An innovative dual-phase protocol for pulsed ablative vaginal Erbium:YAG laser treatment of urogynecological symptoms

• Published in: European journal of obstetrics & gynecology and reproductive biology 2018-10, Vol.229, p.167-171
• Main Authors: Mothes, Anke R., Runnebaum, Marion, Runnebaum, Ingo B.
• Format: Article
• Language: English
• Subjects: Aged; Clavien-Dindo complication classification; Dual-phase protocol; Female; Gynecologic Surgical Procedures - methods; Humans; Lasers, Solid-State - therapeutic use; Middle Aged; Pelvic Floor Disorders - surgery; Pelvic floor medicine; Retrospective Studies; Urogynecology; Vaginal ablative erbium:YAG laser
• ISSN: 0301-2115; 1872-7654
• DOI: 10.1016/j.ejogrb.2018.08.010

To evaluate a dual-phase protocol for vaginal ablative Erbium:YAG laser treatment in pelvic floor medicine. Data from consecutive patients undergoing vaginal Erbium:YAG laser for first-degree pelvic floor complaints at a certified university urogynecological unit were analyzed. Fractional ablative and thermal treatment with adjustable pulse duration, fluence, and pulse interval was performed in single ten-minute treatment course. Followed up interval was 6 weeks including interviews on expectations, goal setting, goal achievement, and satisfaction (EGGS), vaginal pH, and determination of the Gloria-Bachmann-Index (VHI). Post-procedural complications were classified according to definition and classification of the Clavien-Dindo system. Of 84 patients treated, 71 (21% pre-, 79% post-menopausal) were evaluated. 27% had single urogynecological symptoms, 35% had three or more combined symptoms. Minor post-procedural complications occurred in three patients (CD I, n = 1; CD II, n = 3). The ranges of fluence, determined according to the atrophy state, in the first and second phases were 15–35 and 3–12 J/cm2, respectively. In patients with genitourinary syndrome of menopause, pre- and post-treatment VHI and pH differed significantly [15.3 ± 4.5 vs. 19.9 ± 2.8 (p < 0.001, Student’s t test) and 5.2 ± 0.6 vs. 4.8 ± 0.4 (p =  0.024, respectively]. Overall, 82% (n = 58; mean age, 58 ± 12 years) of patients were satisfied with the treatment, 84% (47/56) post-menopausal patients were satisfied. Vaginal ablative Erbium:YAG laser dual-phase protocol for early urogynecological symptoms was successful and safe, with high patient satisfaction and few, minor complications. Prospective studies are needed to confirm our first data.