Laser de CO2 e Radiofrequência fracionados e estriol no tratamento da síndrome genitourináriada menopausa: avaliação clínica e histomorfométrica do vestíbulo vulvar
Data
2022-11-30
Autores
Campos, Madalena Leonor 
Orientadores
Speck, Neila Maria Gois
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Objetivo: Comparar a resposta clínica e histológica no vestíbulo vulvar antes e após tratamentos com Laser (LCO2), Radiofrequência (RF) e estrogenioterapia tópica (ET) em mulheres com Síndrome Geniturinária da Menopausa (SGUM). Métodos: Este foi um estudo piloto prospectivo descritivo de um ensaio clínicorandomizado e controlado realizado no Hospital São Paulo, vinculado à Universidade Federal de São Paulo
(UNIFESP), entre os anos de 2019 e 2022. Mulheres com 2 -10 anos de pós-menopausa que referiam sintomas moderados a graves de SGUM, foram randomizadas para um dos três grupos de tratamento: LCO2, RF ou ET. Os grupos
LCO2 e RF realizaram uma sessão mensal, por três meses para aplicação das
energias na região vaginal e vulvar. O grupo ET fez uso domiciliar de creme por via
vaginal 1mg/g, por 14 dias e, em seguida, duas vezes por semana, por quatro
meses. Foi realizada avaliação pré tratamento e após 120 dias do seu início com a
utilização da escala visual analógica (EVA) para sintomas de SGUM, exame físico
ginecológico, fotografias e análises histológicas de biópsia do vestíbulo vulvar. Além
da impressão subjetiva de melhoraapós os tratamentos pela escala de 5 pontos de
LIKERT. Resultados: Foram recrutadas 75 mulheres, das quais 73 foram
randomizadas, 48 completaram o seguimento e tiveram biópsias pré e pós
tratamento passíveis de avaliação (20LCO2, 17 RF, 11ET). Foi observada redução
significativa dos sintomas de fissuras (p = 0,01),prurido (p = 0,031), pregas da vulva
(p = 0,006) e dispareunia (p < 0,001)em todos os grupos. Na análise dos parâmetros
de exame físico e das fotografias foi observada redução do aspecto atrófico vulvar
em todos os tratamentos empregados (p = 0,010). A Atrofia histológica não foi
confirmada pré-tratamento, no entanto houve melhora no aspecto morfológico como:
aumento da espessura epitelial (p < 0.01) redução de papilas dérmicas (p = 0,002)
nos tres grupos e redução da hiperqueratose (p = 0,020) apenas no LCO2 e RF.
Além disso não foram identificadosdanos teciduais estruturais após os tratamentos.
A dor vulvar foi em média menor nogrupo LCO2 (4.7 ± 2.4 - 2.9 ± 2.6) que no RF (6.8
± 2.3 - 5.4 ± 2.8) independente da sessão (p < 0,001) e diminuiu da 1a sessão para
as demais sessões independente dogrupo (p = 0,012).A satisfação com os tratamentos foi elevada nos três grupos, LCO2 (4.55± 0.9), RF (4.54 ±0.9) e ET (4 ±1.4), p = 0,066. Conclusão: Os tratamentos com LCO2, RF e ET promoveram melhora significativa dos sinais e sintomas da SGUM em relação ao vestíbulo vulvar. Foi demonstrada modificação histológica pós tratamento, de forma semelhante entre os grupos. Não foram identificados danos teciduais nas avaliações.
