TY - JOUR
T1 - The Clinical Role of LASER for Vulvar and Vaginal Treatments in Gynecology and Female Urology
T2 - An ICS/ISSVD Best Practice Consensus Document
AU - Preti, Mario
AU - Vieira-Baptista, Pedro
AU - Digesu, Giuseppe Alessandro
AU - Bretschneider, C. Emi
AU - Damaser, Margot
AU - Demirkesen, Oktay
AU - Heller, Debra S.
AU - Mangir, Naside
AU - Marchitelli, Claudia
AU - Mourad, Sherif
AU - Moyal-Barracco, Micheline
AU - Peremateu, Sol
AU - Tailor, Visha
AU - Tarcan, Tufan
AU - De, Elise J.B.
AU - Stockdale, Colleen K.
N1 - Publisher Copyright:
© 2019 Lippincott Williams & Wilkins.
PY - 2019/4/1
Y1 - 2019/4/1
N2 - In this best practice document, we propose recommendations for the use of LASER for gynecologic and urologic conditions such as vulvovaginal atrophy, urinary incontinence, vulvodynia, and lichen sclerosus based on a thorough literature review. Most of the available studies are limited by their design; for example, they lack a control group, patients are not randomized, follow-up is short term, series are small, LASER is not compared with standard treatments, and most studies are industry sponsored. Because of these limitations, the level of evidence for the use of LASER in the treatment of these conditions remains low and does not allow for definitive recommendations for its use in routine clinical practice. Histological evidence is commonly reported as proof of tissue regeneration after LASER treatment. However, the histological changes noted can also be consistent with reparative changes after a thermal injury rather than necessarily representing regeneration or restoration of function. The use of LASER in women with vulvodynia or lichen sclerosus should not be recommended in routine clinical practice. There is no biological plausibility or safety data on its use on this population of women. The available clinical studies do not present convincing data regarding the efficacy of LASER for the treatment of vaginal atrophy or urinary incontinence. Also, although short-term complications seem to be uncommon, data concerning long-term outcomes are lacking. Therefore, at this point, LASER is not recommended for routine treatment of the aforementioned conditions unless part of well-designed clinical trials or with special arrangements for clinical governance, consent, and audit.
AB - In this best practice document, we propose recommendations for the use of LASER for gynecologic and urologic conditions such as vulvovaginal atrophy, urinary incontinence, vulvodynia, and lichen sclerosus based on a thorough literature review. Most of the available studies are limited by their design; for example, they lack a control group, patients are not randomized, follow-up is short term, series are small, LASER is not compared with standard treatments, and most studies are industry sponsored. Because of these limitations, the level of evidence for the use of LASER in the treatment of these conditions remains low and does not allow for definitive recommendations for its use in routine clinical practice. Histological evidence is commonly reported as proof of tissue regeneration after LASER treatment. However, the histological changes noted can also be consistent with reparative changes after a thermal injury rather than necessarily representing regeneration or restoration of function. The use of LASER in women with vulvodynia or lichen sclerosus should not be recommended in routine clinical practice. There is no biological plausibility or safety data on its use on this population of women. The available clinical studies do not present convincing data regarding the efficacy of LASER for the treatment of vaginal atrophy or urinary incontinence. Also, although short-term complications seem to be uncommon, data concerning long-term outcomes are lacking. Therefore, at this point, LASER is not recommended for routine treatment of the aforementioned conditions unless part of well-designed clinical trials or with special arrangements for clinical governance, consent, and audit.
KW - ICS
KW - ISSVD
KW - LASER
KW - genitourinary syndrome of menopause
KW - lichen sclerosus
KW - urinary incontinence
KW - vaginal laxity
KW - vulvovaginal atrophy
UR - http://www.scopus.com/inward/record.url?scp=85063340288&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85063340288&partnerID=8YFLogxK
U2 - 10.1097/LGT.0000000000000462
DO - 10.1097/LGT.0000000000000462
M3 - Review article
C2 - 30789385
AN - SCOPUS:85063340288
SN - 1089-2591
VL - 23
SP - 151
EP - 160
JO - Journal of lower genital tract disease
JF - Journal of lower genital tract disease
IS - 2
ER -