Vaginal Er:YAG laser application in the menopausal ewe model: a randomised estrogen and sham-controlled trial

K Mackova; A M Mazzer; Mgmc Mori Da Cunha; L Hajkova Hympanova; I Urbankova; A W Kastelein; E Vodegel; K Vander Linden; H Fehervary; Z Guler; J P Roovers; L Krofta; J Verhaeghe; J Deprest

doi:10.1111/1471-0528.16558

Vaginal Er:YAG laser application in the menopausal ewe model: a randomised estrogen and sham-controlled trial

BJOG. 2021 May;128(6):1087-1096. doi: 10.1111/1471-0528.16558. Epub 2020 Nov 10.

Authors

K Mackova^{1

2}, A M Mazzer³, Mgmc Mori Da Cunha¹, L Hajkova Hympanova^{1

2}, I Urbankova², A W Kastelein⁴, E Vodegel⁴, K Vander Linden⁵, H Fehervary⁵, Z Guler⁴, J P Roovers⁴, L Krofta², J Verhaeghe^{1

6}, J Deprest^{1

6}

Affiliations

¹ Department of Development and Regeneration, Cluster Urogenital, Abdominal and Plastic Surgery, KU Leuven, Leuven, Belgium.
² Third Faculty of Medicine, Institute for the Care of Mother and Child, Charles University, Prague, Czech Republic.
³ Department of Obstetrics and Gynaecology, San Raffaele University, Milan, Italy.
⁴ Department of Obstetrics and Gynaecology, Amsterdam University Medical Center, Amsterdam, The Netherlands.
⁵ Department of Mechanical Engineering, KU Leuven, Leuven, Belgium.
⁶ Pelvic Floor Unit, University Hospitals KU Leuven, Leuven, Belgium.

PMID: 33017509
DOI: 10.1111/1471-0528.16558

Abstract

Objective: To describe effects of non-ablative erbium-doped:yttrium-aluminium-garnet (Er:YAG) laser on vaginal atrophy induced by iatrogenic menopause in the ewe.

Design: Animal experimental, randomised, sham and estrogen-treatment controlled study with blinding for primary outcome.

Setting: KU Leuven, Belgium.

Sample: Twenty-four ewes.

Methods: Menopause was surgically induced, after which the ewes were randomised to three groups receiving vaginal Er:YAG laser application three times, with a 1-month interval; three sham manipulations with a 1-month interval; or estrogen replacement and sham manipulations. At given intervals, ewes were clinically examined and vaginal wall biopsies were taken. Vaginal compliance was determined by passive biomechanical testing from explants taken at autopsy.

Main outcome measures: Vaginal epithelial thickness (primary), composition of the lamina propria (collagen, elastin, glycogen and vessel content), vaginal compliance, clinical signs.

Results: Animals exposed to Er:YAG laser application and sham manipulation, but not to estrogens, displayed a significant and comparable increase in vaginal epithelial thickness between baseline and 7 days after the third application (69% and 67%, respectively, both P < 0.0008). In laser-treated ewes, temporary vaginal discharge and limited thermal injury were observed. Estrogen-substituted ewes displayed a more prominent increase in epithelial thickness (202%; P < 0.0001) and higher vaginal compliance (P < 0.05). None of the interventions induced changes in the lamina propria.

Conclusions: Vaginal Er:YAG laser has comparable effect to sham manipulation in menopausal ewes.

Tweetable abstract: Vaginal Er:YAG laser has comparable effect to sham manipulation in menopausal ewes #LASER #GSM #RCT.

Keywords: Atrophy; epithelium; estrogen; laser; planar biaxial testing; sheep; vagina.

MeSH terms

Animals
Atrophy* / diagnosis
Atrophy* / drug therapy
Atrophy* / etiology
Atrophy* / radiotherapy
Biopsy / methods
Disease Models, Animal
Estrogen Replacement Therapy / methods*
Estrogens / pharmacology*
Female
Lasers, Solid-State / therapeutic use*
Low-Level Light Therapy* / adverse effects
Low-Level Light Therapy* / methods
Menopause*
Sheep
Treatment Outcome
Vagina / pathology*
Vaginal Diseases* / drug therapy
Vaginal Diseases* / pathology
Vaginal Diseases* / radiotherapy

Substances

Estrogens