Láser de CO2 en el tratamiento del síndrome genitourinario y la incontinencia urinaria

Resumen

Genitourinary syndrome is defined as the vulvovaginal changes of the lower urinary tract and sexual dysfunctions that occur in women, related to estrogen deficiency, often associated with menopause. It affects approximately 50% of menopausal women and causes a great impact on quality of life and sexual function. For years, the only treatment has been hormone replacement therapy, or topical hormone treatments. The use of the CO2 laser in the treatment of these symptoms has shown significant improvements in the quality of life of patients, as well as in their sexual function. As for urinary incontinence, it is estimated that it affects 17% of the adult population and almost 75% if we talk about the elderly population or over 80 years. In recent years, it has also been used for the treatment of incontinence that also accompanies the so-called genitourinary syndrome. OBJECTIVES The main objective of this study is to test the efficacy of CO2 laser treatment in patients with SGM and urinary incontinence. METHODOLOGY A prospective observational study was conducted, in which 57 patients suffering from the symptoms of SGM were recruited. They were treated with three sessions of CO2 laser adjusting the specific parameters according to the pathology treated. The first session was separated from the second by 6 to 8 weeks, and then a third session was held a year from the first. To evaluate the variable of urinary incontinence, the ICIQ-SF questionnaires and the Sandvick questionnaire were passed to evaluate the severity of incontinence, before and after each session. To assess vulvovaginal atrophy and dyspareunia, patients filled out, before and after each session, an EVA scale numbered from 1 to 5, where the score of 5 corresponded to a maximum level of discomfort/dryness, and 1 corresponded to not experiencing the symptoms of atrophy. Dyspareunia was assessed in the same way. RESULTS The results indicate a significant reduction in the atrophy scores experienced by women, it was based on a baseline score of 3.7 out of 5, and after treatment the scores stood at 1.9 out of 5, with a p =0.0001. In the dyspareunia variable, scores decreased from 3.5 at the beginning of treatment, to 2.4 at the end of treatment, with a p=0.0001. The results show that, after treatment, the quality of life improves in patients suffering from incontinence. At the beginning of treatment, patients placed their quality of life at 3.2 out of 10, and when treatment is completed, these scores were reduced to 1.2, with a p=0.0001. Patients experienced an improvement in urinary incontinence symptoms at the end of treatment, as ICIQ-SF scores were reduced from 7 at the start of treatment to 3.4 at the end of all sessions, with a p=0.001. Regarding the severity of incontinence, the results indicate that CO2 laser treatment significantly reduces the severity of incontinence experienced by patients. The baseline scores were a moderate-mild SUI (3.4), and at the end of treatment, they stood at 1.4, a mild SUI, with a p=0.001. To sum up, we can affirm that laser treatment it´s a safe option, and shows promising results in the treatment of genitourinary syndrome and mild stress incontinence. Nevertheless, more studies are needed, with a larger sample, to generate more robust evidence.