An innovative dual-phase protocol for pulsed ablative vaginal Erbium: YAG laser treatment of urogynecological symptoms

Objectives: To evaluate a dual-phase protocol for vaginal ablative Erbium:YAG laser treatment in pelvic floor medicine. Study design: Data from consecutive patients undergoing vaginal Erbium:YAG laser for first-degree pelvic floor complaints at a certified university urogynecological unit were analyzed. Fractional ablative and thermal treatment with adjustable pulse duration, fluence, and pulse interval was performed in single ten-minute treatment course. Followed up interval was 6 weeks including interviews on expectations, goal setting, goal achievement, and satisfaction (EGGS), vaginal pH, and determination of the Gloria-Bachmann-Index (VHI). Post-procedural complications were classified according to definition and classification of the Clavien-Dindo system. Results: Of 84 patients treated, 71 (21% pre-, 79% post-menopausal) were evaluated. 27% had single urogynecological symptoms, 35% had three or more combined symptoms. Minor post-procedural complications occurred in three patients (CD I, n = 1; CD II, n = 3). The ranges of fluence, determined according to the atrophy state, in the first and second phases were 15-35 and 3-12 J/cm(2), respectively. In patients with genitourinary syndrome of menopause, pre- and post-treatment VHI and pH differed significantly [15.3 +/- 4.5 vs. 19.9 +/- 2.8 (p < 0.001, Student's t test) and 5.2 +/- 0.6 vs. 4.8 +/- 0.4 (p = 0.024, respectively]. Overall, 82% (n = 58; mean age, 58 +/- 12 years) of patients were satisfied with the treatment, 84% (47/56) post-menopausal patients were satisfied. Conclusions: Vaginal ablative Erbium:YAG laser dual-phase protocol for early urogynecological symptoms was successful and safe, with high patient satisfaction and few, minor complications. Prospective studies are needed to confirm our first data. (C) 2018 Elsevier B.V. All rights reserved.