The effect of CO2 laser therapy on vaginal microcirculatory parameters in an animal model for genitourinary syndrome of menopause
Background Vaginal laser therapy for the treatment of genitourinary syndrome of menopause (GSM) has been introduced to the market with limited (pre)clinical and experimental evidence supporting its efficacy. It is suggested that vaginal laser therapy increases epithelial thickness and improves vascu...
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| Veröffentlicht in: | Neurourology and urodynamics 2023-08, Vol.42 (6), p.1381-1389 |
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| creator | Latul, Yani P. Vodegel, Eva V. Kastelein, Arnoud W. Alkemade, Lily Ras, Lamees Hilty, Matthias P. Favaron, Emanuele Ince, Yasin Ince, Can Jeffery, Stephen Guler, Zeliha Roovers, Jan‐Paul W.R. |
| description | Background
Vaginal laser therapy for the treatment of genitourinary syndrome of menopause (GSM) has been introduced to the market with limited (pre)clinical and experimental evidence supporting its efficacy. It is suggested that vaginal laser therapy increases epithelial thickness and improves vascularization, but the underlying biological working mechanism has not been substantiated yet.
Objective
To evaluate the effects of CO2 laser therapy on vaginal atrophy using noninvasive incident dark field (IDF) imaging in a large animal model for GSM.
Design, Setting, and Participants
An animal study was conducted between 2018 and 2019 and included 25 Dohne Merino ewes, of which 20 underwent bilateral ovariectomy (OVX) to induce iatrogenic menopause, and 5 did not. The total study duration was 10 months.
Interventions
Five months after OVX, ovariectomized ewes received monthly applications of CO2 laser (n = 7), vaginal estrogen (n = 7), or no treatment (n = 6) for 3 months. IDF imaging was performed monthly in all animals.
Outcome Measurements and Statistical Analysis
The primary outcome was the proportion of image sequences containing capillary loops (angioarchitecture). Secondary outcomes included focal depth (epithelial thickness), and quantitative measures of vessel density and perfusion. Treatment effects were evaluated using ANCOVA and binary logistic regression.
Results and Limitations
Compared to OVX‐only, ewes treated with estrogen demonstrated a higher capillary loops proportion (4% vs. 75%, p |
| doi_str_mv | 10.1002/nau.25227 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_wiley</sourceid><recordid>TN_cdi_proquest_miscellaneous_2827923312</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2827923312</sourcerecordid><originalsourceid>FETCH-LOGICAL-p2917-c913020ba15c09d97d2fe948900ab2d85413dc2630f19ff342917b4390d5922c3</originalsourceid><addsrcrecordid>eNpdkU9LxDAQxYMouK4e_AYBL166JpO22Rxl8R-IXtxzyaaTNdI2NWmVHv3mpupJGJg5_N4Mbx4h55ytOGNw1elxBQWAPCALXgDLSinlIVkwKUQGeSmPyUmMb4yxtcjVgny9vCJFa9EM1Fu6eQba6IiBDq8YdD9R39EPvXedbmjrTPDGBTM2evBhor0OusUBQ6Suo3ou186gr7Gh1ge6x84NfgxJn_g4dXXwLc6XWux8r8eIp-TI6ibi2V9fku3tzcvmPnt8vnvYXD9mPSguM6O4YMB2mheGqVrJGiyqfK0Y0zuo10XORW2gFMxyZa3IZ9UuF4rVhQIwYkkuf_f2wb-PGIeqddFg0-gO_RgrWINUIASHhF78Q9-Sh_SCmcpBplOlSNTVL_XpGpyqPiTvYao4q-YkqpRE9ZNE9XS9_RnEN-9wfgY</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2842741363</pqid></control><display><type>article</type><title>The effect of CO2 laser therapy on vaginal microcirculatory parameters in an animal model for genitourinary syndrome of menopause</title><source>Wiley-Blackwell Journals</source><creator>Latul, Yani P. ; Vodegel, Eva V. ; Kastelein, Arnoud W. ; Alkemade, Lily ; Ras, Lamees ; Hilty, Matthias P. ; Favaron, Emanuele ; Ince, Yasin ; Ince, Can ; Jeffery, Stephen ; Guler, Zeliha ; Roovers, Jan‐Paul W.R.</creator><creatorcontrib>Latul, Yani P. ; Vodegel, Eva V. ; Kastelein, Arnoud W. ; Alkemade, Lily ; Ras, Lamees ; Hilty, Matthias P. ; Favaron, Emanuele ; Ince, Yasin ; Ince, Can ; Jeffery, Stephen ; Guler, Zeliha ; Roovers, Jan‐Paul W.R.</creatorcontrib><description>Background
Vaginal laser therapy for the treatment of genitourinary syndrome of menopause (GSM) has been introduced to the market with limited (pre)clinical and experimental evidence supporting its efficacy. It is suggested that vaginal laser therapy increases epithelial thickness and improves vascularization, but the underlying biological working mechanism has not been substantiated yet.
