Abstract
Objective
This technical bulletin reviews the evidence relating to risks and benefits of using
intravaginal laser technology in the management of genitourinary syndrome of menopause
and stress urinary incontinence.
Intended Users
Gynaecologists, urogynaecologists, urologists, and other health care professionals
who assess, counsel, and provide care for women with genitourinary syndrome of menopause
and stress urinary incontinence.
Target Population
Adult women with genitourinary syndrome of menopause and stress urinary incontinence
seeking complementary or alternative treatment options to topical estrogen, non-hormonal
vaginal moisturizers, physiotherapy, intravaginal devices, and surgery.
Options
The discussion relates to intravaginal laser treatments for genitourinary syndrome
of menopause compared with topical estrogen and that for stress urinary incontinence.
Outcomes
The outcomes of interest are objective and subjective rates of response to treatment,
histologic outcomes, and procedural complications.
Evidence
PubMed, Medline, the Cochrane Database, and EMBASE were searched using the key words
“genitourinary syndrome of menopause,” “vaginal laser,” “topical estrogen,” and “urogenital
atrophy.” Results were restricted to English and human research. Articles were included
until the end of September 2016. Clinical practice guidelines and guidelines of specialty
societies were reviewed. Included studies were observational or prospective cohort
when available. Only publications with study groups larger than or equal to 20 individuals
were included, and non–peer-reviewed papers were excluded.
Validation Methods
The content and recommendations were drafted and agreed upon by the principal authors.
The Board of the SOGC approved the final draft for publication. The quality of evidence
was rated using the criteria described in the Grading of Recommendations Assessment,
Development, and Evaluation (GRADE) methodology framework.
Benefits, Harms, and/or Costs
It is expected that this technical bulletin will benefit patients with genitourinary
syndrome of menopause by ensuring treating physicians are aware of all treatment options
including the potential benefit and associated risk with intravaginal laser therapy.
This should guide patient informed consent before such procedures are undertaken.
There are no direct harms or costs identified with the implementation of this guideline.
Sponsors
The SOGC.
Summary Statements
- 1.Histologic evaluation has shown a similar short-term improvement in vaginal epithelial maturation in post-procedural vaginal wall biopsies with the use of intravaginal laser as that seen with local estrogen (Moderate).
- 2.Short-term observational studies of small patient number with the use of intravaginal laser have demonstrated reductions in symptoms (including dryness, burning, itching, dysuria, and dyspareunia) and improvements in sexual satisfaction indices (Low).
- 3.Short-term observational studies of small patient number with the use of intravaginal laser have demonstrated improvements in symptoms of stress urinary incontinence (Low).
Recommendations
- 1.In patients declining or with apparent contraindication to local estrogen, intravaginal laser therapy may be considered for short-term relief of symptoms associated with genitourinary syndrome of menopause (Conditional, Low).
- 2.There is insufficient evidence to offer intravaginal laser therapy as an equivalent modality to local estrogen for the treatment of genitourinary syndrome of menopause (including vulvovaginal atrophy, lower urinary tract symptoms, and sexual dysfunction) (Strong, Very Low).
- 3.There is insufficient evidence to offer intravaginal laser therapy as an effective modality for the treatment of stress urinary incontinence over alternate managements such as pelvic floor physiotherapy, incontinence pessaries, or surgery (strong, very low).
- 4.Long-term use of intravaginal laser therapy for the management of genitourinary syndrome of menopause or stress urinary incontinence remains experimental and should remain within the protocols of well-executed clinical trials in attempts to establish its safety and efficacy (Strong, Very Low).
- 5.Intravaginal laser therapy should not be offered to patients to prevent recurrent urinary tract infections as no literature exists to support such use (Strong, Very Low).
Key Words
Abbreviations:
GUSM (genitourinary syndrome of menopause), ICIQ (International Consultation on Incontinence Questionnaire), MUI (mixed urinary incontinence), RCT (randomized controlled trial), SUI (stress urinary incontinence), UTI (urinary tract infection), VVA (vulvovaginal atrophy)To read this article in full you will need to make a payment
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Article Info
Publication History
No. 358, April 2018
Footnotes
This document reflects emerging clinical and scientific advances on the date issued and is subject to change. The information should not be construed as dictating an exclusive course of treatment or procedure to be followed. Local institutions can dictate amendments to these opinions. They should be well-documented if modified at the local level. None of these contents may be reproduced in any form without prior written permission of the publisher.
Patients have the right and responsibility to make informed decisions about their care in partnership with their health care providers. To facilitate informed choice, women should be provided with information and support that is evidence based, culturally appropriate, and tailored to their needs. The values, beliefs, and individual needs of each patient and their family should be sought, and the final decision about the care and treatment options chosen by the patient should be respected.
Identification
Copyright
Copyright © 2018 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.
