Abstract

Objectives: To demonstrate the safety and effectiveness of a vaginal erbium laser treatment for GSM (smooth Hyperstack plus previous hydration of the vaginal mucosa with injectable 20 mg cross-linked HA), in patients with poor or no response to the classic protocol of Smooth Mode erbium laser. Introduction: Treatment of Genitourinary Syndrome of Menopause (GSM) with energy-based devices has a non-small percentage of failure and undesirable effects due to the lack of the main chromophore, amount of water in the aging vaginal mucosa. Materials / method: 21 patients that presented typical symptoms of vaginal atrophy (GSM) during the post-menopausal period and who did not have a satisfactory response to the standard laser protocol (non-ablative erbium) were recruited to participate in this prospective study conducted between September 2022 and October 2023. Patients had a mean age of 70 years with an average BMI of 25.18. All participants were first treated with a single application of 1 ml of injectable reticulated hyaluronic acid (20 mg) to increase the amount of water in tissue (the laser chromophore), after previously applying topical lido Results: 21 patients completed the three-month FU, while 19 completed the six-month FU. Four parameters were evaluated at the FU visits: a) Intercourse pain level using VAS. b) Gloria Bachmann’s Vaginal Health Index (VHI). c) Vaginal cytology (Maturation value and Maturation index). . d) Vaginal pH. No complications or adverse effects were recorded in relation to the procedure. We showed statistically significant improvements in the trophism of the vagina and related symptoms in all parameters evaluated at three- and six-months FU for all treated patients. Conclusion: Following a global evolution towards minimally invasive procedures, results of this study are showing that non-ablative Er:YAG laser in a hyperstack technique with the combination of injectable 20 mg of a cross-link hyaluronic acid in non-responder postmenopausal patients, is safe and effective and can provide better outcomes, avoiding undesirable complications that are possible in elderly women.