The role of vaginal erbium laser as a non-hormonal therapeutical procedure for managing urinary symptoms in breast and gynaecological cancer survivors.

Context: Genitourinary Syndrome of Menopause (GSM) is an umbrella term covering various symptoms of reduced estrogen levels following menopause. Frequently, disabling symptoms like vulvovaginal dryness, sexual dysfunction, and urinary symptoms are treated via a combination of hormones. However, hormone administration is unsuitable in women with breast and gynecological cancer. Hence, non-hormonal regimens as Vaginal Erbium Laser (VEL) are their first-line therapy. Objective: The objective of this study is twofold: first, to examine the prevalence and severity of Lower Urinary Trac Symptoms (LUTS) in breast and gynecological cancer. Second, to analyze VEL as a non-hormonal regime to treat urinary symptoms of GSM. Methods: The study was performed using a VEL with a wavelength of 2,940 nm. The population study includes 59 women diagnosed with breast and gynecological cancers experiencing GSM symptoms. Both a retrospective and prospective studies were carried out, with 25 and 34 patients respectively. Patients had three laser applications (1 every 30 days). Symptoms were assessed before the treatment and after three laser applications using the VAS scale, FSFI-questionnaire, the ICIQ-FLUTS scores, a bladder diary, and the PGI-I. Results: The VAS scale and FSFI questionnaire results confirmed a significant improvement in both retrospective and prospective studies. Analyzing the retrospective arm, we found a significant relief of urinary symptoms. Results reported from patients of the prospective arm who experienced FLUTS reinforced the retrospective data: The ICIQ-FLUTS total score (P<0.001), the I score (P<0.001), UI (P= 0.032), and SUI episodes (P=0.008). Breast cancer survivors who underwent hormonotherapy experienced the best GSM symptoms improvements, the ICIQ-FLUTS total score (P<0.001), F score (P=0.037), I score (P<0.001), SUI episodes (P=0.031). Also, we found that patients who began VEL within three years after the cancer diagnosis demonstrated better results compared to who did it later. The ICIQ-FLUTS (P