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Background and Objectives: Vulvo-vaginal atrophy (VVA), a prevalent condition among postmenopausal women, significantly impairs quality of life through symptoms like vaginal dryness, dyspareunia, and burning. Non-hormonal treatments, such as CO2 laser therapy, have shown promise in managing VVA symptoms with minimal side effects. The addition of adjunctive treatments may enhance efficacy and mitigate possible adverse effects. To evaluate the combined efficacy and safety of CO2 laser therapy and a collagen-based cream in treating VVA and to explore their potential impact on the vaginal microbiome. Materials and Methods: This was a single-center, randomized, interventional. Sixty postmenopausal women diagnosed with VVA were randomized into two groups: a control group receiving laser-only treatment and a treatment group receiving laser therapy with daily collagen-based cream application. Primary outcome measures included symptom improvement on the Visual Analog Scale (VAS) for VVA-associated symptoms. Secondary outcomes involved microbiome composition analysis. Results: Both groups showed significant symptom improvement, with the combination therapy group demonstrating superior reductions in burning, dyspareunia, and vaginal dryness (p < 0.05). Microbiome analysis revealed increased levels of beneficial species (Lactobacillus iners and Lactobacillus crispatus) and decreased pathogenic bacteria (Gardnerella vaginalis and Atopobium vaginae) in the treatment group, though these changes were not statistically significant. Mild side effects, such as burning and swelling in the first days following the treatment, were less frequent in the combination therapy group, likely due to the anti-inflammatory effects of the collagen-based cream. Conclusions: This study provides evidence supporting the use of CO2 laser therapy with collagen-based cream as an effective and well-tolerated treatment for VVA in postmenopausal women, achieving significant symptom relief. The combined therapy approach holds potential for enhanced efficacy and reduced side effects compared to laser-only treatment, offering a promising alternative for women ineligible for hormone-based therapies.

Background and objectives: Involuntary loss of urine owed to dysfunction of the detrusor muscle or muscles of the pelvic floor is known as urinary incontinence (UI). In this study, ultrasound monitoring was employed for the first time to measure the usefulness and safety of electromagnetic stimulation for women with Stress or Urge UI. Materials and Methods: A total of 62 women were enrolled, with a mean age of 55.1 (±14.5); 60% of them were menopausal and presented with urinary incontinence (UI). Eight validated questionnaires were used to evaluate Stress UI, prolapse, overactive bladder urge, faecal incontinence, and quality of life, and the whole study population was tested with ultrasounds at the beginning and at the end of the treatment cycle. The device used was a non-invasive electromagnetic therapeutic system composed of a main unit and an adjustable chair applicator shaped for deep pelvic floor area stimulation. Results: Ultrasound measurements and validated questionnaires revealed a consistent and statistically significant (p < 0.01) improvement of the mean scores when pre- and post-treatment data were considered. Conclusions: Study results showed that the proposed treatment strategy led to a significant improvement in Pelvic Floor Muscle (PFM) tone and strength in patients with UI and pelvic floor disorders, without discomfort or side effects. The demonstration was qualitatively carried out with validated questionnaires and quantitatively with ultrasounds exams. Thus, the “chair” device we used represents valuable and effective support that could be widely employed in the gynaecological field for patients affected by different pathologies.

Childbirth is a great change in woman life because of hormonal, physical and psychological alterations that are associated with this process. Dyspareunia and perineal pain are commonly reported symptoms in the postpartum period, mainly due to perineal trauma, lacerations, episiotomy, and forceps or vacuum use at delivery. Among non-pharmacological treatment, a new trend is gaining popularity, which is the energy-based therapy, including fractional micro-ablative CO2 laser. We conducted a multicentric retrospective study to assess the efficacy and the possible side effects of CO2 laser treatment on transient vulvovaginal atrophy and perineal postpartum pain related to puerperium and breastfeeding period. All patients were submitted to 3 or 4 sessions of CO2 laser treatment. As per protocol, an initial, intermediate (after 2 sessions) and final (3 months after the last cycle) evaluation of the symptoms were made, using a VAS (Visual Analogue Scale 0–10). We also compared this group of patients with a control group with no treatment. At the final evaluation, patients showed a significant improvement for dyspareunia (VAS from 7.95 to 3.14, p < 0.0001). A significant improvement was also registered in pain at the vaginal orifice (VAS from 6.94 to 2.05, p = 0.0001), dryness (VAS from 6.6 to 2.9, p = 0.0022), itching (VAS from 4.5 to 1.16, p = 0.0053), heat (VAS from 3 to 0, p = 0.0119) and burning (VAS from 5.5 to 1.6, p = 0.0013) if compared with the control group. Quality of life for the women during the breastfeeding and puerperium is important and training is mandatory to avoid side effects in order to improve the CO2 laser performance.

