Urogynaecology Unit, 1st Department of Obstetrics and Gynecology, "Alexandra" Hospital, National and Kapodistrian University of Athens, Athens, Greece.
Alfa Institute of Biomedical Sciences (AIBS), Athens, Greece.
Menopause. 2019 Mar;26(3):248-255. doi: 10.1097/GME.0000000000001206.
The aim of this study is to assess the efficacy of microablative fractional CO2 laser therapy for genitourinary syndrome of menopause (GSM) management, when three, four, or five laser therapies were applied in a follow-up period of 12 months.
Retrospective study evaluating GSM symptoms at baseline, and 1, 3, 6, and 12 months after last laser therapy. Visual analog scale, International Consultation on Incontinence Questionnaires- Female Urinary Tract Symptoms, International Consultation on Incontinence Questionnaires-Urinary Incontinence Short Form, Urogenital Distress Inventory-6, and Female Sexual Function Index were used for assessment of GSM symptoms' intensity or bothering and parameters of sexual function.
Overall, 94 women were included (35, 35, and 24 received three, four, and five therapies, respectively). All GSM symptoms improved statistically significantly. Intensity of dyspareunia and dryness decreased from 9 (5-10) (median [minimum-maximum]) and 8 (0-10) at baseline to 0 (0-6) and 0 (0-8), 1 month after last laser therapy (all P < 0.001), respectively. FSFI and frequency of sexual intercourse increased from 10.8 (2-26.9) and 1 (0-8) at baseline to 27.8 (15.2-35.4) and 4 (2-8) 1 month after last laser therapy (all P < 0.001), respectively. The positive laser effect remained unchanged throughout the 12 months of follow-up. The same pattern was followed for symptom-free rates. Four or five laser therapies may be superior in lowering the intensity of GSM symptoms in comparison to three laser therapies, in short and long-term follow-up. Differences between four and five laser therapies were not found.
Laser therapy may provide significant improvement and/or absence of GSM symptoms up to 12 months follow-up, irrespectively to the number of laser therapies applied. Symptoms intensity 1 month after last laser therapy may be indicative of GSM symptoms intensity at 12 months. One month after third laser therapy is the critical time to decide whether treatment extension should be offered.
本研究旨在评估微剥脱性分数 CO2 激光治疗女性泌尿生殖系统综合征（GSM）的疗效，比较在 12 个月的随访期内接受三次、四次或五次激光治疗的效果。
回顾性研究评估 GSM 症状在基线时，以及末次激光治疗后 1、3、6 和 12 个月的情况。采用视觉模拟评分法、国际尿失禁咨询问卷-女性下尿路症状、国际尿失禁咨询问卷-尿失禁简短问卷、泌尿生殖窘迫量表-6 和女性性功能指数评估 GSM 症状的强度或困扰以及性功能参数。
共有 94 名女性入组（分别接受三次、四次和五次治疗的患者数为 35、35 和 24）。所有 GSM 症状均有显著统计学改善。性交痛和阴道干燥的强度从基线时的 9（5-10）（中位数[最小-最大]）和 8（0-10）分别下降至末次激光治疗后 1 个月时的 0（0-6）和 0（0-8）（均 P<0.001）。FSFI 和性交频率从基线时的 10.8（2-26.9）和 1（0-8）分别增加至末次激光治疗后 1 个月时的 27.8（15.2-35.4）和 4（2-8）（均 P<0.001）。在 12 个月的随访期间，积极的激光效应保持不变。症状无复发率也呈现相同的模式。与三次激光治疗相比，四次或五次激光治疗可能在降低 GSM 症状的强度方面更具优势，无论是短期还是长期随访。四次和五次激光治疗之间没有发现差异。
激光治疗可在 12 个月的随访期间显著改善和/或消除 GSM 症状，而与应用的激光治疗次数无关。末次激光治疗后 1 个月时的症状强度可能预示着 12 个月时的 GSM 症状强度。第三次激光治疗后 1 个月是决定是否应提供治疗延伸的关键时间点。
