Walter Jens-Erik, Larochelle Annick
Montréal, QC.
J Obstet Gynaecol Can. 2018 Apr;40(4):503-511. doi: 10.1016/j.jogc.2017.11.040.
This technical bulletin reviews the evidence relating to risks and benefits of using intravaginal laser technology in the management of genitourinary syndrome of menopause and stress urinary incontinence.
Gynaecologists, urogynaecologists, urologists, and other health care professionals who assess, counsel, and provide care for women with genitourinary syndrome of menopause and stress urinary incontinence.
Adult women with genitourinary syndrome of menopause and stress urinary incontinence seeking complementary or alternative treatment options to topical estrogen, non-hormonal vaginal moisturizers, physiotherapy, intravaginal devices, and surgery.
The discussion relates to intravaginal laser treatments for genitourinary syndrome of menopause compared with topical estrogen and that for stress urinary incontinence.
The outcomes of interest are objective and subjective rates of response to treatment, histologic outcomes, and procedural complications.
PubMed, Medline, the Cochrane Database, and EMBASE were searched using the key words "genitourinary syndrome of menopause," "vaginal laser," "topical estrogen," and "urogenital atrophy." Results were restricted to English and human research. Articles were included until the end of September 2016. Clinical practice guidelines and guidelines of specialty societies were reviewed. Included studies were observational or prospective cohort when available. Only publications with study groups larger than or equal to 20 individuals were included, and non-peer-reviewed papers were excluded.
The content and recommendations were drafted and agreed upon by the principal authors. The Board of the SOGC approved the final draft for publication. The quality of evidence was rated using the criteria described in the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology framework.
BENEFITS, HARMS, AND/OR COSTS: It is expected that this technical bulletin will benefit patients with genitourinary syndrome of menopause by ensuring treating physicians are aware of all treatment options including the potential benefit and associated risk with intravaginal laser therapy. This should guide patient informed consent before such procedures are undertaken. There are no direct harms or costs identified with the implementation of this guideline.
The SOGC.
RECOMMENDATIONS.
本技术公报回顾了有关在绝经后泌尿生殖综合征和压力性尿失禁管理中使用阴道激光技术的风险和益处的证据。
评估、咨询并为患有绝经后泌尿生殖综合征和压力性尿失禁的女性提供护理的妇科医生、泌尿妇科医生、泌尿科医生及其他医疗保健专业人员。
寻求替代局部雌激素、非激素阴道保湿剂、物理治疗、阴道装置及手术等补充或替代治疗方案的绝经后泌尿生殖综合征和压力性尿失禁成年女性。
讨论涉及与局部雌激素相比，阴道激光治疗绝经后泌尿生殖综合征以及治疗压力性尿失禁的情况。
关注的结果是治疗的客观和主观反应率、组织学结果及手术并发症。
使用关键词“绝经后泌尿生殖综合征”“阴道激光”“局部雌激素”和“泌尿生殖萎缩”检索了PubMed、Medline、Cochrane数据库和EMBASE。结果仅限于英文和人体研究。纳入截至2016年9月底的文章。审查了临床实践指南和专业学会指南。现有研究为观察性或前瞻性队列研究。仅纳入研究组人数大于或等于20人的出版物，排除未经同行评审的论文。
主要作者起草并商定了内容和建议。SOGC董事会批准了最终出版草案。使用推荐分级评估、制定和评价（GRADE）方法框架中描述的标准对证据质量进行评级。
益处、危害和/或成本：预计本技术公报将使绝经后泌尿生殖综合征患者受益，确保治疗医生了解所有治疗方案，包括阴道激光治疗的潜在益处和相关风险。这应指导在进行此类手术前获得患者知情同意。实施本指南未发现直接危害或成本。
SOGC。
建议。