Objective
To evaluate the effects of CO2 laser therapy on vaginal atrophy using noninvasive incident dark field (IDF) imaging in a large animal model for GSM.
Design, Setting, and Participants
An animal study was conducted between 2018 and 2019 and included 25 Dohne Merino ewes, of which 20 underwent bilateral ovariectomy (OVX) to induce iatrogenic menopause, and 5 did not. The total study duration was 10 months.
Interventions
Five months after OVX, ovariectomized ewes received monthly applications of CO2 laser (n = 7), vaginal estrogen (n = 7), or no treatment (n = 6) for 3 months. IDF imaging was performed monthly in all animals.
Outcome Measurements and Statistical Analysis
The primary outcome was the proportion of image sequences containing capillary loops (angioarchitecture). Secondary outcomes included focal depth (epithelial thickness), and quantitative measures of vessel density and perfusion. Treatment effects were evaluated using ANCOVA and binary logistic regression.
Results and Limitations
Compared to OVX‐only, ewes treated with estrogen demonstrated a higher capillary loops proportion (4% vs. 75%, p < 0.01), and higher focal depth (60 (IQR 60–80) vs. 80 (IQR 80–80) p < 0.05). CO2 laser therapy did not change microcirculatory parameters. As the ewes' vaginal epithelium is thinner than that of humans, it may demand different laser settings.
Conclusions
In a large animal model for GSM, CO2 laser therapy does not affect microcirculatory outcomes related to GSM, whereas vaginal estrogen treatment does. Until more homogeneous and objective evidence about its efficacy is available, CO2 laser therapy should not be adopted into widespread practice for treating GSM.</description><identifier>ISSN: 0733-2467</identifier><identifier>EISSN: 1520-6777</identifier><identifier>DOI: 10.1002/nau.25227</identifier><language>eng</language><publisher>Hoboken: Wiley Subscription Services, Inc</publisher><subject>angioarchitecture ; Animal models ; Atrophy ; Carbon dioxide ; epithelial thickness ; Epithelium ; estrogen ; Estrogens ; genitourinary syndrome of menopause ; laser therapy ; Lasers ; Menopause ; microcirculation ; Ovariectomy ; Statistical analysis ; Vagina ; vaginal atrophy ; Vascularization</subject><ispartof>Neurourology and urodynamics, 2023-08, Vol.42 (6), p.1381-1389</ispartof><rights>2023 The Authors. published by Wiley Periodicals LLC.</rights><rights>2023. This article is published under http://creativecommons.org/licenses/by-nc/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><orcidid>0000-0001-6897-9495 ; 0000-0002-0034-6795 ; 0000-0003-4167-1663</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fnau.25227$$EPDF$$P50$$Gwiley$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fnau.25227$$EHTML$$P50$$Gwiley$$Hfree_for_read</linktohtml><link.rule.ids>314,780,784,1417,27924,27925,45574,45575</link.rule.ids></links><search><creatorcontrib>Latul, Yani P.</creatorcontrib><creatorcontrib>Vodegel, Eva V.</creatorcontrib><creatorcontrib>Kastelein, Arnoud W.</creatorcontrib><creatorcontrib>Alkemade, Lily</creatorcontrib><creatorcontrib>Ras, Lamees</creatorcontrib><creatorcontrib>Hilty, Matthias P.</creatorcontrib><creatorcontrib>Favaron, Emanuele</creatorcontrib><creatorcontrib>Ince, Yasin</creatorcontrib><creatorcontrib>Ince, Can</creatorcontrib><creatorcontrib>Jeffery, Stephen</creatorcontrib><creatorcontrib>Guler, Zeliha</creatorcontrib><creatorcontrib>Roovers, Jan‐Paul W.R.</creatorcontrib><title>The effect of CO2 laser therapy on vaginal microcirculatory parameters in an animal model for genitourinary syndrome of menopause</title><title>Neurourology and urodynamics</title><description>Background
Vaginal laser therapy for the treatment of genitourinary syndrome of menopause (GSM) has been introduced to the market with limited (pre)clinical and experimental evidence supporting its efficacy. It is suggested that vaginal laser therapy increases epithelial thickness and improves vascularization, but the underlying biological working mechanism has not been substantiated yet.
Objective
To evaluate the effects of CO2 laser therapy on vaginal atrophy using noninvasive incident dark field (IDF) imaging in a large animal model for GSM.
Design, Setting, and Participants
An animal study was conducted between 2018 and 2019 and included 25 Dohne Merino ewes, of which 20 underwent bilateral ovariectomy (OVX) to induce iatrogenic menopause, and 5 did not. The total study duration was 10 months.
