medigraphic.com
ISSN 1561-3062 (Electronic)

2022, Number 1

<< Back Next >>

Revista Cubana de Obstetricia y Ginecología 2022; 48 (1)

Histological Changes Related to Fractional CO2 Laser in Genitourinary Syndrome of Menopause

Batista CZ, Benítez RV

Language: Spanish
References: 29
Page:
PDF size: 442.80 Kb.


ABSTRACT

Introduction: The genitourinary syndrome of menopause is a hypoestrogenic condition with genital, urological and sexual implications that affects more than 50% of postmenopausal women. Fractionated CO2 laser therapy has gained interest as a feasible, safe and effective non-hormonal option to reduce symptoms and improve quality of life and sexual function.
Objective: To discuss the histological changes associated with fractional CO2 laser treatment in the genitourinary syndrome of menopause.
Methods: A review was carried out of 255 articles published in scientific journals indexed in PubMed, Cochrane and Scopus from January 1, 2011 to November 30, 2020, written in English and related to the area of gynecology. The study excepted those that did not include histological studies, with therapeutic modalities other than fractionated CO2 laser, pathologies other than the genitourinary syndrome of menopause, and survivors of breast cancer. Only ten publications met the inclusion criteria. The papers with level of evidence IIB and III, were the most frequent.
Conclusions: Histological changes associated with fractional CO2 laser treatment in genitourinary syndrome of menopause were restoration of the flat stratified epithelium with significant degree of maturation and desquamation of glycogen-rich cells, remodeling of the lamina propria with new and larger papillae and abundant blood vessels, and the restoration of the vaginal microenvironment with increase in Lactobacillus concentrations and concomitant Ph decrease.


REFERENCES

  1. Di Donato V, D'Oria O, Scudo M, Prata G, Fischetti M, Lecce F, et al. Safety evaluation of fractional CO2 laser treatment in post-menopausal women with vaginal atrophy: A prospective observational study. Maturitas. 2020;135:34-9. DOI: https://doi.org/10.1016/j.maturitas.2020.02.009

  2. Palacios S, Cancelo HMJ, González PS, Manubens M, Sánchez BR. Síndrome genitourinario de la menopausia: recomendaciones de la Sociedad Española de Ginecología y Obstetricia. Prog Obstet Ginecol. 2019 [acceso 29/07/2021];62(2):141-8. Disponible en: https://sego.es/documentos/progresos/v62-2019/n2/09-AE_Sindrome- menopausia.pdf

  3. Espitia De La Hoz FJ. Prevalencia del síndrome genitourinario de la menopausia en mujeres e impacto en la sexualidad, en Quindío (Colombia) 2013-2016. Rev Colomb Obstet Ginecol. 2018;69(4):249-59. DOI: https://doi.org/10.18597/rcog.3111

  4. Mac Bride MB, Rhodes DJ, Shuster LT. Vulvovaginal atrophy. Mayo Clin Proc. 2010;85(1):87-94. DOI: https://doi.org/10.4065/mcp.2009.0413

  5. Escribano JJT, Rodea GG, Martín ÁJ, Cristóbal I, González PJ, Salinas JP, et al. Tratamiento del síndrome genitourinario de la menopausia mediante láser fraccionado CO2: Una opción terapéutica emergente. Rev Chil Obstet Ginecol. 2016;81(2):138-51. DOI: http://dx.doi.org/10.4067/S0717-75262016000200011

  6. Salvatore S, Maggiore ULR, Athanasiou S, Origoni M, Candiani M, Calligaro A, et al. Histological study on the effects of microablative fractional CO2 laser on atrophic vaginal tissue: an ex vivo study. Menopause. 2015;22(8):845-9. DOI: https://doi.org/10.1097/gme.0000000000000401

  7. Lev-Sagie A. Vulvar and Vaginal Atrophy: Physiology, Clinical Presentation, and Treatment Considerations. Clin Obstet Gynecol. 2015;58(3):476-91. DOI: https://doi.org/10.1097/grf.0000000000000126

  8. Samuels JB, Garcia MA. Treatment to External Labia and Vaginal Canal with CO2 Laser for Symptoms of Vulvovaginal Atrophy in Postmenopausal Women. Aesthet Surg J. 2019;39(1):83-93. DOI: https://doi.org/10.1093/asj/sjy087

  9. Gittens P, Mullen G. The effects of fractional microablative CO2 laser therapy on sexual function in postmenopausal women and women with a history of breast cancer treated with endocrine therapy. J Cosmet Laser Ther. 2019;21(3):127-31. DOI: https://doi.org/10.1080/14764172.2018.1481510

  10. Goldberg DJ. Laserterapia. Volumen 1. 1ed. Madrid: Elsevier España S.A.; 2006.

  11. Rabley A, Shea TO, Terry R, Byun S, Moy ML. Laser Therapy for Genitourinary Syndrome of Menopause. Curr Urol Rep. 2018;19(10):83. DOI: https://doi.org/10.1007/s11934-018-0831-y

  12. Siliquini GP, Tuninetti V, Bounous VE, Bert F, Biglia N. Fractional CO2 laser therapy: a new challenge for vulvovaginal atrophy in postmenopausal women. Climacteric. 2017;20(4):379-84. DOI: https://doi.org/10.1080/13697137.2017.1319815

