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LASER VULVO VAGINAL
UNA TECNOLOGIA QUE
AVANZA Y SE JUSTIFICA
INSTITUTO PALACIOS
wwwinstitutopalacioscom
Santiago Palacios MD Ph
bull Symposium speaker or advisory board member
bull Bayer Schering Novo Nordisk Servier Eli Lilly Daiichi Sankyo Sanofi MSD Gedeon Richter Exeltis Procter amp Gamble Teva Syneron-Candela
bull Research grants andor consulting fees from
bull Pfizer Servier Eli Lilly Daiichi Sankyo Amgen Arkochim and Bayer Schering Gedeon Richter Exeltis
LASER
Agenda
bull PRESENTE
bull FUTURO
bull - MEJORAR EL EFECTO
- PROTOCOLOS MAacuteS DEFINIDOS
- FUTURAS INDICACIONES
1 COEFFICIENTE DE ABSORCIOacuteN (ENERGIA DEL LASER Y AGUA)
2 FRACCIONADO
3 ABLACCIOacuteN Y EFECTOS TERMICOS
iquestPorqueacute el laser en vulva y
vagina
7
Immediately After the Treatment
Courtesy of Dr Alexandros Bader OBampGYN ndash Urogynecologist ndash Cosmetic Gynecologist London
OBJETIVOS 1
Proteccioacuten natural
ABLACION
NEOCOLAGENOGENESIS
absorcioacuten
OBJETIVOS 2
Proteccioacuten natural
ABLACION
NEOCOLAGENOGENESIS
absorcioacuten
OBJETIVOS 3
Proteccioacuten natural
ABLACION
NEOCOLAGENOGENESIS
absorcioacuten
11
Mechanism of Action - Phases
Phase 1(within 48-72 hr)
EARLY THERMAL EFFECT
- Edema
- Release of chemical mediators
- Shrinkage of collagen and elastic fibers
Phase 2 (in the following 30 days) PROLIFERATION
- Fibroblastic recruiting
- New extracellular matrix
- New collagen fibers
Phase 3 (After 30-40 days) REMODELLING
- Mature collagen fibers
- Increase of collagen fiber strain
- Neovascularization new blood vessel formation
- Improved lubrication pH (acidity)
VAGINAL MUCOSA PHYSIOLOGIC AND FUNCTIONAL RECOVERY
EFECTOS BIOLOacuteGICOS TEacuteRMICOS
Calentamiento (estimulacioacuten) 40-60degC
Activacioacuten o dantildeos menores y reversibles
Efectos metaboacutelicos (gt425degC) ndash Colageacutenesis
Coagulacioacuten (necrosis) 60-90degC
Dantildeos de reversibles a irreversibles
Rotura de viacutenculos quiacutemicos desnaturalizacioacuten de las proteiacutenas
Efectos metaboacutelicosndash Tensado
Ablacioacuten (evaporacioacuten) gt100degC
Dantildeos irreversibles evaporacioacuten de tejido
Efectos metaboacutelicosndash Ablacioacuten
CO2RE Indications for Use Path
CO2RE has received FDA clearance for more than 90 new indications for
use across a range of specialties including gynecology and genitourinary of a
wide range of indications See appendix of this PPT for full list of new indications
for use
bull FDA Letter to File for internal amp external handpieces ndash Mid-Feb2016
bull CE submission for vaginal atrophy and rejuvenation based on safety
and efficacy clinical studies ndash Jan 2016 Approval anticipated in Mar-Apr
2016
bull Health Canada submission after receipt of CE approval Approval can
take some months
bull Other countries ndash dependent on receipt of CE approval
bull FDA Indication for vaginal atrophy and SUI - will
require clinical data and traditional FDA 510K
submission
Agenda
bull PASADO-PRESENTE
-Condilomas vulvares
-Patologia cervical
-Toda cirugia suceptible de corte
coagulacioacuten o extirpacioacuten (evaporizacioacuten)
INDICACIONES MAacuteS USUALES
bull ATROFIA VULVO-VAGINAL
bull INCONTINENDIA URINARIA DE STRESS
bull SINDROME DE HIPERLAXITUD
bull PROLAPSO GENITAL
EFICACIA LASER EN LA ATROFIA VULVO-VAGINAL
bull Hay mucha evidencia de su eficacia tanto con erbio como con (CO 2) en la atrofia vulvo-vaginal de la mujer menopausica
Salvatore S Nappi RE Zerbinati N et al A 12-week treatmentwith fractional CO 2 laser for
vulvovaginal atrophy a pilot study Climacteric 2014 17 363 ndash 9
Salvatore S Nappi RE Parma M et al Sexual function after fractional microablative CO 2 laser in women with vulvovaginal atrophy Climacteric 2015 18 219 ndash 25
