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CO2-Laser therapy and Genitourinary Syndrome of Menopause: A Systematic Review and Meta-Analysis.
J Sex Med. 2022 03; 19(3):452-470.JS

Abstract

BACKGROUND

Genitourinary syndrome of menopause (GSM) is a widespread condition with a great impact on quality of life and self-image.

AIM

We aimed to systematically review the current literature on CO2-Laser therapy efficacy for the treatment of GSM.

METHODS

MEDLINE and Embase databases were systematically queried in December 2020 Studies included women with a diagnosis of Vulvo-Vaginal Atrophy (VVA) or GSM without an history of gynaecological and/or breast cancer, pelvic organ prolapse staged higher than 2, pelvic radiotherapy or Sjogren's Syndrome. The quality of the evidence was assessed with the Cochrane risk of bias tool. This study is registered on PROSPERO, number CRD42021238121.

OUTCOMES

Effects of CO2-Laser therapy on GSM symptoms assessed through subjective or objective efficacy measurement methods.

RESULTS

A total of 803 articles were identified. Of these, 25 studies were included in this review for a total of 1,152 patients. All studies showed a significant reduction in VVA and/or GSM symptoms (dryness, dyspareunia, itching, burning, dysuria). The pooled mean differences for the symptoms were: dryness -5.15 (95% CI:-5.72,-4.58; P < .001; I2:62%; n = 296), dyspareunia -5.27 (95% CI:-5.93,-4.62; P < .001; I2:68%; n = 296), itching -2.75 (95% CI:-4.0,-1.51; P < .001; I2:93%; n = 281), burning -2.66 (95% CI:-3.75, -1.57; P < .001; I2:86%; n = 296) and dysuria -2.14 (95% CI:-3.41,-0.87; P < .001; I2:95%; n = 281). FSFI, WHIS and VMV scores also improved significantly. The pooled mean differences for these scores were: FSFI 10.8 (95% CI:8.41,13.37; P < .001; I2:84%; n = 273), WHIS 8.29 (95% CI:6.16,10.42; P < .001; I2:95%; n = 262) and VMV 30.4 (95% CI:22.38,38.55; P < .001; I2:24%; n = 68). CO2-Laser application showed a beneficial safety profile and no major adverse events were reported.

CLINICAL IMPLICATIONS

Vaginal laser treatment resulted in both a statistically and clinically significant improvement in GSM symptoms. FSFI improved significantly in all 8 included studies but it reached a clinically relevant level only in 2 of them.

STRENGTHS & LIMITATIONS

The strength of the current meta-analysis is the comprehensive literature search. We reported data from a high number of patients (1,152) and high number of laser applications (more than 3,800). The main limitations are related to the high heterogeneity of the included studies investigating laser effects. Moreover, most of them are single center and nonrandomized studies.

CONCLUSION

The data suggest that CO2-Laser is a safe energy-based therapeutic option for the management of VVA and/or GSM symptoms in postmenopausal women; however, the quality of the body of evidence is "very low" or "low". Filippini M, Porcari I, Ruffolo AF, et al., CO2-Laser therapy and Genitourinary Syndrome of Menopause: A Systematic Review and Meta-Analysis. J Sex Med 2022;19:452-470.

Authors+Show Affiliations

Department of Obstetrics and Gynecology, Hospital State of Republic of San Marino, San Marino, Republic of San Marino.Department of Obstetrics and Gynecology, University of Verona, Verona, Italy. Electronic address: irene.porcari@gmail.com.Department of Obstetrics and Gynecology, IRCCS San Raffaele Scientific Institute, University Vita and Salute, Milan, Italy.Department of Obstetrics and Gynecology, IRCCS San Raffaele Scientific Institute, University Vita and Salute, Milan, Italy.Department of Obstetrics and Gynecology, Hospital State of Republic of San Marino, San Marino, Republic of San Marino.Department of Obstetrics and Gynecology, University of Verona, Verona, Italy.Department of Obstetrics and Gynecology, University of Verona, Verona, Italy.Department of Obstetrics and Gynecology, IRCCS San Raffaele Scientific Institute, University Vita and Salute, Milan, Italy.Department of Obstetrics and Gynecology, IRCCS San Raffaele Scientific Institute, University Vita and Salute, Milan, Italy.