Background/Objectives: Stress urinary incontinence (SUI) is a common and often under-reported condition that significantly impacts quality of life. SUI is more than just a physical issue; it can also affect social interactions, mental health, and emotional well-being due to the embarrassment and limitations it can cause. SUI is often acquired during pregnancy and childbirth as a result of pelvic floor muscle weakness. The aim of this study was to evaluate the effectiveness of an innovative dual-wavelength laser system (CO2 + 1540 nm) in SUI management. Methods: A total of 56 women affected by SUI were enrolled in this study. Half of the patients were treated with CO2 alone, while the other half were treated with the combination of CO2 + 1540 nm wavelengths. The patients were split into four groups based on the type of treatment they received and their menopausal status. Data were acquired at baseline and at various follow-ups (T1, T2, and T3, respectively, after the first, second, and third treatment). The Visual Analog Scale (VAS) (score 0–10) was used. Cystoscopic images were acquired before and at the end of the laser treatment cycle. Results: At the end of the treatment, the patients in each group were very satisfied, on average. In each group, the treatment led to a statistically significant improvement in the SUI VAS score between baseline and follow-up after the first treatment; in both groups 3 and 4, the treatment led to a significant change in the dryness score, both from baseline to T1 (p < 0.05) and also for T2 and T3 compared to baseline. Finally, cystoscopic photos showed an evident increase in mucosa epithelial thickness after the laser treatment cycle. Conclusions: The use of a dual-wavelength laser system (CO2 + 1540 nm) was proven to be well tolerated and safe, with promising outcomes in reducing SUI symptoms, especially in non-menopausal patients.

Background and Objectives: Urinary incontinence (UI) is the involuntary loss of urine caused by a weakness in the pelvic floor muscles (PFMs) that affects urethral closure. Myostatin, which prevents the growth of muscles, is a protein expressed by human skeletal muscle cells. Indeed, it has been observed that myostatin concentration rises during skeletal muscle inactivity and that suppressing serum myostatin promotes muscle growth and strength. Furthermore, therapeutic interventions that reduce myostatin signalling may lessen the effects of aging on skeletal muscle mass and function. For this reason, the aim of the study was to assess if flat magnetic stimulation technology affects serum myostatin levels, as myostatin can block cell proliferation at the urethral sphincter level. Materials and Methods: A total of 19 women, 75% presenting stress urinary incontinence (SUI) and 25% urgency urinary incontinence (UUI), were enrolled. A non-invasive electromagnetic therapeutic system designed for deep pelvic floor area stimulation was used for eight sessions. Results: The ELISA (enzyme linked immunosorbent assay) test indicated that the myostatin levels in blood sera had significantly decreased. Patients’ ultrasound measurements showed a significant genital hiatus length reduction at rest and in a stress condition. The Pelvic Floor Bother Questionnaire consistently revealed a decrease in mean scores when comparing the pre- and post-treatment data. Conclusions: Effective flat magnetic stimulation reduces myostatin concentration and genital hiatus length, minimizing the severity of urinary incontinence. The results of the study show that without causing any discomfort or unfavourable side effects, the treatment plan significantly improved the PFM tone and strength in patients with UI.

