Klap J, Campagne-Loiseau S, Berrogain N, Bosset P O, Cardot V, Charles T, Deffieux X, Donon L, Girard F, Peyrat L, Roulette P, Thuillier C, Tibi B, Vidart A, Wagner L, Hermieu J-F, Cornu J-N
Service d'urologie, hôpital privé Claude-Galien, 91480 Quincy-sous-Senart, France.
Service de gynécologie-obstétrique, CHU d'Estaing, Clermont-Ferrand, France.
Prog Urol. 2021 Sep;31(11):634-650. doi: 10.1016/j.purol.2020.11.003. Epub 2021 Jan 28.
Vaginal LASER therapy is increasingly used in the field of urogynecology, but several points remain unclear. Our goal was to produce a systematic review of available evidence and provide a critical appraisal of available data.
A systematic review until march 2020 was conducted using PubMed/MEDLINE, Cochrane and Embase databases. All studies about vaginal LASER use in the field of urogynecology were included.
Forty studies have been included (8 for genitourinary syndrome of menopause, 19 for stress urinary incontinence, 3 for overactive bladder, 7 for urogenital prolapse, 3 for other indications). Data were heterogeneous, and level of evidence was weak or very weak. Few studies were comparative, and only 3 were randomized). Mild improvement of symptoms and quality of life and limited satisfaction were seen for genitourinary syndrome, stress urinary incontinence, overactive bladder and prolapse. Few adverse events were reported. However, major methodological biases were noted regarding efficacy and safety evaluation. No long-term results were available.
While Vaginal LASER therapy seem to provide encouraging results, the level of evidence supporting its use was weak, especially regarding long-term outcomes. Studies of better quality are warranted before any recommendation can be made. Current use should be limited to clinical research.
阴道激光疗法在泌尿妇科领域的应用日益广泛，但仍有几点尚不清楚。我们的目标是对现有证据进行系统综述，并对现有数据进行批判性评估。
利用PubMed/MEDLINE、Cochrane和Embase数据库进行截至2020年3月的系统综述。纳入了所有关于阴道激光在泌尿妇科领域应用的研究。
共纳入40项研究（8项针对绝经后泌尿生殖综合征，19项针对压力性尿失禁，3项针对膀胱过度活动症，7项针对泌尿生殖器官脱垂，3项针对其他适应症）。数据具有异质性，证据级别为低或极低。很少有研究为比较性研究，仅有3项为随机研究。对于绝经后泌尿生殖综合征、压力性尿失禁、膀胱过度活动症和脱垂，症状和生活质量有轻度改善，满意度有限。报告的不良事件较少。然而，在疗效和安全性评估方面存在主要的方法学偏倚。没有长期结果可用。
虽然阴道激光疗法似乎能提供令人鼓舞的结果，但支持其使用的证据级别较低，尤其是关于长期结局。在做出任何推荐之前，需要开展质量更高的研究。目前其应用应仅限于临床研究。
