Long term clinical and histological safety and efficacy of CO2 laser for
the treatment of genitourinary syndrome of menopause: an original study
Abstract
Objective: To evaluate the histological modifications of the vaginal
mucosa after repeated microablative fractional CO2 lasers treatments. As
secondary objectives we evaluated the clinical effects associated with
repeated microablative fractional CO2 lasers treatments using validated
questionnaires. Design: Prospective intervention study. Setting:
Division of Gynecology and Obstetrics, Urogynecology Unit, IRCCS San
Raffaele Scientific Institute Sample: 15 postmenopausal women
complaining of genitourinary syndrome of menopause symptoms. Methods:
one cohort of patients submitted to at least two previous laser
treatment cycles in the past years. Main outcome measures: Vaginal
Health Index (VHI), Visual Analog Scale (VAS), Female Sexual Function
Index (FSFI), Urinary Distress Inventory-6 (UDI-6), International
Consultation on Incontinence Questionnaire – Urinary Incontinence
(ICIQ-UI) and 5-point Likert scale. Moreover an histological
examinations were carried out on all samples. Results: At 4 weeks after
the last treatment VHI score and all FSFI items resulted significantly
increased compared baseline. We observed a statistically significant
decrease both in frequency and severity for all urinary symptoms after
the follow up. We observed a statistically significant increase in the
number of epithelial cell layer with a consequent increase in epithelial
thickness, in the number of glycogen filled cells, and in the number of
papillae, after the laser treatment. No signs of fibrosis were observed
since neovascularization was observed in each single woman. Conclusions:
This is the first study demonstrating the histological persistency of
efficacy in repeated annually laser treatment cycles, with tissue
changes always leading to regenerative results without any sign of
fibrosis.