BackgroundMany women diagnosed with gynecological cancers undergo adjuvant therapy, which may lead to transient or permanent menopause that ultimately leads to urogenital syndrome and vulvovaginal atrophy. Studies advise against the use of estrogen in women with a history of hormone-dependent cancer. One alternative is vaginal microablative fractional CO2 laser, which promotes tissue regeneration through the production of collagen and elastic fibers.ObjectiveTo evaluate the effectiveness of CO2 laser in the treatment of urogenital syndrome—in particular, symptomatic vulvovaginal atrophy in women who have survived gynecological cancers.MethodsA retrospective study was carried out, including all patients with a history of gynecological cancers and vulvovaginal atrophy who underwent CO2 laser treatment between November 2012 and February 2018 in four Italian centers. The study was approved by the local ethics committee of each participating institution. The inclusion criteria were women aged between 18 and 75; Eastern Cooperative Oncology Group performance status <2; and history of breast, ovarian, cervical, or uterus cancer. Patients had to have vulvovaginal atrophy and at least one of the following symptoms of urogenital syndrome: vaginal dryness, dyspareunia, vaginal introitus pain, burning, or itching. Three applications were administered at baseline, 30 days, and 60 days. All patients were evaluated before the first laser session, at each session, and 4 weeks after the last session. In particular, patients were asked to indicate the intensity of symptoms before the first session and 4 weeks after the last session, using Visual Analog Scale (VAS) scoring from 0 ('no discomfort') to 10 ('maximum discomfort').ResultsA total of 1213 patients underwent CO2 laser treatment and of these, 1048 were excluded because they did not meet the inclusion criteria in the analysis. Finally, a total of 165 patients were included in the study. The mean age at the time of treatment was 53 years (range 31–73). Dryness improved by 66%, dyspareunia improved by 59%, burning improved by 66%, pain at introitus improved by 54%, and itching improved by 54%. The side effects were evaluated as pain greater than VAS score 6 during and after the treatment period. No side effects were seen in any sessions.ConclusionsFractional microablative CO2 laser therapy offers an effective strategy in the management of the symptoms of genitourinary syndrome in post-menopausal women and in survivors of gynecological cancer.

Background/Objectives: Stress urinary incontinence (SUI) is a common and often under-reported condition that significantly impacts quality of life. SUI is more than just a physical issue; it can also affect social interactions, mental health, and emotional well-being due to the embarrassment and limitations it can cause. SUI is often acquired during pregnancy and childbirth as a result of pelvic floor muscle weakness. The aim of this study was to evaluate the effectiveness of an innovative dual-wavelength laser system (CO[sub.2] + 1540 nm) in SUI management. Methods: A total of 56 women affected by SUI were enrolled in this study. Half of the patients were treated with CO[sub.2] alone, while the other half were treated with the combination of CO[sub.2] + 1540 nm wavelengths. The patients were split into four groups based on the type of treatment they received and their menopausal status. Data were acquired at baseline and at various follow-ups (T1, T2, and T3, respectively, after the first, second, and third treatment). The Visual Analog Scale (VAS) (score 0–10) was used. Cystoscopic images were acquired before and at the end of the laser treatment cycle. Results: At the end of the treatment, the patients in each group were very satisfied, on average. In each group, the treatment led to a statistically significant improvement in the SUI VAS score between baseline and follow-up after the first treatment; in both groups 3 and 4, the treatment led to a significant change in the dryness score, both from baseline to T1 (p < 0.05) and also for T2 and T3 compared to baseline. Finally, cystoscopic photos showed an evident increase in mucosa epithelial thickness after the laser treatment cycle. Conclusions: The use of a dual-wavelength laser system (CO[sub.2] + 1540 nm) was proven to be well tolerated and safe, with promising outcomes in reducing SUI symptoms, especially in non-menopausal patients.

: Stress urinary incontinence (SUI) is a common and often under-reported condition that significantly impacts quality of life. SUI is more than just a physical issue; it can also affect social interactions, mental health, and emotional well-being due to the embarrassment and limitations it can cause. SUI is often acquired during pregnancy and childbirth as a result of pelvic floor muscle weakness. The aim of this study was to evaluate the effectiveness of an innovative dual-wavelength laser system (CO + 1540 nm) in SUI management. : A total of 56 women affected by SUI were enrolled in this study. Half of the patients were treated with CO alone, while the other half were treated with the combination of CO + 1540 nm wavelengths. The patients were split into four groups based on the type of treatment they received and their menopausal status. Data were acquired at baseline and at various follow-ups (T1, T2, and T3, respectively, after the first, second, and third treatment). The Visual Analog Scale (VAS) (score 0-10) was used. Cystoscopic images were acquired before and at the end of the laser treatment cycle. : At the end of the treatment, the patients in each group were very satisfied, on average. In each group, the treatment led to a statistically significant improvement in the SUI VAS score between baseline and follow-up after the first treatment; in both groups 3 and 4, the treatment led to a significant change in the dryness score, both from baseline to T1 ( < 0.05) and also for T2 and T3 compared to baseline. Finally, cystoscopic photos showed an evident increase in mucosa epithelial thickness after the laser treatment cycle. : The use of a dual-wavelength laser system (CO + 1540 nm) was proven to be well tolerated and safe, with promising outcomes in reducing SUI symptoms, especially in non-menopausal patients.