Objective: To compare the clinical and histological response in the vulvar vestibule, before and after treatments with Laser (LCO2), Radiofrequency (RF), and topical estrogen therapy (TE), in women with Genitourinary Syndrome of Menopause (GSM). Methods: This was a descriptive prospective pilot study of a secondary outcome of a randomized controlled trial conducted at Hospital São Paulo, linked to the Federal University of São Paulo (UNIFESP), between 2019 and 2022. Were eligible postmenopausal women (2-10 years), who reported moderate to severe GSM symptoms. They were randomized in three treatment groups: LCO2, RF, or ET. LCO2 and RF groups had three sessions, monthly, to apply the energies to the vaginal and vulvar regions. ET group used Estriol vaginal cream (1mg/g), for 14 days and then twice a week for four months. The pre- and post-treatment evaluation used the visual analog scale (VAS) for GSM symptoms, gynecological exam, vulvar photographs, and histological analysis of vulvar vestibule biopsy. Follow-up was performed 120 days after the beginning of each treatment, with the evaluation of parameters initially measured, and a subjective impression of women improvement by the 5-point LIKERT scale. Results: 75 women were recruited, of which 73 were randomized, 48 completed follow-ups, and had pre-and post-treatment biopsies adequate to evaluation (20 LCO2, 17 RF, 11ET). Significant reduction in fissure (p=0.01), pruritus (p=0.031), thinning of vulvar rugae (p=0.006), and dyspareunia (p<0.001) were observed with the treatments. Gynecological exam and photographs analysis showed a reduction in atrophic vulvar appearance with all treatments (p=0.010). Histological Atrophy was not confirmed pre- treatment; however, tissue modifications were observed as increase in epithelial thickness (p<0.01) and reduction of papillomatosis (p=0.002) in all treatments, and reduction of hyperkeratosis (p=0.020) only in LCO2 and RF. In addition, no structural tissue damage was identified after the treatments. Vulvar pain was lower in the LCO2 group (4.7 ± 2.4 - 2.9 ± 2.6) than in the RF group (6.8 ± 2.3 - 5.4 ± 2.8) independent of the session (p < 0.001) and decreased from the 1st to the other sessions independent of the group (p 0.012). No clinical or histological complications were identified after the treatments. Satisfaction with treatments was high LCO2 (4.55± 0.9), RF (4.54 ±0.9), and ET (4 ±1.4), p=0. 066.Conclusion: Treatments with LCO2, RF, and ET promoted significant improvement in GSM signs and symptoms concerning the vulvar vestibule. Post-treatment histological modifications were observed in a similar way in all groups. No tissue damage was identified in the clinical or histological evaluations.
Objective: To compare the clinical and histological response in the vulvar vestibule, before and after treatments with Laser (LCO2), Radiofrequency (RF), and topical estrogen therapy (TE), in women with Genitourinary Syndrome of Menopause (GSM). Methods: This was a descriptive prospective pilot study of a secondary outcome of a randomized controlled trial conducted at Hospital São Paulo, linked to the Federal University of São Paulo (UNIFESP), between 2019 and 2022. Were eligible postmenopausal women (2-10 years), who reported moderate to severe GSM symptoms. They were randomized in three treatment groups: LCO2, RF, or ET. LCO2 and RF groups had three sessions, monthly, to apply the energies to the vaginal and vulvar regions. ET group used Estriol vaginal cream (1mg/g), for 14 days and then twice a week for four months. The pre- and post-treatment evaluation used the visual analog scale (VAS) for GSM symptoms, gynecological exam, vulvar photographs, and histological analysis of vulvar vestibule biopsy. Follow-up was performed 120 days after the beginning of each treatment, with the evaluation of parameters initially measured, and a subjective impression of women improvement by the 5-point LIKERT scale. Results: 75 women were recruited, of which 73 were randomized, 48 completed follow-ups, and had pre-and post-treatment biopsies adequate to evaluation (20 LCO2, 17 RF, 11ET). Significant reduction in fissure (p=0.01), pruritus (p=0.031), thinning of vulvar rugae (p=0.006), and dyspareunia (p<0.001) were observed with the treatments. Gynecological exam and photographs analysis showed a reduction in atrophic vulvar appearance with all treatments (p=0.010). Histological Atrophy was not confirmed pre- treatment; however, tissue modifications were observed as increase in epithelial thickness (p<0.01) and reduction of papillomatosis (p=0.002) in all treatments, and reduction of hyperkeratosis (p=0.020) only in LCO2 and RF. In addition, no structural tissue damage was identified after the treatments. Vulvar pain was lower in the LCO2 group (4.7 ± 2.4 - 2.9 ± 2.6) than in the RF group (6.8 ± 2.3 - 5.4 ± 2.8) independent of the session (p < 0.001) and decreased from the 1st to the other sessions independent of the group (p 0.012). No clinical or histological complications were identified after the treatments. Satisfaction with treatments was high LCO2 (4.55± 0.9), RF (4.54 ±0.9), and ET (4 ±1.4), p=0. 066.Conclusion: Treatments with LCO2, RF, and ET promoted significant improvement in GSM signs and symptoms concerning the vulvar vestibule. Post-treatment histological modifications were observed in a similar way in all groups. No tissue damage was identified in the clinical or histological evaluations.