and 6-month follow-up visits after the total of three treatments. Histological review at 3-month followup showed increased collagen and elastin, a thicker epithelium, an increased number of cell layers and a better degree of surface maturation in all patients.…”

Section: Co 2 Lasersmentioning

confidence: 99%

“…Subjective patient reports Sixteen studies used a VAS to report on VVA/GSM signs/symptoms. 39,44,[47][48][49]52,59,[63][64][65][67][68][69][71][72][73] Most used a scale from 0 to 10, but one used a scale from 1 to 5. 49 All reported an improvement compared to baseline.…”

Section: Physician Assessmentsmentioning

confidence: 99%

“…Five were related to probe insertion or movement. 44,49,52,63,72 Other adverse effects included vaginal discharge, 68,74,75 urinary tract infection, 66,75 dysuria, 59,71 yeast infection, 59 pelvic pain, 64 recurrence of genital herpes, 75 burning sensation, 59,66,70 itching 59,66 bruising, 66 swelling, 59,66 numbness, 66 purpura, 66 mild irritation 65,67,70 Recommendations/long-term follow-up data Athanasiou et al 67 suggest that up to 4 or 5 sessions of CO 2 laser therapy may contribute to complete regression of dyspareunia and dryness and help re-establish normal sexual function. Sokol et al 77 found statistically significant improvement in all study parameters up to 1 year, excluding dysuria.…”

Section: Physician Assessmentsmentioning

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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Genitourinary Syndrome of Menopause

Rubin

Simon

2020

Female Sexual Pain Disorders

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Fractional microablative CO2 laser in breast cancer survivors affected by iatrogenic vulvovaginal atrophy after failure of nonestrogenic local treatments: a retrospective study

Cited by 67 publications

References 31 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

Genitourinary Syndrome of Menopause

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