Опубликована: Март 21, 2023
em 1,3, 6 e 12 meses após completarem o tratamento.
JAMA Network Open, Год журнала: 2023, Номер 6(2), С. e2255697 - e2255697
Опубликована: Фев. 10, 2023
Importance Survivors of breast cancer present more severe symptoms genitourinary syndrome menopause (GSM) than patients without history cancer. Recently, new treatments, such as vaginal laser therapy, have appeared, but evidence their efficacy remains scarce. Objective To assess the safety and carbon dioxide (CO 2 ) vs sham therapy after 6 months follow-up in survivors with GSM receiving aromatase inhibitors. Design, Setting, Participants This prospective double-blind sham-controlled randomized clinical trial two parallel study groups was performed during October 2020 to March 2022 a tertiary referral hospital. using inhibitors were assessed for eligibility, eligible into treatment groups. Follow-up conducted at months. Data analyzed July 2022. Interventions All from both instructed use first-line (FLT) based on nonhormonal moisturizers vibrator stimulation. Patients each group allocated 5 monthly sessions fractional CO (CLT) or (SLT). Main Outcomes Measures The primary outcome sexual function, evaluated through Female Sexual Function Index (FSFI) score. Other subjective measures included visual analog scale dyspareunia, pH, Vaginal Health Index, quality life (assessed via Short-Form 12), body image Spanish Body Image Scale). maturation index, epithelial elasticity (measured Pascals) thickness millimeters). before intervention. Tolerance Likert scale), adverse effects, estradiol levels recorded. Results Among 211 assessed, 84 women deemed 72 (mean [SD] age, 52.6 [8.3] years) CLT (35 participants) SLT (37 analyzed. There no statistically significant differences between baseline. At months, showed improvement FSFI score baseline months: CLT, 14.8 [8.8] points 20.0 [9.5] points; SLT, 15.6 [7.0] 23.5 [6.5] points), there difference function test overall difference, 5.2 [1.5] 7.9 [1.2] P = .15) excluding who not sexually active 2.9 [1.4] 5.5 [1.1] .15). also other outcomes, including dyspareunia −4.3 [3.4] −4.5 [2.3]; .73), 3.3 [4.1] 5.0 [4.5]; .17), −3.7 [4.5] −2.7 [4.8]; .35), −0.3 [3.6] −0.7 [3.2]; .39). Similarly, improvements objective pH −0.6 [0.9] −0.8 [1.2]; .29), index 10.2 [17.4] 14.4 [17.1]; .15), 0.021 [0.014] mm 0.013 [0.012] mm; .30), −1373 [3197] Pascals −2103 [3771] Pascals; .64). analysis regardless many outcomes. interventions well tolerated, tolerance significantly lower score, [1.3] 4.1 [1.0]; .007). No observed complications serum levels. Conclusions Relevance In this trial, found be safe follow-up, SLT. Trial Registration ClinicalTrials.gov Identifier: NCT04619485
Язык: Английский
Процитировано
45
Journal of Clinical Medicine, Год журнала: 2024, Номер 13(5), С. 1377 - 1377
Опубликована: Фев. 28, 2024
Stress urinary incontinence (SUI) affects around 20% of women. In addition to the established suburethral sling insertion, two less invasive approaches are interest today: urethral bulking agents and vaginal laser therapy. This review discusses articles through December 2023 identified by a PubMed literature search using keywords "incontinence" "bulking" or "laser". Although effective than insertions, there specific conditions in which one other technique is more advantageous. Injecting into urethra only takes some minutes works without general anesthesia. The method particularly suited for elderly, frail, obese patients with multiple comorbidities, but also applicable all combination therapies. Generally, safety profile good differs between materials. Two types-the Erbium:YAG SMOOTH-mode fractional ablative CO
Язык: Английский
Процитировано
7
Women s Health, Год журнала: 2024, Номер 20
Опубликована: Янв. 1, 2024