Salvatore S H istological study on the effects of microablative fractional CO 2 laser on atrophic vaginal tissue an ex vivo study Menopause 2015 22 845 ndash 9
Zerbinati N S erati M O rigoni M e t a l M icroscopic and ultrastructural modifi cations of postmenopausal atrophic vaginal mucosa after fractional carbon dioxide laser treatment Laser Med Sci 2015 30 429 ndash 36
Perino A Calligaro A Forlani F e t al Vulvo-vaginal atrophy a new treatment modality using thermo-ablative fractional CO 2 laser Maturitas 2015 80 296 ndash 301
ATROFIA VULVO-VAGINAL
Irradiaccion 360ordm circular haz completo Pases (3 to 5) Dosis 10 to 5 joules cm2
Irradiacioacuten en mapeo Pases (3) cubriendo vagina y vulva
Efectivo durante 6-12 meses
Se necesitan de 2-4 sesiones
Breast Cancer Increased risk of presenting
Genitourinary Syndrome
Natural or Induced Menopause Pharmaceuticals (Tamoxifen AIs ) Estrogenic contraindication Lubricants Moisturizers Dilating Therapy Botox Injections
Laser therapy (effectiveness at least equal to estrogen)
Cancer de mama y laser vaginal
Menopause 2017 Mar24(3)316-319 doi 101097GME0000000000000761
Vaginal erbium laser as second-generation thermotherapy for the genitourinary syndrome of menopause a pilot study in breast cancer survivors Gambacciani M1 Levancini M OBJECTIVE The aim of this study was to evaluate the efficacy and acceptability of a second generation of vaginal laser treatment the vaginal erbium laser as a nonablative photothermal therapy for the management of genitourinary syndrome of menopause in postmenopausal breast cancer survivors CONCLUSIONS This study suggests that the vaginal erbium laser is effective and safe for the treatment of genitourinary syndrome of menopause in breast cancer survivors
Menopause 2017 Dec 28 doi Fractional microablative CO2 laser in breast cancer survivors affected by iatrogenic vulvovaginal atrophy after failure of nonestrogenic local treatments a retrospective study Pagano T1 METHODS We treated 82 BC survivors with three cycles of CO2 laser after failure of topical nonestrogenic therapy The severity of symptoms was assessed with a visual analog scale (VAS) at baseline and after completion of laser therapy Differences in mean VAS scores of each symptom before and after treatment were assessed with multiple t tests for pairwise comparisons Multivariate analyses were used to adjust the final mean scores for the main confounding factors RESULTS Pre versus post-treatment differences in mean VAS scores were significant for sensitivity during sexual intercourse vaginal dryness itchingstinging dyspareunia and dysuria (P lt 0001 for all) bleeding (P = 0001) probe insertion (P = 0001) and movement-related pain (P = 0011) Multivariate analyses confirmed that results were significant irrespective of patients age and type of adjuvant therapy CONCLUSION This study shows that CO2 laser treatment is effective and safe in BC patients with iatrogenic menopause However the optimal number of cycles to administer and the need for retreatment remain to be defined Prospective trials are needed to compare CO2 laser therapy with therapeutic alternatives
INDICACIONES MAacuteS USUALES
bull ATROFIA VULVO-VAGINAL
bull INCONTINENDIA URINARIA DE STRESS
bull SINDROME DE HIPERLAXITUD
bull PROLAPSO GENITAL
22
INCONTINENCIA URINARIA
INCONTINENCIA URINARIA Contraccion del colageno suburetral Neocolagenosis suburetral Irradiaccioacuten angular fraccionada Pases (4 to 5) Dosis 10 A 5 JulIOs cm2 Radiacion 90-120ordm circular Sesiones (2 to 3) Leve-Moderate SUI (ICIQ_SF lt13)
PALACIOS INSTITUTE EXPERIENCE
bull Average age 526 years
