SOUNDING BOARD
The clinical role of LASER for vulvar and vaginal treatments in gynecology and female urology: An ICS/ISSVD best practice consensus document
Correction(s) for this article
-
Corrigendum
- Volume 39Issue 3Neurourology and Urodynamics
- pages: 1028-1028
- First Published online: February 5, 2020
Mario Preti MD,
Pedro Vieira-Baptista MD,
Giuseppe Alessandro Digesu PhD,
Carol Emi Bretschneider MD,
Margot Damaser PhD,
Oktay Demirkesen MD,
Debra S. Heller MD,
Naside Mangir MD,
Claudia Marchitelli MD,
Sherif Mourad MD,
Micheline Moyal-Barracco MD,
Sol Peremateu MD,
Visha Tailor MD,
Tufan Tarcan MD,
Elise J.B. De MD,
Colleen K. Stockdale MD, MS,
Mario Preti MD
Department of Obstetrics and Gynecology, University of Torino, Torino, Italy
Search for more papers by this authorPedro Vieira-Baptista MD
Hospital Lusíadas Porto, Porto, Portugal
Lower Genital Tract Unit, Centro Hospitalar de São João, Porto, Portugal
Search for more papers by this authorCorresponding Author
Giuseppe Alessandro Digesu PhD
Department of Urogynaecology, Imperial College Healthcare, London, UK
Correspondence
Giuseppe Alessandro Digesu, Imperial College Healthcare, Department of Urogynaecology, London, UK.
Email: [email protected]
Search for more papers by this authorCarol Emi Bretschneider MD
Center for Urogynecology and Pelvic Reconstructive Surgery, Obstetrics, Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, Ohio
Search for more papers by this authorMargot Damaser PhD
Center for Urogynecology and Pelvic Reconstructive Surgery, Obstetrics, Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, Ohio
Glickman Urological and Kidney Institute and Department of Biomedical Engineering Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
Advanced Platform Technology Center, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio
Search for more papers by this authorOktay Demirkesen MD
Faculty of Medicine, Department of Urology, Istanbul University Cerrahpaşa, Istanbul, Turkey
Search for more papers by this authorDebra S. Heller MD
Department of Pathology and Laboratory Medicine, Rutgers-New Jersey Medical School, Newark, New Jersey
Search for more papers by this authorNaside Mangir MD
Kroto Research Institute, Department of Material Science and Engineering, University of Sheffield, Sheffield, UK
Department of Urology, Royal Hallamshire Hospital, Sheffield, UK
Search for more papers by this authorClaudia Marchitelli MD
Department of Gynecology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
Search for more papers by this authorSherif Mourad MD
Department of Urology, Ain Shams University, Cairo, Egypt
Search for more papers by this authorMicheline Moyal-Barracco MD
Department of Dermatology, Hôpital Tarnier-Cochin, Paris, France
Search for more papers by this authorSol Peremateu MD
Department of Gynecology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
Search for more papers by this authorVisha Tailor MD
Department of Urogynaecology, Imperial College Healthcare, London, UK
Search for more papers by this authorTufan Tarcan MD
Department of Urology, Marmara University School of Medicine, Istanbul, Turkey
Search for more papers by this authorElise J.B. De MD
Department of Urology, Massachusetts General Hospital—Harvard Medical School Boston, Boston, Massachusetts
Search for more papers by this authorColleen K. Stockdale MD, MS
Department of Obstetrics and Gynecology, University of Iowa, Iowa City, Iowa
Search for more papers by this authorMario Preti MD,
Pedro Vieira-Baptista MD,
Giuseppe Alessandro Digesu PhD,
Carol Emi Bretschneider MD,
Margot Damaser PhD,
Oktay Demirkesen MD,
Debra S. Heller MD,
Naside Mangir MD,
Claudia Marchitelli MD,
Sherif Mourad MD,
Micheline Moyal-Barracco MD,
Sol Peremateu MD,
Visha Tailor MD,
Tufan Tarcan MD,
Elise J.B. De MD,
Colleen K. Stockdale MD, MS,
Mario Preti MD
Department of Obstetrics and Gynecology, University of Torino, Torino, Italy
Search for more papers by this authorPedro Vieira-Baptista MD
Hospital Lusíadas Porto, Porto, Portugal
Lower Genital Tract Unit, Centro Hospitalar de São João, Porto, Portugal
Search for more papers by this authorCorresponding Author
Giuseppe Alessandro Digesu PhD
Department of Urogynaecology, Imperial College Healthcare, London, UK
Correspondence
Giuseppe Alessandro Digesu, Imperial College Healthcare, Department of Urogynaecology, London, UK.
Email: [email protected]
Search for more papers by this authorCarol Emi Bretschneider MD
Center for Urogynecology and Pelvic Reconstructive Surgery, Obstetrics, Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, Ohio
Search for more papers by this authorMargot Damaser PhD
Center for Urogynecology and Pelvic Reconstructive Surgery, Obstetrics, Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, Ohio
Glickman Urological and Kidney Institute and Department of Biomedical Engineering Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
Advanced Platform Technology Center, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio
Search for more papers by this authorOktay Demirkesen MD
Faculty of Medicine, Department of Urology, Istanbul University Cerrahpaşa, Istanbul, Turkey
Search for more papers by this authorDebra S. Heller MD
Department of Pathology and Laboratory Medicine, Rutgers-New Jersey Medical School, Newark, New Jersey
Search for more papers by this authorNaside Mangir MD
Kroto Research Institute, Department of Material Science and Engineering, University of Sheffield, Sheffield, UK
Department of Urology, Royal Hallamshire Hospital, Sheffield, UK
Search for more papers by this authorClaudia Marchitelli MD
Department of Gynecology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
Search for more papers by this authorSherif Mourad MD
Department of Urology, Ain Shams University, Cairo, Egypt
Search for more papers by this authorMicheline Moyal-Barracco MD
Department of Dermatology, Hôpital Tarnier-Cochin, Paris, France
Search for more papers by this authorSol Peremateu MD
Department of Gynecology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
Search for more papers by this authorVisha Tailor MD
Department of Urogynaecology, Imperial College Healthcare, London, UK
Search for more papers by this authorTufan Tarcan MD
Department of Urology, Marmara University School of Medicine, Istanbul, Turkey
Search for more papers by this authorElise J.B. De MD
Department of Urology, Massachusetts General Hospital—Harvard Medical School Boston, Boston, Massachusetts
Search for more papers by this authorColleen K. Stockdale MD, MS
Department of Obstetrics and Gynecology, University of Iowa, Iowa City, Iowa
Search for more papers by this authorRoger Dmochowski led the peer-review process as the Associate Editor responsible for the paper.
Abstract
BACKGROUND
The clinical role of LASER for vulvar and vaginal treatments in gynecology and female urology is controversial.
AIMS
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.
MATERIALS & METHODS
This project was developed between January and September 2018. The development of this document followed the ICS White Paper Standard Operating Procedures.
RESULTS
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 studies are industry sponsored. Due to 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 following 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.
DISCUSSION
The available clinical studies do not present convincing data regarding the efficacy of LASER for the treatment of vaginal atrophy or urinary incontinence. Also, while short-term complications seem to be uncommon, data concerning long-term outcomes are lacking.
CONCLUSION
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.
CONFLICT OF INTEREST
No conflicts of interest to declare.
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