Pub Type(s)

Journal Article
Meta-Analysis
Systematic Review

Language

eng

PubMed ID

35101378

Citation

Filippini, Maurizio, et al. "CO2-Laser Therapy and Genitourinary Syndrome of Menopause: a Systematic Review and Meta-Analysis." The Journal of Sexual Medicine, vol. 19, no. 3, 2022, pp. 452-470.
Filippini M, Porcari I, Ruffolo AF, et al. CO2-Laser therapy and Genitourinary Syndrome of Menopause: A Systematic Review and Meta-Analysis. J Sex Med. 2022;19(3):452-470.
Filippini, M., Porcari, I., Ruffolo, A. F., Casiraghi, A., Farinelli, M., Uccella, S., Franchi, M., Candiani, M., & Salvatore, S. (2022). CO2-Laser therapy and Genitourinary Syndrome of Menopause: A Systematic Review and Meta-Analysis. The Journal of Sexual Medicine, 19(3), 452-470. https://doi.org/10.1016/j.jsxm.2021.12.010
Filippini M, et al. CO2-Laser Therapy and Genitourinary Syndrome of Menopause: a Systematic Review and Meta-Analysis. J Sex Med. 2022;19(3):452-470. PubMed PMID: 35101378.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - CO2-Laser therapy and Genitourinary Syndrome of Menopause: A Systematic Review and Meta-Analysis. AU - Filippini,Maurizio, AU - Porcari,Irene, AU - Ruffolo,Alessandro F, AU - Casiraghi,Arianna, AU - Farinelli,Miriam, AU - Uccella,Stefano, AU - Franchi,Massimo, AU - Candiani,Massimo, AU - Salvatore,Stefano, Y1 - 2022/01/29/ PY - 2021/04/27/received PY - 2021/11/28/revised PY - 2021/12/20/accepted PY - 2022/2/2/pubmed PY - 2022/3/30/medline PY - 2022/2/1/entrez KW - Genitourinary Syndrome of Menopause (GSM) KW - Menopause KW - Vaginal CO2-Laser KW - Vulvo-Vaginal Atrophy (VVA) SP - 452 EP - 470 JF - The journal of sexual medicine JO - J Sex Med VL - 19 IS - 3 N2 - BACKGROUND: Genitourinary syndrome of menopause (GSM) is a widespread condition with a great impact on quality of life and self-image. AIM: We aimed to systematically review the current literature on CO2-Laser therapy efficacy for the treatment of GSM. METHODS: MEDLINE and Embase databases were systematically queried in December 2020 Studies included women with a diagnosis of Vulvo-Vaginal Atrophy (VVA) or GSM without an history of gynaecological and/or breast cancer, pelvic organ prolapse staged higher than 2, pelvic radiotherapy or Sjogren's Syndrome. The quality of the evidence was assessed with the Cochrane risk of bias tool. This study is registered on PROSPERO, number CRD42021238121. OUTCOMES: Effects of CO2-Laser therapy on GSM symptoms assessed through subjective or objective efficacy measurement methods. RESULTS: A total of 803 articles were identified. Of these, 25 studies were included in this review for a total of 1,152 patients. All studies showed a significant reduction in VVA and/or GSM symptoms (dryness, dyspareunia, itching, burning, dysuria). The pooled mean differences for the symptoms were: dryness -5.15 (95% CI:-5.72,-4.58; P < .001; I2:62%; n = 296), dyspareunia -5.27 (95% CI:-5.93,-4.62; P < .001; I2:68%; n = 296), itching -2.75 (95% CI:-4.0,-1.51; P < .001; I2:93%; n = 281), burning -2.66 (95% CI:-3.75, -1.57; P < .001; I2:86%; n = 296) and dysuria -2.14 (95% CI:-3.41,-0.87; P < .001; I2:95%; n = 281). FSFI, WHIS and VMV scores also improved significantly. The pooled mean differences for these scores were: FSFI 10.8 (95% CI:8.41,13.37; P < .001; I2:84%; n = 273), WHIS 8.29 (95% CI:6.16,10.42; P < .001; I2:95%; n = 262) and VMV 30.4 (95% CI:22.38,38.55; P < .001; I2:24%; n = 68). CO2-Laser application showed a beneficial safety profile and no major adverse events were reported. CLINICAL IMPLICATIONS: Vaginal laser treatment resulted in both a statistically and clinically significant improvement in GSM symptoms. FSFI improved significantly in all 8 included studies but it reached a clinically relevant level only in 2 of them. STRENGTHS & LIMITATIONS: The strength of the current meta-analysis is the comprehensive literature search. We reported data from a high number of patients (1,152) and high number of laser applications (more than 3,800). The main limitations are related to the high heterogeneity of the included studies investigating laser effects. Moreover, most of them are single center and nonrandomized studies. CONCLUSION: The data suggest that CO2-Laser is a safe energy-based therapeutic option for the management of VVA and/or GSM symptoms in postmenopausal women; however, the quality of the body of evidence is "very low" or "low". Filippini M, Porcari I, Ruffolo AF, et al., CO2-Laser therapy and Genitourinary Syndrome of Menopause: A Systematic Review and Meta-Analysis. J Sex Med 2022;19:452-470. SN - 1743-6109 UR - https://www.unboundmedicine.com/medline/citation/35101378/CO2_Laser_therapy_and_Genitourinary_Syndrome_of_Menopause:_A_Systematic_Review_and_Meta_Analysis_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1743-6095(21)00830-4 DB - PRIME DP - Unbound Medicine ER -