: Vulvo-vaginal atrophy (VVA), a prevalent condition among postmenopausal women, significantly impairs quality of life through symptoms like vaginal dryness, dyspareunia, and burning. Non-hormonal treatments, such as CO laser therapy, have shown promise in managing VVA symptoms with minimal side effects. The addition of adjunctive treatments may enhance efficacy and mitigate possible adverse effects. To evaluate the combined efficacy and safety of CO laser therapy and a collagen-based cream in treating VVA and to explore their potential impact on the vaginal microbiome. : This was a single-center, randomized, interventional. Sixty postmenopausal women diagnosed with VVA were randomized into two groups: a control group receiving laser-only treatment and a treatment group receiving laser therapy with daily collagen-based cream application. Primary outcome measures included symptom improvement on the Visual Analog Scale (VAS) for VVA-associated symptoms. Secondary outcomes involved microbiome composition analysis. : Both groups showed significant symptom improvement, with the combination therapy group demonstrating superior reductions in burning, dyspareunia, and vaginal dryness ( < 0.05). Microbiome analysis revealed increased levels of beneficial species ( and ) and decreased pathogenic bacteria ( and ) in the treatment group, though these changes were not statistically significant. Mild side effects, such as burning and swelling in the first days following the treatment, were less frequent in the combination therapy group, likely due to the anti-inflammatory effects of the collagen-based cream. : This study provides evidence supporting the use of CO laser therapy with collagen-based cream as an effective and well-tolerated treatment for VVA in postmenopausal women, achieving significant symptom relief. The combined therapy approach holds potential for enhanced efficacy and reduced side effects compared to laser-only treatment, offering a promising alternative for women ineligible for hormone-based therapies.

Background and Objectives: The study aimed to evaluate the ability defining the risk of developing preeclampsia by a screening test carried out in the first trimester (between 11 + 0 and 13 + 6 weeks of gestational age), in order to identify high-risk women requiring more intensive health surveillance. The secondary objective was to evaluate the ability of this test to predict the risk of adverse obstetric outcomes such as fetal growth restriction, intrauterine fetal death, gestational hypertension, HELLP syndrome, placental abruption, and preterm birth. Materials and Methods: This was a single-center study, conducted at the Operative Unit of Obstetrics of the State Hospital of the Republic of San Marino. Medical history was collected at the time of enrolment in writing. Subsequently, obstetric outcomes were collected for each enrolled woman, through the analysis of medical records. Results: From October 2014 to May 2019, 589 pregnant women were recruited, of whom, 474 (80.5%) were included in the “low-risk” group, and 115 (19.5%) in the “high-risk” group. At the time of analysis of this population, the obstetric outcomes were available for 498 women (84.5%), while 91 cases (15.5%) were current pregnancies. The PI of the uterine arteries was not significantly different between the two study groups. Otherwise, a significant difference was highlighted for MAP, which is higher in the case of pregnancies at high risk based on the risk factors only, and for PAPP-A, higher in the case of low-risk pregnancies. Regarding the percentage of fetal DNA, according to the most recent literature data, in our series, we report a statistically significant difference of the average between the low and high-risk groups. Conclusions: In our study, we demonstrate that the multiparametric screening test for early PE performed well in identifying women at high risk of early PE, which certainly has the most severe maternal–fetal outcomes. The data reported that ASA intake at low doses is significantly higher in the population with high-risk tests for both early PE and late PE suggest once again that anamnestic evaluation plays an essential role in women’s screening.