bull 41 IUM 59 SUI
bull Average parity 2 children Average BMI
28
bull Average duration per session 19 minutes
bull Very good procedure tolerance
bull Adverse effects during the procedure
NO (32 local heat or slight stinging that
self-limited)
bull Adverse effects after the procedure NO
bull 100 were incorporated into their
activity in lt24 h
110 paTIENTS
1 month after the last session
NOT effective with the emergency component but YES of the effort component in the IUM (12) NOT effective in athletes Overall satisfaction 100 MP improves atrophy
INDICACIONES MAacuteS USUALES
bull ATROFIA VULVO-VAGINAL
bull INCONTINENDIA URINARIA DE STRESS
bull SINDROME DE HIPERLAXITUD
bull PROLAPSO GENITAL
TERMINOLOGIacuteA Y DEFINICIOacuteN iquestPOR QUEacute SIacuteNDROME DE HIPERLAXITUD VAGINAL
bull Anatoacutemicas y Fisioloacutegicas o Laxitud Normal
o Hiperlaxitud Anormal
bull Cliacutenicas o Siacutendrome = Agrupacioacuten de diversos siacutentomas
DEFINICIOacuteN DE SIacuteNDROME DE
HIPERLAXITUD VAGINAL
Conjunto de siacutentomas que aparecen por un exceso
de laxitud vaginal debido a la alteracioacuten de la
estructura de la vagina y tejidos circundantes
Santiago Palacios 2017
29
VAGINAL TIGHTENING
bull Mejoria y uso en 360 grados
bull Remodelado del tejido vaginal y prevencion
INDICACIONES MAacuteS USUALES
bull ATROFIA VULVO-VAGINAL
bull INCONTINENDIA URINARIA DE STRESS
bull SINDROME DE HIPELAXITUD
bull PROLAPSO GENITAL
PROLAPSO GENITAL
bull Prolapso central no lateral Grado 1
y 2
bull Sesiones Como poco 5
)
Agenda
bull PRESENTE
bull FUTURO
bull - MEJORAR EL EFECTO
- PROTOCOLOS MAacuteS DEFINIDOS
-FUTURAS INDICACIONES
COLAGENO Y EDAD
EPHITELIUM AND LAMINA PROPIA
FUNCIONES DEL FIBROBLASTO
LAMINA PROPIA
Agenda
bull PRESENTE
bull FUTURO
bull - MEJORAR EL EFECTO
- PROTOCOLOS MAacuteS DEFINIDOS
- FUTURAS INDICACIONES
CO2RE
20-40 micras proporciona una mejora similar a la de un peeling quiacutemico pero
con un mayor control de la profundidad y menos efectos adversos
Moacutedulo Aesthetic ndash Modo Fraccionado Light
SELECCIOacuteN DE PACIENTES
bull Evaluacioacuten de los sintomas
bull Motivacioacuten y demanda del paciente
bull Abilidad y posibilidades del aparato laser
Agenda
bull PRESENTE
bull FUTURO
bull - MEJORAR EL EFECTO
- PROTOCOLOS MAacuteS DEFINIDOS
- FUTURAS INDICACIONES
NUEVAS PERSPECTIVAS
copy 2016 VIVEVE Not for publication or podium presentation 41
Dermatitis vulvares Dispareunia-vaginismo Retraccioacuten de cicatrices Recuperar la flora vaginal Problemas de las mallas Fisuras vulvares Vejiga hiperactiva Patologias conocidas ( infecciosas y tumorales)
VULVAR DERMATITIS
copy 2016 VIVEVE Not for publication or podium presentation 42
GRADOS DE DOLOR SUB-CLASIFICACIOacuteN DE
MI VISION DE FUTURO
1 Todas las mujeres despueacutes de tres meses del parto Para - Evitar laxitud vaginal
- Evitar incontinencia urinaria
- Volver a una tensioacuten vulvar y vaginal normal
2 En la menopausia y de forma anual para prevenir - Atrofia vulvo-vaginal
- Incontinencia urinaria
- Prolapso
Santiago Palacios MD Ph
bull Symposium speaker or advisory board member
bull Bayer Schering Novo Nordisk Servier Eli Lilly Daiichi Sankyo Sanofi MSD Gedeon Richter Exeltis Procter amp Gamble Teva Syneron-Candela
bull Research grants andor consulting fees from
bull Pfizer Servier Eli Lilly Daiichi Sankyo Amgen Arkochim and Bayer Schering Gedeon Richter Exeltis
LASER
Agenda
bull PRESENTE
bull FUTURO
bull - MEJORAR EL EFECTO
- PROTOCOLOS MAacuteS DEFINIDOS
- FUTURAS INDICACIONES
1 COEFFICIENTE DE ABSORCIOacuteN (ENERGIA DEL LASER Y AGUA)
2 FRACCIONADO
3 ABLACCIOacuteN Y EFECTOS TERMICOS
iquestPorqueacute el laser en vulva y
vagina
7
Immediately After the Treatment
