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Three, four or five CO2 laser-therapies for the management of the genitourinary syndrome of menopause? Long-term follow-up of a case-controlled study
IUGA Academy. Pitsouni E. Jun 30, 2018; 212995; 281 Topic: Sexual Dysfunction
Dr. Eleni Pitsouni
Dr. Eleni Pitsouni

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281

Three, four or five CO2 laser-therapies for the management of the genitourinary syndrome of menopause? Long-term follow-up of a case-controlled study

Pitsouni, E1; Grigoriadis, T2; Zacharakis, D2; Douskos, A2; Theofanakis, C2; Protopapas, A2; Athanasiou, S2

1: National and Kapodistrian University of Athens, Greece; 2: National and Kapodistrian University of Athens, Greece

Introduction: Microablative fractional CO2-laser have been proposed recently for the management of the genitourinary syndrome of menopause (GSM). Due to its novelty, many queries are unanswered, such as how many laser-sessions results in lower symptoms intensity and higher symptoms-free rates in postmenopausal women with severe intensity of GSM symptoms. A standard protocol of 3 CO2-laser therapies may improve all GSM symptoms in short and long-term follow-up, as have been suggested by almost all studies. Currently, only 1 observational uncontrolled study has evaluated the efficacy of a 4th and a 5th laser-therapy. This study suggested that symptom-free rates may rise from 27% following 3 laser-sessions to 86% following 5 laser-sessions. However, there is lack of data regarding the long-term efficacy of the additional therapies.

Objectives: Current study aimed to assess the long-term efficacy of the CO2-laser therapy for the management of GSM when 3, 4 or 5 laser-therapies were applied.

Methods: Case-controlled study evaluating GSM symptoms following 3, 4 or 5 laser-therapies at baseline and 1,3,6 and 12-months. VAS, ICIQ-FLUTS (filling domain), ICIQ-UI SF, UDI-6 and FSFI were used for the assessment of GSM-symptoms intensity or bothering or presence and the parameters of sexual function.

Results: Overall 94 women (35, 35 and 24 in 3,4 and 5-therapies, respectively) were included. All baseline characteristics, symptom’s intensity or bothering and the parameters of sexual function were the same among the 3 groups. Four or 5 laser-therapies were superior in lowering the intensity of GSM symptoms in comparison to 3 laser-therapies, in short and long-term follow-up. In particular, for the 3-therapies group at 1-month follow-up dyspareunia, dryness, ICIQ-FLUTS, ICIQ-UI SF and UDI-6 decreased significantly from 8/2 (median/IQR) to 2/3, 8/1 to 2/3, 0/14 to 4/5, 4/5 to 0/8 and 8.3/41.7 to 0/25, respectively; FSFI and all its domain increased significantly. In the 4-therapies group at 1-month follow-up dyspareunia, dryness, ICIQ-FLUTS, ICIQ-UI SF and UDI-6 decreased significantly from 9/4 (median/IQR) to 0/0, 7/4 to 0/0, 3/8 to 3/4, 3/4 to 0/0 and 12.5/37.5 to 0/8.3, respectively; FSFI and all its domain increased significantly. In the 5-therapies group at 1-month follow-up dyspareunia, dryness, ICIQ-FLUTS, ICIQ-UI SF and UDI-6 decreased significantly from 10/3.8 (median/IQR) to 0/2, 7.5/5 to 0/1, 0/5.3 to 3/3, 3/3 to 0/0 and 10.4/31.2 to 0/3.1, respectively; FSFI and all its domain increased significantly. Differences between 4 and 5 laser-therapies were not found. All the above results remained unchanged through the 12-months of follow-up in all groups. Similar pattern was detected for the symptoms-free rates. Specifically, significant differences between the 3 groups at 1-month follow-up, that maintained through 12-months of follow-up, was found for the free rates of dyspareunia, dryness, urgency and incontinence.

Conclusion: Laser-therapy may provide significant improvement or even absence of GSM symptoms up to 12-months follow-up, irrespectively to the number of laser-therapies applied. However, 4 or 5 laser-therapies may result in lower symptoms’ intensity and higher symptom free-rates.

Disclosure:

Work supported by industry: no.

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