Knowledge of female genital anatomy and physiology is often inadequate or incorrect among women. Precise patient–physician conversations can be inhibited by a reluctance inability to speak accurately about the vulva vagina, with terms being used interchangeably. There paucity scientific evidence clinical guidelines support women physicians in ensuring best practices feminine hygiene. In this review, unmet needs field are highlighted. Evidence provided for complex array physiological pathological systems, mechanisms behaviours that either protect or, if inappropriate, predispose vagina infections, irritation other conditions. The need attention perineal health recommended, given interdependence vulvar microbiota risk colonic pathogens reaching vagina. Differences hygiene vary widely across world varying age groups, suboptimal habits (such as vaginal douching use certain cleansers) associated increased risks Critical areas discussion when advising on their intimate include: advice surrounding aesthetic cosmetic trends depilation surgery), bowel habits, protection against sexually transmitted infections. Routine, once-daily (maximum twice-daily) washing pH-balanced, mild cleanser optimal, ideally soon after voiding, feasible. Due finely balanced ecosystems vulva, area, perspective essential determining most appropriate cleansers based components. Correct care may contribute improved sexual overall well-being. An awareness correct will empower advocates own health.
Язык: Английский
Процитировано
6
International Journal of Women s Health, Год журнала: 2023, Номер Volume 15, С. 1261 - 1282
Опубликована: Авг. 1, 2023
Abstract: Genitourinary syndrome of menopause (GSM) is a frequent consequence iatrogenic or anti-estrogenic adjuvant therapies in breast cancer survivors (BCSs). GSM may profoundly affect sexual health and quality life, multidimensional unique model care needed to address the burden this chronic heterogeneous condition. Severe symptoms be insufficiently managed with non-hormonal traditional treatments, such as moisturizers lubricants, recommended first-line approach by current guidelines, because concerns exist around use vaginal estrogens, particularly women on aromatase inhibitors (AIs). Vaginal laser therapy has emerged promising alternative who are not suitable do respond hormonal management, willing pharmacological strategies. We aim systematically review evidence about efficacy safety BCSs highlight gaps literature. analyzed results from 20 studies, including over 700 treated either CO 2 erbium laser, quite primary outcomes duration follow up (4 weeks– 24 months). Although for comes mostly single-arm prospective only one randomized double-blind sham-controlled trial comparative hyaluronic acid, available data reassuring short term indicate effectiveness both lasers most common symptoms. However, further studies mandatory establish long-term menopausal women, BCSs. Keywords: genitourinary menopause, GSM, cancer, vulvovaginal atrophy, VVA
Язык: Английский
Процитировано
11
Urogynecology, Год журнала: 2024, Номер unknown
Опубликована: Апрель 25, 2024
Pelvic floor muscle training (PFMT) is considered the first option as a conservative treatment for female stress urinary incontinence (SUI). However, there still debate whether energy-based devices are effective treating SUI.
Язык: Английский
Процитировано
4
Menopause The Journal of The North American Menopause Society, Год журнала: 2025, Номер 32(3), С. 228 - 233
Опубликована: Янв. 7, 2025
Abstract Objective A randomized controlled trial showed that Neodymium:YAG/Erbium:YAG laser therapy was safe and significantly improved clinical outcomes subjective symptoms of vulvar lichen sclerosus (LS). Most improvements were similar to those after the recommended first-line with topical steroid. In this exploratory study, we wanted analyze impact menopausal status on perception treatment outcome. Methods Sixty-six women assigned or steroid arm (2:1). Participants received four treatments a follow-up 6 months initiation. Clinical objective (LS score) (vulvovaginal questionnaire [VSQ], symptom visual analogue scale [VAS] score, patient satisfaction) evaluated. Results Nineteen 66 study participants premenopausal, 47 postmenopausal. At baseline, premenopausal younger (39.4 vs 67.4 yr, P < 0.001), only few applied local estrogen (16% 74%, their VSQ score higher (9.58 7.32, = 0.015) indicating more severe vulvovaginal symptoms. Laser objectively led for pre- postmenopausal (−2.62 −2.23, 0.437), but subjectively improvement in (−4.13 −1.08, 0.005). Postmenopausal satisfied than (71% 46%, 0.002). Conclusion Compared women, experienced lower burden disease better therapy. Perceptions expectations are age-dependent should be considered when treating sclerosus.
