Bhide Alka A, Khullar Vik, Swift Stephen, Digesu Giuseppe A
St Mary's Hospital, Imperial College NHS Trust, London, UK.
Medical University of South Carolina, Charleston, SC, USA.
Int Urogynecol J. 2019 May;30(5):683-692. doi: 10.1007/s00192-018-3844-7. Epub 2018 Dec 18.
The use of lasers in urogynaecology has increased in recent years. Their use has been described in pelvic organ prolapse, urinary incontinence and genito-urinary symptoms of menopause. The aim of this study was to review the published literature on CO and erbium:YAG laser use in urogynaecological conditions.
An extensive search of literature databases (PubMed, EMBASE) was performed for publications (full text and abstracts) written in English up to July 2018. Relevant trials were selected and analysed by an independent reviewer. Twenty-five studies were identified in total.
All studies were either prospective cohort or case-control studies. The results of individual studies indicate that both CO and erbium lasers are effective in treating urogynaecological conditions. Most studies use a vaginal approach with only two investigations of intraurethral application.
The use of lasers to treat these conditions may seem appealing; however, the lack of good-quality evidence in the form of multi-centre randomised placebo-controlled trials is concerning. The safety and effectiveness of these laser devices have not been established. Use of lasers may lead to serious adverse events such as vaginal burns, scarring, dyspareunia and chronic pain. Randomised placebo-controlled trials in addition to formal evaluation of the laser devices are required before this treatment modality can be recommended.
近年来，激光在泌尿妇科领域的应用有所增加。其应用已见于盆腔器官脱垂、尿失禁及绝经后的泌尿生殖系统症状。本研究的目的是回顾已发表的关于在泌尿妇科疾病中使用二氧化碳激光和铒激光的文献。
对文献数据库（PubMed、EMBASE）进行广泛检索，查找截至2018年7月以英文撰写的出版物（全文和摘要）。由一名独立评审员选择并分析相关试验。总共确定了25项研究。
所有研究均为前瞻性队列研究或病例对照研究。个别研究结果表明，二氧化碳激光和铒激光在治疗泌尿妇科疾病方面均有效。大多数研究采用经阴道途径，仅有两项研究涉及尿道内应用。
使用激光治疗这些疾病似乎很有吸引力；然而，缺乏多中心随机安慰剂对照试验形式的高质量证据令人担忧。这些激光设备的安全性和有效性尚未确立。使用激光可能导致严重不良事件，如阴道烧伤、瘢痕形成、性交困难和慢性疼痛。在推荐这种治疗方式之前，除了对激光设备进行正式评估外，还需要进行随机安慰剂对照试验。