Courtesy of Dr Alexandros Bader OBampGYN ndash Urogynecologist ndash Cosmetic Gynecologist London
OBJETIVOS 1
Proteccioacuten natural
ABLACION
NEOCOLAGENOGENESIS
absorcioacuten
OBJETIVOS 2
Proteccioacuten natural
ABLACION
NEOCOLAGENOGENESIS
absorcioacuten
OBJETIVOS 3
Proteccioacuten natural
ABLACION
NEOCOLAGENOGENESIS
absorcioacuten
11
Mechanism of Action - Phases
Phase 1(within 48-72 hr)
EARLY THERMAL EFFECT
- Edema
- Release of chemical mediators
- Shrinkage of collagen and elastic fibers
Phase 2 (in the following 30 days) PROLIFERATION
- Fibroblastic recruiting
- New extracellular matrix
- New collagen fibers
Phase 3 (After 30-40 days) REMODELLING
- Mature collagen fibers
- Increase of collagen fiber strain
- Neovascularization new blood vessel formation
- Improved lubrication pH (acidity)
VAGINAL MUCOSA PHYSIOLOGIC AND FUNCTIONAL RECOVERY
EFECTOS BIOLOacuteGICOS TEacuteRMICOS
Calentamiento (estimulacioacuten) 40-60degC
Activacioacuten o dantildeos menores y reversibles
Efectos metaboacutelicos (gt425degC) ndash Colageacutenesis
Coagulacioacuten (necrosis) 60-90degC
Dantildeos de reversibles a irreversibles
Rotura de viacutenculos quiacutemicos desnaturalizacioacuten de las proteiacutenas
Efectos metaboacutelicosndash Tensado
Ablacioacuten (evaporacioacuten) gt100degC
Dantildeos irreversibles evaporacioacuten de tejido
Efectos metaboacutelicosndash Ablacioacuten
CO2RE Indications for Use Path
CO2RE has received FDA clearance for more than 90 new indications for
use across a range of specialties including gynecology and genitourinary of a
wide range of indications See appendix of this PPT for full list of new indications
for use
bull FDA Letter to File for internal amp external handpieces ndash Mid-Feb2016
bull CE submission for vaginal atrophy and rejuvenation based on safety
and efficacy clinical studies ndash Jan 2016 Approval anticipated in Mar-Apr
2016
bull Health Canada submission after receipt of CE approval Approval can
take some months
bull Other countries ndash dependent on receipt of CE approval
bull FDA Indication for vaginal atrophy and SUI - will
require clinical data and traditional FDA 510K
submission
Agenda
bull PASADO-PRESENTE
-Condilomas vulvares
-Patologia cervical
-Toda cirugia suceptible de corte
coagulacioacuten o extirpacioacuten (evaporizacioacuten)
INDICACIONES MAacuteS USUALES
bull ATROFIA VULVO-VAGINAL
bull INCONTINENDIA URINARIA DE STRESS
bull SINDROME DE HIPERLAXITUD
bull PROLAPSO GENITAL
EFICACIA LASER EN LA ATROFIA VULVO-VAGINAL
bull Hay mucha evidencia de su eficacia tanto con erbio como con (CO 2) en la atrofia vulvo-vaginal de la mujer menopausica
Salvatore S Nappi RE Zerbinati N et al A 12-week treatmentwith fractional CO 2 laser for
vulvovaginal atrophy a pilot study Climacteric 2014 17 363 ndash 9
Salvatore S Nappi RE Parma M et al Sexual function after fractional microablative CO 2 laser in women with vulvovaginal atrophy Climacteric 2015 18 219 ndash 25
Salvatore S H istological study on the effects of microablative fractional CO 2 laser on atrophic vaginal tissue an ex vivo study Menopause 2015 22 845 ndash 9
Zerbinati N S erati M O rigoni M e t a l M icroscopic and ultrastructural modifi cations of postmenopausal atrophic vaginal mucosa after fractional carbon dioxide laser treatment Laser Med Sci 2015 30 429 ndash 36
Perino A Calligaro A Forlani F e t al Vulvo-vaginal atrophy a new treatment modality using thermo-ablative fractional CO 2 laser Maturitas 2015 80 296 ndash 301
ATROFIA VULVO-VAGINAL
Irradiaccion 360ordm circular haz completo Pases (3 to 5) Dosis 10 to 5 joules cm2
Irradiacioacuten en mapeo Pases (3) cubriendo vagina y vulva
Efectivo durante 6-12 meses
Se necesitan de 2-4 sesiones
