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IMS Menopause Live

Can Vaginal Prolapse be treated with vaginal laser?

14 December 2020

Summary

This study from the urogynaecology department in Athens is a randomized, assessor-blinded controlled trial of the Erbium YAG smooth laser in postmenopausal women with symptomatic stage 2 or 3 vaginal prolapse who had opted to undergo surgery (1).

All 30 women in the study had extensive assessment of their symptoms by various appropriately validated questionnaires and by physical assessment using the POP-Q scoring system (Pelvic Organ Prolapse Quantification System).  The primary endpoint, defined as the ‘objective cure rate,’ was the proportion of patients with POP-Q stage 0 or 1. Secondary endpoints included measurements of all POP-Q points and subjective cure rates assessed by the Pelvic Floor Distress Inventory Questionnaire short-form [PFDI-20], Pelvic Floor Impact Questionnaire short- form [PFIQ-7] and the Patients Global Impression of Improvement [PGI-I]). The women were randomised to receive either Laser therapy (n=15) or a watchful-waiting group (n=15) who were not offered any additional therapy such as pelvic floor muscle training or a pessary. Laser therapy was performed using the Er:YAG laser (Intimalase Fotona SMOOTHTM), and all women in the laser group received one treatment at monthly intervals for three consecutive months. The treatments were all performed by an experienced independent physician blinded to the study objective. Outcomes in both groups were assessed at baseline and 4 months post-baseline. The POP-Q assessment was carried out by another independent physician who was blinded to participant allocation. Patient-reported outcome questionnaires, as above, were completed at baseline and 4 months.

The study found that after three Er:YAG laser treatments, there was no improvement in the pelvic anatomy as judged by the POP-Q assessment, and none of the participants in this study were objectively or subjectively cured following laser therapies. There were no changes in the patient-reported outcomes, and the laser therapy results were no different from those of the watchful-waiting group. No adverse events were reported by any of the participants.  The authors conclude that their study results do not support the use of intravaginal Er:YAG laser as a therapeutic option in postmenopausal patients with symptomatic pelvic organ prolapse.

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