Interventions
Five months after OVX, ovariectomized ewes received monthly applications of CO2 laser (n = 7), vaginal estrogen (n = 7), or no treatment (n = 6) for 3 months. IDF imaging was performed monthly in all animals.
Outcome Measurements and Statistical Analysis
The primary outcome was the proportion of image sequences containing capillary loops (angioarchitecture). Secondary outcomes included focal depth (epithelial thickness), and quantitative measures of vessel density and perfusion. Treatment effects were evaluated using ANCOVA and binary logistic regression.
Results and Limitations
Compared to OVX‐only, ewes treated with estrogen demonstrated a higher capillary loops proportion (4% vs. 75%, p < 0.01), and higher focal depth (60 (IQR 60–80) vs. 80 (IQR 80–80) p < 0.05). CO2 laser therapy did not change microcirculatory parameters. As the ewes' vaginal epithelium is thinner than that of humans, it may demand different laser settings.
Conclusions
In a large animal model for GSM, CO2 laser therapy does not affect microcirculatory outcomes related to GSM, whereas vaginal estrogen treatment does. Until more homogeneous and objective evidence about its efficacy is available, CO2 laser therapy should not be adopted into widespread practice for treating GSM.</description><subject>angioarchitecture</subject><subject>Animal models</subject><subject>Atrophy</subject><subject>Carbon dioxide</subject><subject>epithelial thickness</subject><subject>Epithelium</subject><subject>estrogen</subject><subject>Estrogens</subject><subject>genitourinary syndrome of menopause</subject><subject>laser therapy</subject><subject>Lasers</subject><subject>Menopause</subject><subject>microcirculation</subject><subject>Ovariectomy</subject><subject>Statistical analysis</subject><subject>Vagina</subject><subject>vaginal atrophy</subject><subject>Vascularization</subject><issn>0733-2467</issn><issn>1520-6777</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>24P</sourceid><sourceid>WIN</sourceid><recordid>eNpdkU9LxDAQxYMouK4e_AYBL166JpO22Rxl8R-IXtxzyaaTNdI2NWmVHv3mpupJGJg5_N4Mbx4h55ytOGNw1elxBQWAPCALXgDLSinlIVkwKUQGeSmPyUmMb4yxtcjVgny9vCJFa9EM1Fu6eQba6IiBDq8YdD9R39EPvXedbmjrTPDGBTM2evBhor0OusUBQ6Suo3ou186gr7Gh1ge6x84NfgxJn_g4dXXwLc6XWux8r8eIp-TI6ibi2V9fku3tzcvmPnt8vnvYXD9mPSguM6O4YMB2mheGqVrJGiyqfK0Y0zuo10XORW2gFMxyZa3IZ9UuF4rVhQIwYkkuf_f2wb-PGIeqddFg0-gO_RgrWINUIASHhF78Q9-Sh_SCmcpBplOlSNTVL_XpGpyqPiTvYao4q-YkqpRE9ZNE9XS9_RnEN-9wfgY</recordid><startdate>202308</startdate><enddate>202308</enddate><creator>Latul, Yani P.</creator><creator>Vodegel, Eva V.</creator><creator>Kastelein, Arnoud W.</creator><creator>Alkemade, Lily</creator><creator>Ras, Lamees</creator><creator>Hilty, Matthias P.</creator><creator>Favaron, Emanuele</creator><creator>Ince, Yasin</creator><creator>Ince, Can</creator><creator>Jeffery, Stephen</creator><creator>Guler, Zeliha</creator><creator>Roovers, Jan‐Paul W.R.</creator><general>Wiley Subscription Services, Inc</general><scope>24P</scope><scope>WIN</scope><scope>7T5</scope><scope>7TK</scope><scope>H94</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-6897-9495</orcidid><orcidid>https://orcid.org/0000-0002-0034-6795</orcidid><orcidid>https://orcid.org/0000-0003-4167-1663</orcidid></search><sort><creationdate>202308</creationdate><title>The effect of CO2 laser therapy on vaginal microcirculatory parameters in an animal model for genitourinary syndrome of menopause</title><author>Latul, Yani P. ; Vodegel, Eva V. ; Kastelein, Arnoud W. ; Alkemade, Lily ; Ras, Lamees ; Hilty, Matthias P. ; Favaron, Emanuele ; Ince, Yasin ; Ince, Can ; Jeffery, Stephen ; Guler, Zeliha ; Roovers, Jan‐Paul W.R.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-p2917-c913020ba15c09d97d2fe948900ab2d85413dc2630f19ff342917b4390d5922c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>angioarchitecture</topic><topic>Animal models</topic><topic>Atrophy</topic><topic>Carbon dioxide</topic><topic>epithelial thickness</topic><topic>Epithelium</topic><topic>estrogen</topic><topic>Estrogens</topic><topic>genitourinary syndrome of menopause</topic><topic>laser therapy</topic><topic>Lasers</topic><topic>Menopause</topic><topic>microcirculation</topic><topic>Ovariectomy</topic><topic>Statistical analysis</topic><topic>Vagina</topic><topic>vaginal atrophy</topic><topic>Vascularization</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Latul, Yani P.</creatorcontrib><creatorcontrib>Vodegel, Eva V.