Study design, materials and methods
37 patients with Genitourinary Syndrome of Menopause (GSM) average age 58,3 years and a BMI average 27,1 where included in this protocol. Patients received three urethral and vaginal laser sessions of a 2940 nm Er:YAG laser in non-ablative mode, using a special vaginal robotic laser probe and a 4 mm intraurethral laser cannula. Visual Analog Scale (VAS) analysis for both urinary and vaginal symptoms, was performed for assessment of the severity of the following GSM symptoms: dyspareunia, dryness, irritation, leucorrhea, dysuria, urinary frequency and urinary urgency. Vaginal pH testing as well as the vaginal maturation index (MI) calculated by cytological examination using light microscopy, was used to not only determine the severity of the atrophy, but also to objectify the degree of the improvement after the treatment. The data of MI were then used to calculate the maturation value (MV) which better shows the overall improvement. These were performed before and at 3, and 12 months after the first laser session.
Interpretation of results
In 2014, GSM has been accepted as a consensus new terminology for vulvovaginal and urethral atrophy and defined as a collection of symptoms and signs associated with aging and a decrease in estrogen and other sex steroids syndrome, including but not limited to genital symptoms of dryness, burning, and irritation; sexual symptoms of lack of lubrication, discomfort or pain, and impaired function; and urinary symptoms of urgency, dysuria, and recurrent urinary tract infections. Improvement in the symptoms of GSM can be achieved either by increasing the local estrogen levels or the blood flow in the affected area (1). The positive effect of the Erbium:YAG laser on the epithelium and lamina propria is presumably due to the stimulation of cell proliferation via heat shock protein activation, vasodilation, an increase of collagen production, angiogenesis as well as anti-inflammatory action (2). The tropism of the urethral mucosa can also be improved through a controlled local warming process (3) by using a non-ablative Erbium:YAG laser with a special modality that deliver the energy in trains of long pulses.