From the Department of Obstetrics and Gynecology, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, Turkey.
Department of Radiology, American Hospital, Istanbul, Turkey.
Menopause. 2024 Aug 1;31(8):716-723. doi: 10.1097/GME.0000000000002380. Epub 2024 Jun 11.
The aim of the study was to investigate the effectiveness of intravaginal Er:YAG laser for treating atrophic vaginitis in postmenopausal women utilizing shear wave elastography.
In this prospective randomized sham-controlled double-blind pilot study, 20 participants were included (laser group [n = 12] / sham-control group [n = 8]). A nonablative (Smooth mode) Er:YAG laser with a wavelength of 2,940 nm was used. Objective evaluation of laser treatment efficacy was conducted using a special ultrasonic technique: shear wave elastography. Ultrasonic velocity measurements were taken from the anterior and posterior vaginal walls. Mean elasticity (E mean ) was expressed in kilopascals (kPa). Additional outcome parameters were vaginal pH, Vaginal Health Index (VHI), Female Sexual Function Index (FSFI), and visual analog scale (VAS) scores for dyspareunia.
Baseline clinical characteristics, vaginal pH, VHI, VAS and FSFI scores, and E mean values were comparable between the laser and sham-control groups. Statistically significant differences were observed in the final E mean values of the anterior vaginal wall (13.1 ± 6.3 vs 20.0 ± 3.3 kPA, P = 0.01) and posterior vaginal wall (12.7 ± 10.3 vs 19.4 ± 6.9 kPA, P = 0.04) between the laser and sham-control group. Despite comparable baseline E mean values, significant differences in vaginal wall stiffness posttreatment indicated a notable increase in tissue elasticity following laser treatment. Statistically significant differences were also observed in final vaginal pH values, VHI, VAS scores, and FSFI score improvement in favor of laser treatment.
Shear wave elastography may be considered as a reliable and objective technique for evaluating the efficacy of Er:YAG laser treatment in women with atrophic vaginitis. However, additional studies with larger sample sizes are necessary to establish conclusive evidence.
本研究旨在利用剪切波弹性成像探讨阴道内铒：钇石榴石（Er:YAG）激光治疗绝经后萎缩性阴道炎的疗效。
本前瞻性随机假对照双盲初步研究纳入了 20 名参与者（激光组 [n=12] / 假对照组 [n=8]）。使用非消融（平滑模式）2940nm 的 Er:YAG 激光。采用特殊的超声技术（剪切波弹性成像）对激光治疗效果进行客观评估。从前壁和后壁测量超声速度。平均弹性（Emean）以千帕斯卡（kPa）表示。其他的结果参数包括阴道 pH 值、阴道健康指数（VHI）、女性性功能指数（FSFI）和性交疼痛的视觉模拟评分（VAS）。
激光组和假对照组之间的基线临床特征、阴道 pH 值、VHI、VAS 和 FSFI 评分以及 Emean 值无统计学差异。在前壁（13.1 ± 6.3 与 20.0 ± 3.3kPa，P=0.01）和后壁（12.7 ± 10.3 与 19.4 ± 6.9kPa，P=0.04）的最终 Emean 值上，激光组和假对照组之间存在统计学显著差异。尽管基线 Emean 值相当，但治疗后阴道壁硬度的显著差异表明，激光治疗后组织弹性明显增加。在最终阴道 pH 值、VHI、VAS 评分和 FSFI 评分的改善方面，激光治疗也显示出统计学显著差异。
剪切波弹性成像可被视为评估 Er:YAG 激光治疗萎缩性阴道炎疗效的可靠、客观的技术。然而，需要更大样本量的进一步研究来确立确凿的证据。
