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The Clinical Role of LASER for Vulvar and Vaginal Treatments in Gynecology and Female Urology

An ICS/ISSVD Best Practice Consensus Document

Preti, Mario, MD1; Vieira-Baptista, Pedro, MD2,3; Digesu, Giuseppe Alessandro, PhD4; Bretschneider, Carol Emi, MD5; Damaser, Margot, PhD5,6,7; Demirkesen, Oktay, MD8; Heller, Debra S., MD9; Mangir, Naside, MD10,11; Marchitelli, Claudia, MD12; Mourad, Sherif, MD13; Moyal-Barracco, Micheline, MD14; Peremateu, Sol, MD12; Tailor, Visha, MD4; Tarcan, Tufan, MD15; De, Elise J. B., MD16; Stockdale, Colleen K., MD, MS17

Journal of Lower Genital Tract Disease: April 2019 - Volume 23 - Issue 2 - p 151–160
doi: 10.1097/LGT.0000000000000462
Benign Vulvovaginal Disorders
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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. 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 most studies are industry sponsored. Because of 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 after 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. The available clinical studies do not present convincing data regarding the efficacy of LASER for the treatment of vaginal atrophy or urinary incontinence. Also, although short-term complications seem to be uncommon, data concerning long-term outcomes are lacking. Therefore, 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.

1Department of Obstetrics and Gynecology, University of Torino, Torino, Italy;

2Hospital Lusíadas Porto;

3Lower Genital Tract Unit, Centro Hospitalar de São João, Porto, Portugal;

4Imperial College Healthcare, Department of Urogynaecology, London, UK;

5Center for Urogynecology and Pelvic Reconstructive Surgery, Obstetrics, Gynecology and Women's Health Institute, Cleveland Clinic;

6Glickman Urological and Kidney Institute and Department of Biomedical Engineering Lerner Research Institute, Cleveland Clinic;

7Advanced Platform Technology Center Louis Stokes Cleveland VA Medical Center, Cleveland, OH;

8Istanbul University Cerrahpaşa Faculty of Medicine, Department of Urology, Istanbul, Turkey;

9Department of Pathology & Laboratory Medicine, Rutgers–New Jersey Medical School, Newark, NJ;

10Kroto Research Institute, Department of Material Science and Engineering, University of Sheffield;

11Royal Hallamshire Hospital, Department of Urology, Sheffield, UK;

12Department of Gynecology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina;

13Ain Shams University, Department of Urology, Cairo, Egypt;

14Department of Dermatology, Hôpital Tarnier-Cochin, Paris, France;

15Marmara University School of Medicine, Department of Urology, Istanbul, Turkey;

16Department of Urology, Massachusetts General Hospital–Harvard Medical School Boston, MA; and

17Department of Obstetrics and Gynecology, University of Iowa, Iowa City, IA

Reprint requests to: Pedro Vieira-Baptista, MD, Hospital Lusíadas Porto, Porto, Portugal. E-mail: Secretary.general@issvd.org

No funds were received for the elaboration of this paper.

IRB status: this paper was considered IRB exempt.

The authors declare no conflicts of interest.

Copyright © 2019 by the American Society for Colposcopy and Cervical Pathology