  13. Romero-Otero J, Lauterbach R, Aversa A, Serefoglu EC, García-Gómez B, Parnham A, et al. Laser-Based Devices for Female Genitourinary Indications: Position Statements from the European Society for Sexual Medicine (ESSM). J Sex Med. 2020;17(5):841-8. DOI: https://doi.org/10.1016/j.jsxm.2020.02.013

  14. Sandvik H, Seim A, Vanvik A, Hunskaar S. A severity index for epidemiological surveys of female urinary incontinence: comparison with 48-hour pad-weighing tests. Neurourol Urodyn. 2000;19(2):137-45. DOI: https://doi.org/10.1002/(sici)1520-6777(2000)19:2%3C137::aid-nau4%3E3.0.co;2-g

  15. Espuña PM, Puig CM, González AM, Zardain PC, Rebollo AP. Cuestionario para evaluación de la función sexual en mujeres con prolapso genital y/o incontinencia: Validación de la versión española del “Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12)”. Actas Urol Esp. 2008 [acceso 25/07/2021];32(2):211-9. Disponible en: http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S0210-48062008000200009&lng=es

  16. Tadir Y, Gaspar A, Lev-Sagie A, Alexiades M, Alinsod R, Bader A, et al. Light and energy based therapeutics for genitourinary syndrome of menopause: Consensus and controversies. Lasers Surg Med. 2017;49(2):137-59. DOI: https://doi.org/10.1002/lsm.22637

  17. Capon A, Mordon S. Can thermal lasers promote skin wound healing? Am J Clin Dermatol. 2003;4(1):1-12. DOI: https://doi.org/10.2165/00128071-200304010-00001

  18. Zerbinati N, Serati M, Origoni M, Candiani M, Iannitti T, Salvatore S, et al. Microscopic and ultrastructural modifications of postmenopausal atrophic vaginal mucosa after fractional carbon dioxide laser treatment. Lasers Med Sci. 2015;30(1):429-36. DOI: https://doi.org/10.1007/s10103-014-1677-2

  19. Chou R, Baker WL, Bañez LL, Iyer S, Myers ER, Newberry S, et al. Agency for Healthcare Research and Quality Evidence-based Practice Center methods provide guidance on prioritization and selection of harms in systematic reviews. J Clin Epidemiol. 2018;98:98-104. DOI: https://doi.org/10.1016/j.jclinepi.2018.01.007

  20. Phillips C, Hillard T, Salvatore S, Toozs-Hobson P, Cardozo L. Lasers in gynaecology. Eur J Obstet Gynecol Reprod Biol. 2020;251:146-55. DOI: https://doi.org/10.1016/j.ejogrb.2020.03.034

  21. Pagano T, Travaglino A, Raffone A, Vallone R, Buonfantino C, De Rosa P, et al. Fractional Microablative CO2 Laser-Related Histological Changes on Vulvar Tissue in Patients with Genitourinary Syndrome of Menopause. Lasers Surg Med. 2021;53(4):521-7. DOI: https://doi.org/10.1002/lsm.23311

  22. Gambacciani M, Palacios S. Laser therapy for the restoration of vaginal function. Maturitas. 2017;99:10-5. DOI: http://dx.doi.org/10.1016/j.maturitas.2017.01.012

  23. Aguiar LB, Politano CA, Costa-Paiva L, Teatin Juliato CR. Efficacy of Fractional CO2 Laser, Promestriene, and Vaginal Lubricant in the Treatment Randomized Clinical Trial. Lasers Surg Med Effic. 2020;52(8):713-20. DOI: https://doi.org/10.1002/lsm.23220

  24. Adabi K, Golshahi F, Niroomansh S, Razzaghi Z, Ghaemi M. Effect of the Fractional CO2 Laser on the Quality of Life, General Health, and Genitourinary Symptoms in Postmenopausal Women with Vaginal Atrophy: A Prospective Cohort. J Lasers Med Sci. 2020;11(1):65-9. DOI: https://doi.org/10.15171/jlms.2020.11

  25. Li J, Li H, Zhou Y, Xie M, Miao Y, Wang L, et al. The Fractional CO2 Laser for the Treatment of Genitourinary Syndrome of Menopause: A Prospective Multicenter Cohort Study. Lasers Surg Med. 2021;53(5):647-53. DOI: https://doi.org/10.1002/lsm.23346

  26. Preti M, Vieira-Baptista P, Digesu GA, Bretschneider CE, Damaser M, Demirkesen O, et al. The Clinical Role of LASER for Vulvar and Vaginal Treatments in Gynecology and Female Urology: An ICS/ISSVD Best Practice Consensus Document. J Low Genit Tract Dis. 2019;23(2):151-60. DOI: https://doi.org/10.1097/lgt.0000000000000462

  27. Fistonic I. Laser therapy for vaginal atrophy. Maturitas. 2019;124:128-9. DOI: http://dx.doi.org/10.1016/j.maturitas.2019.04.066

  28. Pitsouni E, Grigoriadis T, Zacharakis D, Theocharis, S Danas, E, Douskos, et al. Microablative fractional CO2-laser for the management of genitourinary syndrome of menopause. A placebo controlled histopathogical pilot study. Int Urogynecol J. 2018;29(1):272. DOI: http://dx.doi.org/10.1016/j.maturitas.2016.09.012

  29. Sokol ER, Karram MM. Use of a novel fractional CO2 laser for the treatment of genitourinary syndrome of menopause: 1-year outcomes. Menopause. 2017;24(7):810-4. DOI: https://doi.org/10.1097/gme.0000000000000839




2020     |     www.medigraphic.com