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The effects of fractional CO2 laser treatment on the symptoms of pelvic floor dysfunctions and vulvovaginal atrophy
IUGA Academy. Kozma B. Jun 30, 2018; 212885
Topic: Pelvic Organ Prolapse
Dr. Bence Kozma
Dr. Bence Kozma

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The effects of fractional CO2 laser treatment on the symptoms of pelvic floor dysfunctions and vulvovaginal atrophy

Kozma, B1; Takacs, P2; Sipos, A3; Poka, R4

1: University of Debrecen Faculty of Medicine, Department of Obstetrics and Gynecology, Debrecen Hungary; 2: Eastern Virginia Medical School, Norfolk, Virginia, USA; 3: University of Debrecen Faculty of Medicine, Department of Obstetrics and Gynecology, Debrecen, Hungary; 4: University of Debrecen Faculty of Medicine, Department of OBGYN, Debrecen, Hungary

Introduction: Vaginal laser treatment became a popular treatment modality for genitourinary syndrome of menopause. However scientific data is limited regarding the effects of laser treatment on different pelvic floor dysfunctions.

Objectives: To evaluate the effect of the Mona Lisa Touch CO2 laser treatment on postmenopausal women vulvovaginal and pelvic floor dysfunction symptoms.

Methods: Forty-three postmenopausal women were enrolled and underwent vaginal laser treatment with. Mona Lisa Touch. Patients received three vaginal laser treatments with the 360 degree probe 4-6 weeks apart. Pelvic Organ Prolapse Distress Inventory 6 (POPDI-6), Colorectal?Anal Distress Inventory 8 (CRADI-8) and Urinary Distress Inventory 6 (UDI-6) validated questionnaires were filled out by each patient before each session and 4 weeks after the final treatment. Vaginal Health Index (Elasticity, Fluid Secretion, pH, Epithelial mucosa, Moisture) was calculated before each session and 4 weeks after the final treatment. In addition, patients were asked to fill out a Visual Analog Scale (1-10, lower scores indicates less bother) on vaginal pain, dryness, burning, itching, dyspareunia and dysuria. Paired t-test was used to compare the before and after treatment results.

Results: All patients were in menopause. The average age was 57±10 years. POPD-6 standardized scores were not significantly different after the first treatment (20 ±19 vs. 14±11 after the first treatment). But after the second treatment there was a significant improvement in the standardized score to 11±12 ( P=0.02). After the third treatment the score was even lower 10±13 (P=0.01). CRADI-8 standardized scores did not change significantly after three laser treatment (16±18 vs. 13±17 after the 1st treatment/13±16 after the 2nd treatment/12±18 after the 3rd treatment). UDI-6 standardized scores were not significantly different after the first laser treatment (32±23 vs. 26±23 after the first treatment). But after the second treatment there was a significant improvement in the standardized score to 25 ± 20 ( P=0.03). The Vaginal Health Index was 15±5 before and 17±4 after the first treatment, 19±5 after the second and 21±4 after the third treatment. VHI was significantly improved after each treatment (P<0.01). The largest incremental change occurred in vaginal moisture, followed by vaginal fluid and elasticity. The patient reported combined Visual Analog Score (VAS) was 16±16 before and 9±12 after the first treatment, 6 ± 9 after the second and 3 ± 8 after the third treatment. VAS was significantly lower (P<0.01) after each laser treatment. The largest improvement occurred after the first laser treatment, but each additional treatment added additional symptoms relief.

Conclusion: CO2 vaginal laser treatment significantly improves patient reported urinary and pelvic organ prolapse bother. The minimum of two laser treatments were needed to achieve a significant benefit. In addition, CO2 vaginal laser treatment significantly improves both the patient reported subjective symptoms and the Vaginal Health Index in postmenopausal women even after a single laser treatment.

Disclosure:

Work supported by industry: no, by Peter Takacs. A consultant, employee (part time or full time) or shareholder is among the authors (Fempharma).

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