Efficacy of laser remodeling treatment in genitourinary syndrome of menopause

Abstract

Objective: To evaluate the efficacy of laser remodeling in genitourinary syndrome of menopause using fractional microablative CO2 laser remodeling treatment (SmartXide2 V2LR Monalisa Touch; DEKA (Florence, Italy)).Materials and Methods: This prospective, observational study included 105 patients (n=105) aged 52.0 ± 1.3 years with a verified diagnosis of postmenopausal atrophic vaginitis (ICD N.95.2) who provided voluntary informed consent to participate in this study. Based on the regimens of fractional microablative CO2 laser remodeling treatment using the SmartXide2 V2LR Monalisa Touch laser system (DEKA, Florence, Italy) patients in the study cohort were assigned to either group I (n= 50; 40/1000/1000/1 ST/DP) or group II (n=55; 40/1400/1000/1 ST/DP). The control group for clinical and morphological comparison (n=30) included women of the similar age who did not have a verified diagnosis of postmenopausal atrophic vaginitis, N95.2.For objectification, the clinical manifestations of GSM in patients of the study cohort were scored using a 5-point D. Barlow scale and the vaginal health index was calculated (G. Bachmann, 1995).RESULTS: Following the laser remodeling procedure, patients in groups I and II demonstrated a significant increase in the vaginal health index, i.e., 1.25-fold (3.0 ± 0.81 versus 3.74 ± 0.69; p < 0.001) and 1.3-fold (3.15 ± 0.65 versus 4.11 ± 0.57; p < 0.001) after 3 months and 1.55-fold (3.0 ± 0.81 versus 4.66 ± 0.48; p < 0.001) and 1.5-fold (3.15 ± 0.65 versus 4.71 ± 0.46; p < 0.001) after 12 months, respectively. However, there were no statistically significant differences between the study groups (p= 0.310, p= 0.003, p= 0.593, respectively). In patients in the study cohort the baseline scores of the clinical manifestations of GSM using the D. Barlow scale were 2.74 ± 1.23 and 2.92 ± 1,14 in groups I and II, respectively. Following the laser remodeling procedure, patients in groups I and II experienced a significant decrease in these scores of 1.49-fold (2.74 ± 1.23 versus 1.84 ± 0.93; p < 0.001) and 1.45-fold (2.92 ± 1.14 versus 2.02 ± 0.87; p < 0.001) after 3 months and 3.8-fold (2.74 ± 1.23 versus 0.72 ± 0.7; p < 0.001) and 4.11-fold (2.92 ± 1.14 versus 0.71 ± 0.66; p < 0.001) after 12 months, respectively. However, there were no statistically significant differences between the study groups (p= 0.418, p= 0.314, p= 0.935, respectively). In this study, two regimens (40/1000/1000/1 ST/DP and 40/1400/1000/1 ST/DP) of the microablative laser remodeling treatment using the SmartXide2 V2LR Monalisa Touch fractional CO2 laser (DEKA, Florence, Italy) were found to be similar in clinical efficacy and safety and had no adverse effects associated with burns and/or adhesions to the vaginal mucosa.conclusions: Therefore, it can be concluded that the use of the SmartXide2 V2LR Monalisa Touch fractional CO2 laser (DEKA, Florence, Italy) in treatment of GSM is pathogenetically justified and is an effective and safe treatment option in postmenopausal patients with vulvovaginal atrophy.