Department of Obstetrics and Gynecology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands.
Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands.
Neurourol Urodyn. 2023 Aug;42(6):1381-1389. doi: 10.1002/nau.25227. Epub 2023 Jun 19.
Vaginal laser therapy for the treatment of genitourinary syndrome of menopause (GSM) has been introduced to the market with limited (pre)clinical and experimental evidence supporting its efficacy. It is suggested that vaginal laser therapy increases epithelial thickness and improves vascularization, but the underlying biological working mechanism has not been substantiated yet.
To evaluate the effects of CO laser therapy on vaginal atrophy using noninvasive incident dark field (IDF) imaging in a large animal model for GSM.
DESIGN, SETTING, AND PARTICIPANTS: An animal study was conducted between 2018 and 2019 and included 25 Dohne Merino ewes, of which 20 underwent bilateral ovariectomy (OVX) to induce iatrogenic menopause, and 5 did not. The total study duration was 10 months.
Five months after OVX, ovariectomized ewes received monthly applications of CO laser (n = 7), vaginal estrogen (n = 7), or no treatment (n = 6) for 3 months. IDF imaging was performed monthly in all animals.
The primary outcome was the proportion of image sequences containing capillary loops (angioarchitecture). Secondary outcomes included focal depth (epithelial thickness), and quantitative measures of vessel density and perfusion. Treatment effects were evaluated using ANCOVA and binary logistic regression.
Compared to OVX-only, ewes treated with estrogen demonstrated a higher capillary loops proportion (4% vs. 75%, p < 0.01), and higher focal depth (60 (IQR 60-80) vs. 80 (IQR 80-80) p < 0.05). CO laser therapy did not change microcirculatory parameters. As the ewes' vaginal epithelium is thinner than that of humans, it may demand different laser settings.
In a large animal model for GSM, CO laser therapy does not affect microcirculatory outcomes related to GSM, whereas vaginal estrogen treatment does. Until more homogeneous and objective evidence about its efficacy is available, CO laser therapy should not be adopted into widespread practice for treating GSM.
阴道激光疗法已被引入治疗女性生殖泌尿综合征（GSM）的市场，但其疗效仅得到有限的（临床前）和实验证据的支持。据推测，阴道激光疗法可以增加上皮厚度并改善血管生成，但潜在的生物学作用机制尚未得到证实。
使用非侵入性的暗场成像（IDF）技术，在 GSM 的大型动物模型中评估 CO 激光治疗对阴道萎缩的影响。
设计、设置和参与者：这项动物研究于 2018 年至 2019 年进行，共纳入 25 只多内美利奴羊，其中 20 只接受双侧卵巢切除术（OVX）以诱导医源性绝经，5 只未接受 OVX。总研究持续时间为 10 个月。
OVX 后 5 个月，接受 CO 激光（n=7）、阴道雌激素（n=7）或不治疗（n=6）治疗，每月 1 次，共 3 个月。所有动物均每月进行 IDF 成像。
主要结局是包含毛细血管环（血管结构）的图像序列比例。次要结局包括焦点深度（上皮厚度）和血管密度及灌注的定量测量。采用协方差分析和二项逻辑回归评估治疗效果。
与 OVX 组相比，接受雌激素治疗的母羊毛细血管环比例更高（4%比 75%，p<0.01），焦点深度更大（60（IQR 60-80）比 80（IQR 80-80），p<0.05）。CO 激光治疗未改变微循环参数。由于母羊的阴道上皮比人类更薄，可能需要不同的激光设置。
在 GSM 的大型动物模型中，CO 激光治疗不会影响与 GSM 相关的微循环结果，而阴道雌激素治疗则会。在获得更多关于其疗效的同质和客观证据之前，CO 激光治疗不应被广泛用于治疗 GSM。
