Intraurethral Erbium:YAG laser for the management of urinary symptoms of genitourinary syndrome of menopause: A pilot study

Abstract

ObjectivesGenitourinary syndrome of menopause (GSM) combines the conditions of vulvovaginal atrophy (VVA) and urinary tract dysfunction, which is a result of urethral atrophy. There are several treatment methods available for the management of vulvovaginal symptoms of GSM, whereas urinary tract dysfunction often remains overlooked and undertreated. The objective of this pilot study was to assess the safety and efficacy of intraurethral Er:YAG laser treatment of urinary symptoms of GSM.Patients and MethodsPatients with diagnosed GSM, having less than 5% of vaginal superficial cells in the cytology, vaginal pH higher than 5, with urinary symptoms of GSM (dysuria, frequency, urgency) and impaired continence due to urethral atrophy, received two sessions of intraurethral Er:YAG laser with a 3‐week interval in‐between the sessions. Laser energy was delivered in non‐ablative way using Erbium SMOOTH™ mode technology and a 4‐mm thick cannula. Therapeutic efficacy was determined using ICIQ‐SF, the 1‐hour pad test and VAS scores. Occurrence of adverse effects was followed at every visit. Follow ups (FU) were at 3 and 6 months.Results29 female patients fulfilling the inclusion criteria were included in this pilot study and received two sessions of the intraurethral non‐ablative Erbium SMOOTH™ laser therapy. Significant improvement was observed in all measured parameters at both FU. ICIQ‐SF improved by an average of 64% at 3 months FU and by 40% at 6 months. The 1‐hour pad test showed a reduction of the quantity of leaked urine by 59% at 3 months FU and by 42% at 6 months FU. All urinary symptoms of GSM improved. Dysuria dropped to 13% and 31% of baseline values at three and 6 months respectively, urinary urgency dropped to 23% and 47% and frequency dropped to 22% and 43% after 3 and 6 months, respectively. Adverse effects were mild and transient.ConclusionsOur findings suggest that intraurethral Er:YAG laser is an efficacious and safe modality for treatment of urinary symptoms of GSM, however, prospective, randomized, and controlled trials with larger number of patients are needed to better assess the long‐term effect of this novel procedure. Lasers Surg. Med. 50:802–807, 2018. © 2018 The Authors. Lasers in Surgery and Medicine Published by Wiley Periodicals, Inc.

Laser therapy for urinary incontinence and pelvic organ prolapse: a systematic review

“…23 Seven studies had improvement in GSM as a primary outcome, but also included women with SUI. 25,28,40,44,[50][51][52] These studies also reported a significant reduction in the ICIQ-UI SF scores that was sustained at the 1-year follow up (P < 0.01). 25,50,51 In the longer term, the effect was no longer present at the 2-year follow up, 52 but Gonz alez Isaza reported a positive effect up to 3 years after treatment (P < 0.001).…”

“…25,28,40,44,[50][51][52] These studies also reported a significant reduction in the ICIQ-UI SF scores that was sustained at the 1-year follow up (P < 0.01). 25,50,51 In the longer term, the effect was no longer present at the 2-year follow up, 52 but Gonz alez Isaza reported a positive effect up to 3 years after treatment (P < 0.001). 28 There were three other GSM studies in which women with unspecified incontinence were included showing significant improvement on the ICIQ-UI SF scores at 4 weeks of follow up (P < 0.001) 42 and 12 months of follow up (P < 0.001), 53 as well as a satisfaction rate of 75%.…”

“…23 The lasers were used mainly vaginally (29 studies) and on the vulva (n = 21) and/or urethra (n = 2). 24,25 Settings of the lasers varied; however, some authors did not mention the laser settings. [26][27][28][29][30][31][32][33] Table S3 and S4 (see Supplementary material) displays the laser setting details.…”

“…Nineteen declared that they received no funding neither they did have a conflict of interest. 25,32,[39][40][41][42][43][44] Eight declared financial support from the laser company (laser company provided the equipment, funded the study or authors of the study were employees of the company at the same time as the study). Four articles did not mention whether they received funding, nor whether there was a conflict of interest even though it was required by the journal.…”

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.…”