</creatorcontrib><creatorcontrib>Kastelein, Arnoud W.</creatorcontrib><creatorcontrib>Alkemade, Lily</creatorcontrib><creatorcontrib>Ras, Lamees</creatorcontrib><creatorcontrib>Hilty, Matthias P.</creatorcontrib><creatorcontrib>Favaron, Emanuele</creatorcontrib><creatorcontrib>Ince, Yasin</creatorcontrib><creatorcontrib>Ince, Can</creatorcontrib><creatorcontrib>Jeffery, Stephen</creatorcontrib><creatorcontrib>Guler, Zeliha</creatorcontrib><creatorcontrib>Roovers, Jan‐Paul W.R.</creatorcontrib><collection>Wiley Open Access</collection><collection>Wiley Open Access</collection><collection>Immunology Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Neurourology and urodynamics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Latul, Yani P.</au><au>Vodegel, Eva V.</au><au>Kastelein, Arnoud W.</au><au>Alkemade, Lily</au><au>Ras, Lamees</au><au>Hilty, Matthias P.</au><au>Favaron, Emanuele</au><au>Ince, Yasin</au><au>Ince, Can</au><au>Jeffery, Stephen</au><au>Guler, Zeliha</au><au>Roovers, Jan‐Paul W.R.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The effect of CO2 laser therapy on vaginal microcirculatory parameters in an animal model for genitourinary syndrome of menopause</atitle><jtitle>Neurourology and urodynamics</jtitle><date>2023-08</date><risdate>2023</risdate><volume>42</volume><issue>6</issue><spage>1381</spage><epage>1389</epage><pages>1381-1389</pages><issn>0733-2467</issn><eissn>1520-6777</eissn><abstract>Background
Vaginal laser therapy for the treatment of genitourinary syndrome of menopause (GSM) has been introduced to the market with limited (pre)clinical and experimental evidence supporting its efficacy. It is suggested that vaginal laser therapy increases epithelial thickness and improves vascularization, but the underlying biological working mechanism has not been substantiated yet.
Objective
To evaluate the effects of CO2 laser therapy on vaginal atrophy using noninvasive incident dark field (IDF) imaging in a large animal model for GSM.
Design, Setting, and Participants
An animal study was conducted between 2018 and 2019 and included 25 Dohne Merino ewes, of which 20 underwent bilateral ovariectomy (OVX) to induce iatrogenic menopause, and 5 did not. The total study duration was 10 months.
Interventions
Five months after OVX, ovariectomized ewes received monthly applications of CO2 laser (n = 7), vaginal estrogen (n = 7), or no treatment (n = 6) for 3 months. IDF imaging was performed monthly in all animals.
Outcome Measurements and Statistical Analysis
The primary outcome was the proportion of image sequences containing capillary loops (angioarchitecture). Secondary outcomes included focal depth (epithelial thickness), and quantitative measures of vessel density and perfusion. Treatment effects were evaluated using ANCOVA and binary logistic regression.
Results and Limitations
Compared to OVX‐only, ewes treated with estrogen demonstrated a higher capillary loops proportion (4% vs. 75%, p < 0.01), and higher focal depth (60 (IQR 60–80) vs. 80 (IQR 80–80) p < 0.05). CO2 laser therapy did not change microcirculatory parameters. As the ewes' vaginal epithelium is thinner than that of humans, it may demand different laser settings.
Conclusions
In a large animal model for GSM, CO2 laser therapy does not affect microcirculatory outcomes related to GSM, whereas vaginal estrogen treatment does. Until more homogeneous and objective evidence about its efficacy is available, CO2 laser therapy should not be adopted into widespread practice for treating GSM.</abstract><cop>Hoboken</cop><pub>Wiley Subscription Services, Inc</pub><doi>10.1002/nau.25227</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0001-6897-9495</orcidid><orcidid>https://orcid.org/0000-0002-0034-6795</orcidid><orcidid>https://orcid.org/0000-0003-4167-1663</orcidid><oa>free_for_read</oa></addata></record> |
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| language | eng |
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| source | Wiley-Blackwell Journals |
| subjects | angioarchitecture Animal models Atrophy Carbon dioxide epithelial thickness Epithelium estrogen Estrogens genitourinary syndrome of menopause laser therapy Lasers Menopause microcirculation Ovariectomy Statistical analysis Vagina vaginal atrophy Vascularization |
| title | The effect of CO2 laser therapy on vaginal microcirculatory parameters in an animal model for genitourinary syndrome of menopause |
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