Erbium laser in the management of the genitourinary syndrome in patients after radical therapy for uterine cancer


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Abstract

Objective. To investigate the effectiveness of erbium laser in the management of the genitourinary menopausal syndrome in gynecologic oncology patients. Material and methods. The study comprised 17 patients (mean age 63.5±5.9 years) with the following diagnoses: I-II grade pelvic organ prolapse, mixed urinary incontinence (overactive bladder with stress incontinence), stress urinary incontinence, and vulvovaginal atrophy. All patients were treated with three YAG laser procedures using IntimaLase and IncontiLase with a 28-day interval. The study participants completed PFDI-20 (Pelvic Floor Distress Inventory), VSQ (Vulvovaginal Symptom Questionnaire), and VHI (Vaginal Health Index) questionnaires. The patients also underwent real-time sonoelastography to determine the tissue elasticity and examination of vaginal wall blood flow before, during and after treatment. Results. Median PFDI-20 scores at baseline and after treatment were 87 [67; 105] and 21 [17; 30], respectively. Mean VSQ scores at baseline and after treatment were 10.9 ± 2.3 and 4.5 ± 2.0, respectively. VHIscorefrom 21 to 25 was observed in 12% of patients before and in 76% after treatment (p <0.05). Mean vaginal pH before and after treatment was 6.1 ± 0.6 and 4.5 ± 0.3, respectively (p <0.05). According to vaginal wall ultrasound findings, 56% of patients showed an increase in the number of visualized vaginal wall vessels (p <0.05). In 70% of patients, post-treatment sonoelastography showed an increase in the elasticity of the vaginal wall (p <0.05). Conclusion. YAG laser is effective for the treatment of urogynecological disorders and pelvic floor dysfunction and could be recommended as monotherapy in patients after radical therapy for uterine cancer. However, further clinical studies are needed to confirm the effectiveness and safety of this method, clarify the indications and procedure parameters, and determine the duration of the positive effect.

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About the authors

Yu. E Dobrokhotova

N.I. Pirogov Russian National Research Medical University of Minzdrav of Russia

MD, professor, head of the Department of Obstetrics and Gynecology, Medical Faculty

I. Yu Il'ina

N.I. Pirogov Russian National Research Medical University of Minzdrav of Russia

MD, professor at the Department of Obstetrics and Gynecology, Medical Faculty

M. G Venediktova

N.I. Pirogov Russian National Research Medical University of Minzdrav of Russia

MD, professor at the Department of Obstetrics and Gynecology, Medical Faculty

K. V Morozova

N.I. Pirogov Russian National Research Medical University of Minzdrav of Russia

teaching assistant at the Department of Obstetrics and Gynecology, Medical Faculty

V. A Suvorova

N.I. Pirogov Russian National Research Medical University of Minzdrav of Russia

PhD student at the Department of Obstetrics and Gynecology, Medical Faculty

M. S Utina

N.I. Pirogov Russian National Research Medical University of Minzdrav of Russia

PhD, teaching assistant at the Department of Obstetrics and Gynecology, Medical Faculty

S. A Zalesskaya

N.I. Pirogov Russian National Research Medical University of Minzdrav of Russia

teaching assistant at the Department of Obstetrics and Gynecology, Medical Faculty

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