Lasers in the era of evidence-based medicine

Abstract

Transvaginal laser therapies are being increasingly used for a variety of indications, particularly genitourinary syndrome of the menopause and stress urinary incontinence. This article reviews the current data pertaining to the place of these devices in current clinical practice. Whilst there has been a rapid increase in the number of publications over the last few years, many of the studies are of small numbers, short duration, and poor quality and are device-sponsored. The evidence suggests that vaginal laser therapy with either the erbium-doped yttrium aluminum garnet laser (FotonaSmooth^®) or the CO₂ laser (MonaLisa Touch^®) is an effective intervention for the relief of symptoms of vulvovaginal atrophy in symptomatic women. The benefits of three laser treatments appear to last for at least 12 months and the procedure is generally well tolerated, with transient minor discomfort being the most common adverse event. Whilst the vaginal laser certainly has the potential to be an alternative treatment to vaginal estrogens for those groups of women, such as breast cancer patients, who cannot take them, there are still many unanswered questions about the role of vaginal laser therapy in clinical practice, particularly in relation to standard conservative management. The place of vaginal laser therapy in other conditions such as stress urinary incontinence is less clear. The outcomes from several ongoing randomized trials should help to answer some of these questions. In the meantime, the use of vaginal laser devices should be confined to clinical trials.

摘要

经阴道激光治疗越来越多地用于各种适应证, 特别是绝经期泌尿生殖系统综合征和压力性尿失禁。这篇文章回顾了目前临床实践中激光设备应用的最新数据。虽然在过去的几年中, 关于激光治疗方面的论文数量迅速增加, 但许多研究样本量少, 持续时间短, 质量差, 而且是由设备商赞助的。有证据表明, 阴道激光治疗中使用YAG激光(FotonaSmooth^®)或二氧化碳激光(MonaLisa Touch^®)均能有效缓解女性外阴阴道萎缩。三种激光治疗的疗效均持续至少12个月, 且治疗过程中患者有良好的耐受性, 短暂的轻微不适是最常见的不良事件。而阴道激光治疗有可能成为不能使用雌激素治疗的女性的一种替代治疗, 如乳腺癌患者。关于阴道激光治疗在临床实践中的作用仍有诸多尚未解决的问题, 特别是在标准的保守治疗方面。阴道激光治疗在其他情况的应用如压力性尿失禁的治疗中的地位还不清楚。目前有一些随机临床试验还在进行, 其结果应该有助于回答其中一些问题。在此期间, 应该限制阴道激光设备在临床的试验。

Keywords:

• Vulvovaginal atrophy
• genitourinary syndrome of the menopause
• stress urinary incontinence
• vaginal laser therapy
• energy-based devices

Potential conflict of interest

The author’s travel and subsistence expenses to the Vaginal Erbrium Laser Academy (VELA) conference, March 2020 in Florence, were covered by Fotona. The author has received remuneration for presentations from Theramex and Shionogi.

Source of funding

Nil.