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

Abstract

El síndrome genitourinario se define como los cambios vulvovaginales del tracto urinario inferior y las disfunciones sexuales que ocurren en la mujer, relacionadas con la deficiencia estrogénica. Afecta aproximadamente al 50% de las mujeres menopaúsicas y causa un gran impacto en la calidad de vida y en la función sexual. Durante años, el único tratamiento ha sido la terapia hormonal sustitutiva, o los tratamientos hormonales tópicos. El uso del láser de CO2 en el tratamiento de estos síntomas está demostrando eficacia en la mejora de la calidad de vida de las pacientes, así como en la mejora de su función sexual. En cuanto a la incontinencia urinaria, se estima que afecta a un 17% de la población adulta, y a casi un 75% si hablamos de la población anciana o mayor de 80 años. En los últimos años, también se ha utilizado para el tratamiento de la incontinencia que también acompaña al llamado síndrome genitourinario.

OBJETIVOS

El objetivo principal de este estudio es comprobar la eficacia del tratamiento del láser

CO2 en pacientes con SGM e incontinencia urinaria.

METODOLOGÍA

Se realizó un estudio de tipo observacional prospectivo, en el que se reclutaron 57 pacientes que padecían los síntomas del SGM. Se les trató con tres sesiones de láser de CO2 ajustando los parámetros específicos según la patología tratada. La primera sesión se separó de la segunda de 6 a 8 semanas, y luego se realizó una tercera sesión al año de la primera. Para evaluar la variable de incontinencia urinaria, se pasaron los cuestionarios de ICIQ-SF, y el de Sandvick para evaluar la gravedad de la incontinencia, antes y después de cada sesión. Para evaluar la atrofia vulvovaginal y la dispareunia, las pacientes rellenaron, antes y después de cada sesión, una escala tipo EVA numerada del 1 al 5, donde la puntuación de 5 se correspondía con un nivel de incomodidad/sequedad máximo, y 1 se correspondía con no experimentar los síntomas de atrofia. Se evaluó la dispareunia de la misma manera.

RESULTADOS

Los resultados indican una reducción significativa en las puntuaciones de atrofia experimentada por las mujeres, se partía de una puntuación basal de 3,7 sobre 5, y tras

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.