Язык: Английский
Процитировано
0
Menopause The Journal of The North American Menopause Society, Год журнала: 2025, Номер unknown
Опубликована: Янв. 7, 2025
Abstract Importance Hormone treatments for genitourinary syndrome of menopause (GSM) symptoms have limitations. There is interest in nonhormone therapies, including energy-based interventions. Benefits and harms interventions are not currently well known. Objective The aim this study was to assess the benefits therapies (eg, CO 2 laser, Er:YAG radiofrequency) GSM. Outcomes eight “Core Menopause” include following: dyspareunia, vulvovaginal dryness, discomfort/irritation, dysuria, change most bothersome symptom, quality life, treatment satisfaction, adverse effects. Evidence Review Eligible studies included English language randomized controlled trials (RCT) or prospective observational with ≥8 weeks follow-up postmenopausal women ≥1 GSM symptom any design reporting effects ≥12 months postintervention. Ovid/MEDLINE, Embase, CINAHL were searched from inception December 11, 2023 using vocabulary natural terms, along free-text words. Two authors extracted data assessed studies. Findings We identified 32 unique (16 RCT; 1 quasi-RCT; 15 nonrandomized). Ten RCT quasi-RCT rated low moderate risk bias (RoB) underwent extraction. Included evaluated laser (k = 7), 3), radiofrequency 1). compared sham 4) may result little no difference life (low certainty evidence [COE]). vaginal conjugated estrogens cream 2) COE). Treatment on all other outcomes outcome very uncertain (very Studies noted few events serious events. Conclusions Relevance resulted estrogen; effect versus comparators outcomes. Adverse event limited. a need further assessing
Язык: Английский
Процитировано
0
Journal of Gynecology Obstetrics and Human Reproduction, Год журнала: 2025, Номер unknown, С. 102933 - 102933
Опубликована: Фев. 1, 2025
Язык: Английский
Процитировано
0
Archives of Gynecology and Obstetrics, Год журнала: 2023, Номер 308(2), С. 643 - 649
Опубликована: Май 5, 2023
Abstract Purpose Vulvar lichen sclerosus (LS) is a chronic debilitating inflammatory skin disease. Today, the gold standard life-long topical steroid treatment. Alternative options are highly desired. We present study protocol of prospective, randomized, active-controlled, investigator-initiated clinical trial comparing novel non-invasive dual Nd:YAG/Er:YAG laser therapy with for management LS. Methods recruited 66 patients, 44 in arm and 22 arm. Patients physician-administered LS score ≥ 4 were included. Participants received either four treatments 1–2 months apart, or 6 application. Follow-ups planned at 6, 12, 24 months. The primary outcome looks efficacy treatment 6-month follow-up. Secondary outcomes look comparisons between baseline follow-ups within arm, vs. Objective (LS score, histopathology, photo documentation) subjective (Vulvovaginal Symptoms Questionnaire, symptom VAS patient satisfaction) measurements, tolerability, adverse events evaluated. Conclusion findings this have potential to offer option standardized settings regime presented paper. Clinical identification number NCT03926299.
Язык: Английский
Процитировано
7
Journal of Women s Health, Год журнала: 2024, Номер 33(5), С. 685 - 691
Опубликована: Апрель 2, 2024
Background: This study aims to evaluate the safety and efficacy of erbium:yttrium–aluminum–garnet (Er:YAG) laser treatment in female patients with mild-to-moderate stress urinary incontinence (SUI).
Язык: Английский
Процитировано
2