ERBIUM-YAG LASER: OUR 4 YEARSEXPERIENCE FOR TREATMENT PELVIC FLOOR DISFUNCTION
I. APOLIKHINA1, E.GORBUNOVA 1, G. SUKHIKH 2;
1AestheticGynecology and Rehabilitation, Res. Ctr. for Obstetrics, Gynecologyand Perinatology, Moscow, Russian Federation, 2Directory,Res. Ctr. for Obstetrics, Gynecology and Perinatology, Moscow,Russian Federation.
Introduction: The most frequenturogynecological problems in women are include pelvic organ prolapse,stress urinary incontinence (SUI), overactive bladder, vulvovaginalatrophy or genitourinary syndrome of menopause (GSM) and sexualdysfunction. Their occurrence are often associated with damage to thestructures of connective tissue due of pregnancy and childbirth,surgical aids in childbirth, perineal tears, increasedintra-abdominal pressure, aging involution changes, undifferentiatedconnective tissue dysplasia. The prevalence of urinary incontinencein women in Russia and in many countries is about 25-30%, and reaches50% in the older age group. The understanding the molecularmechanisms and pathophysiology of involutive processes in theurogenital tract in women makes it possible purposefully to influencethe structure of connective tissue by stimulating the synthesis ofextracellular matrix components and providing a structural remodelingof tissues. Particularly noteworthy the modern minimally invasivelaser techniques, which offer more possibilities in solving problemsurogynaecological.
Objective: This study aimed to assessthe efficacy and feasibility of Er-YAG laser in the treatment ofgenitourinary syndrome of menopause (GSM), stress urinaryincontinence, vaginal prolapse or combination of the two lastnosologies.
Methods: To date, 223 women (age 47,0 years)have been treated. A treatment cycle included 3-4 laser treatments at4-6-week intervals.Symptoms were assessed before and after everyapplications of laser. Subjective (visual analog scale) and objective(Vaginal Health Index Score, VHIS, perineometry and high-frequencyultrasound) measures were used during the study period to assesssymptoms. Quality of life was measured by using the SF-36. Quality ofsexual life was measured by using the PISQ-12 and the Female SexualFunction Index (FSFI). All patients completed the King's HealthQuestionnaire,the International Consultation on IncontinenceQuestionnaire-Short Form (ICIQ-SF). In this study, we presentmicroscopic and immunohistochemical staining modifications of vaginalmucosa before and after Er-YAG laser treatment, carried out onbioptic vaginal mucosa samples in some women. This study aimed toassess the efficacy and feasibility of Er-YAG laser in the treatmentof genitourinary syndrome of menopause (GSM), stress urinaryincontinence, vaginal prolapse or combination of the two.
Results:Initial improvement was noted in most patients, within 3 week afterthe first treatment, with further improvement after each lasersession. Er-YAG laser treatment was effective to improve symptoms ofsexual dysfunction, vaginal relaxation, stress urinary incontinence,pelvic organ prolapse, overactive bladder, genitourinary syndrome ofmenopause (GSM). Physical and mental scores of quality of life andquality of sexual life were significantly improved in comparison withbaseline, as well as the VHIS and perineometry. We observed therestoration of the vaginal thick squamous stratified epithelium witha significant storage of glycogen in the epithelial cells. In theconnective tissue constituting the lamina propria, active fibroblastssynthesized new components of the extracellular matrix includingcollagen I and III, and elastin. After laser treatment we sawstatistically significant changes for urgency and urge urinaryincontinence.
Conclusions: Er-YAG laser treatment waseffective for symptoms of sexual dysfunction, stress urinaryincontinence, pelvic organ prolapse I-II, genitourinary syndrome ofmenopause. Er-YAG laser treatment was more effective for thecombination of UUI and prolapse. Our morphological findings supportthe effectiveness of Er-YAG laser application for the restoration ofvaginal mucosa structure and related physiologicaltrophism.
References: 1. Laser Vaginal Tightening (LVT) -evaluation of a novel noninvasive laser treatment for vaginalrelaxation syndrome. Jorge E. Gaviria P., Jose A. Lanz L.2012.2. Thehidden epidemic of pelvic floor dysfunction: achievable goals forimproved prevention and treatment. DeLansey J. 2005