Ruffolo Alessandro F, Casiraghi Arianna, Marotta Elena, Degliuomini Rebecca, Parma Marta, Athanasiou Stavros, Benini Vittoria, Candiani Massimo, Salvatore Stefano
Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, 20132, Italy.
First Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Athens, 20132, Greece.
Lasers Surg Med. 2021 Sep;53(7):953-959. doi: 10.1002/lsm.23378. Epub 2021 Jan 21.
To evaluate the safety and efficacy of transvaginal fractional microablative CO laser therapy (MLT) on urinary symptoms in postmenopausal women with genitourinary syndrome of menopause (GSM) in relation to the timing of their onset; if prior to or after menopause. Secondary, the efficacy of MLT on vulvovaginal atrophy (VVA)-related symptoms.
STUDY DESIGN/MATERIALS AND METHODS: This is a retrospective analysis of prospectively collected data. Postmenopausal women affected by at least one urinary symptom (urinary frequency, urgency incontinence, stress urinary incontinence) and VVA symptom each (dryness, dyspareunia, itching, burning) were enrolled. Our population was divided into two groups in relation to the onset of urinary symptoms, prior to or after menopause. Women were treated with three CO MLT laser sessions, administered at a 4-week interval. For urinary symptoms evaluation, we used the following disease-specific questionnaires previously validated in Italy: the Urogenital Distress Inventory score (UDI-6) and the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF). For each single VVA symptom, we assessed patient's severity perception with a 10-point visual analog scale. Time points of the study were at entry (T0) and at 16 weeks since the first treatment (T1). Collected data were analyzed with the Pearson χ test for categorical variables and the Wilcoxon rank-sum test (for non-normally distributed data), and statistical significance was defined with a P-value <0.05.
Sixty-one women were enrolled in this study. Overall, at T1 MLT brought to a significant improvement in urinary symptoms (P < 0.05) in women with urinary symptoms started after the menopause (Group B), contrary to the ones with urinary symptoms started before the menopause (Group A). Specifically, urinary frequency significantly improved only in Group B (P < 0.05), while urgency incontinence, significantly reduced in both groups (P < 0.05). Stress urinary incontinence did not significantly improve in both groups (P > 0.05). Secondary, all VVA symptoms showed a statistically significant improvement (P < 0.05) at 16 weeks from baseline; no differences were registered between groups. No adverse events were recorded.
This study confirms the safety and efficacy of CO MLT for GSM symptoms. When urinary symptoms are considered, it seems that MLT might have a higher efficacy when symptoms started after menopause, in particular when they are part of the OAB syndrome. Lasers Surg. Med. © 2021 Wiley Periodicals LLC.
评估经阴道分次微消融二氧化碳激光治疗（MLT）对绝经后女性泌尿生殖综合征（GSM）相关泌尿症状的安全性和有效性，并探讨症状出现时间（绝经前或绝经后）的影响；其次，评估MLT对外阴阴道萎缩（VVA）相关症状的疗效。
研究设计/材料与方法：这是一项对前瞻性收集数据的回顾性分析。纳入至少有一项泌尿症状（尿频、尿急失禁、压力性尿失禁）和一项VVA症状（干燥、性交困难、瘙痒、灼痛）的绝经后女性。根据泌尿症状出现时间，将研究人群分为两组，即绝经前或绝经后。对女性进行三次二氧化碳MLT激光治疗，间隔4周进行一次。对于泌尿症状评估，我们使用了先前在意大利验证过的以下特定疾病问卷：泌尿生殖系统困扰量表评分（UDI-6）和国际尿失禁咨询问卷简表（ICIQ-SF）。对于每一项单一的VVA症状，我们使用10分视觉模拟量表评估患者的严重程度感知。研究的时间点为入组时（T0）和首次治疗后16周（T1）。对收集的数据进行分类变量的Pearson χ检验和（对于非正态分布数据）Wilcoxon秩和检验，以P值<0.05定义统计学显著性。
本研究共纳入61名女性。总体而言，在T1时，MLT使绝经后出现泌尿症状的女性（B组）的泌尿症状有显著改善（P<0.05），而绝经前出现泌尿症状的女性（A组）则不然。具体而言，仅B组的尿频有显著改善（P<0.05），而两组的尿急失禁均显著减轻（P<0.05）。两组的压力性尿失禁均无显著改善（P>0.05）。其次，所有VVA症状在基线后16周均有统计学显著改善（P<0.05）；两组之间无差异。未记录到不良事件。
本研究证实了二氧化碳MLT治疗GSM症状的安全性和有效性。当考虑泌尿症状时，似乎MLT在绝经后出现症状时可能具有更高的疗效，特别是当这些症状是膀胱过度活动症综合征的一部分时。激光外科医学。©2021威利期刊有限责任公司。
