Effects of local laser treatment on vulvovaginal atrophy among women with breast cancer: a prospective study with long-term follow-up

PURPOSE

Women with breast cancer (BC) often suffer from severe vulvovaginal atrophy (VVA) which ultimately leads to poor sexual and urinary quality of life. We conducted a prospective study among women with BC and VVA, in order to evaluate the long-term effect of laser therapy on VVA.

METHODS

Women with BC and VVA were proposed to have fractional microablative CO₂ laser therapy (MonaLisaTouch®, DEKA) once per month for 3 months. Efficacy of laser therapy was assessed at baseline, 6 months and 18 months after treatment, using Female Sexual Function Index (FSFI) score, Ditrovie score and vaginal pH. A pap smear was also performed and the epithelial maturation pattern was noted. Paired statistical tests were used to compare results between baseline, 6 months and 18 months.

RESULTS

46 women with BC (median age [interquartile range] 56.5 years [47.0 - 59.4]) were included between May and October 2018. PH level slightly decreased over time (mean Δ at 18 months -0.3, SD = 0.7, p = 0.02) whereas maturation pattern on pap smear did not change. Sexual quality of life was significantly improved at 6 months and 18 months (mean Δ at 6 months 8.3, SD = 6.2 (p < 0.0001) and mean Δ at 18 months 4.3, SD = 8.4 (p = 0.01)). Ditrovie total score improved at 6 months (mean Δ -1.2, SD = 2.7, p = 0.01) but returned to baseline afterwards. Side effects were very mild. Three women developed low (2)- and high (1)-grade HPV-linked cervical lesions during follow-up.

CONCLUSION

Among women with BC, fractional microablative CO₂ laser is effective on the long term on VVA symptoms and gynaecological quality of life.

TRIAL REGISTRATION NUMBER

ID-RCB 2018-A01500-55.

[Vaginal laser therapy for urinary incontinence and genitourinary syndrome of menopause : A review]

BACKGROUND

Use of vaginal laser therapy in the treatment of grade I stress urinary incontinence and genitourinary syndrome of menopause is gaining in importance across the globe.

MATERIALS AND METHODS

On the basis of the research that is currently available, an analysis is carried out regarding whether laser therapy is already suitable for use in the field of urology.

RESULTS

The research available is still limited: randomized controlled studies in particular are lacking. All the data published to date demonstrate a response to laser therapy with minimal side effects, high patient compliance and satisfaction, and a long-term response for a minimum of 12 months.

CONCLUSIONS

Vaginal laser therapy has shown potential and demonstrated its safety for use in urology as either a complementary or alternative treatment to existing treatment options, such as topical hormonal therapies, pelvic floor exercises or surgical procedures. It is necessary to define it as separate from aesthetic procedures.

Laser therapy for the restoration of vaginal function

Laser therapy has a therapeutic role in various medical conditions and most recently has gained interest as a non-hormonal treatment for genitourinary syndrome of menopause (GSM) and as a non-invasive option for stress urinary incontinence (SUI). Several therapies are available to alleviate GSM symptoms, including hormonal and non-hormonal products. Both microablative fractional CO₂ laser and the non-ablative vaginal Er:YAG laser (VEL) induce morphological changes in the vaginal tissues, and data from non-randomized clinical trials suggest that laser therapy can alleviate vaginal dryness and dyspareunia. VEL has been reported to improve SUI as well as vaginal prolapse. Although large randomized trials have not been reported, the evidence suggests that VEL can be offered as a safe and efficacious alternative to hormone replacement therapy (HRT) for GSM, as well as a first-line treatment for mild to moderate SUI, before surgical procedures are resorted to. Randomized studies are needed to compare laser treatments with other therapies, as well as to assess the duration of the therapeutic effects and the safety of repeated applications. Research is presently evaluating both an automated robotic probe for VEL treatments and an intraurethral probe for the treatment of severe and type III SUI.