Breast Cancer Increased risk of presenting
Genitourinary Syndrome
Natural or Induced Menopause Pharmaceuticals (Tamoxifen AIs ) Estrogenic contraindication Lubricants Moisturizers Dilating Therapy Botox Injections
Laser therapy (effectiveness at least equal to estrogen)
Cancer de mama y laser vaginal
Menopause 2017 Mar24(3)316-319 doi 101097GME0000000000000761
Vaginal erbium laser as second-generation thermotherapy for the genitourinary syndrome of menopause a pilot study in breast cancer survivors Gambacciani M1 Levancini M OBJECTIVE The aim of this study was to evaluate the efficacy and acceptability of a second generation of vaginal laser treatment the vaginal erbium laser as a nonablative photothermal therapy for the management of genitourinary syndrome of menopause in postmenopausal breast cancer survivors CONCLUSIONS This study suggests that the vaginal erbium laser is effective and safe for the treatment of genitourinary syndrome of menopause in breast cancer survivors
Menopause 2017 Dec 28 doi Fractional microablative CO2 laser in breast cancer survivors affected by iatrogenic vulvovaginal atrophy after failure of nonestrogenic local treatments a retrospective study Pagano T1 METHODS We treated 82 BC survivors with three cycles of CO2 laser after failure of topical nonestrogenic therapy The severity of symptoms was assessed with a visual analog scale (VAS) at baseline and after completion of laser therapy Differences in mean VAS scores of each symptom before and after treatment were assessed with multiple t tests for pairwise comparisons Multivariate analyses were used to adjust the final mean scores for the main confounding factors RESULTS Pre versus post-treatment differences in mean VAS scores were significant for sensitivity during sexual intercourse vaginal dryness itchingstinging dyspareunia and dysuria (P lt 0001 for all) bleeding (P = 0001) probe insertion (P = 0001) and movement-related pain (P = 0011) Multivariate analyses confirmed that results were significant irrespective of patients age and type of adjuvant therapy CONCLUSION This study shows that CO2 laser treatment is effective and safe in BC patients with iatrogenic menopause However the optimal number of cycles to administer and the need for retreatment remain to be defined Prospective trials are needed to compare CO2 laser therapy with therapeutic alternatives
INDICACIONES MAacuteS USUALES
bull ATROFIA VULVO-VAGINAL
bull INCONTINENDIA URINARIA DE STRESS
bull SINDROME DE HIPERLAXITUD
bull PROLAPSO GENITAL
22
INCONTINENCIA URINARIA
INCONTINENCIA URINARIA Contraccion del colageno suburetral Neocolagenosis suburetral Irradiaccioacuten angular fraccionada Pases (4 to 5) Dosis 10 A 5 JulIOs cm2 Radiacion 90-120ordm circular Sesiones (2 to 3) Leve-Moderate SUI (ICIQ_SF lt13)
PALACIOS INSTITUTE EXPERIENCE
bull Average age 526 years
bull 41 IUM 59 SUI
bull Average parity 2 children Average BMI
28
bull Average duration per session 19 minutes
bull Very good procedure tolerance
bull Adverse effects during the procedure
NO (32 local heat or slight stinging that
self-limited)
bull Adverse effects after the procedure NO
bull 100 were incorporated into their
activity in lt24 h
110 paTIENTS
1 month after the last session
NOT effective with the emergency component but YES of the effort component in the IUM (12) NOT effective in athletes Overall satisfaction 100 MP improves atrophy
INDICACIONES MAacuteS USUALES
bull ATROFIA VULVO-VAGINAL
bull INCONTINENDIA URINARIA DE STRESS
bull SINDROME DE HIPERLAXITUD
bull PROLAPSO GENITAL
TERMINOLOGIacuteA Y DEFINICIOacuteN iquestPOR QUEacute SIacuteNDROME DE HIPERLAXITUD VAGINAL
bull Anatoacutemicas y Fisioloacutegicas o Laxitud Normal
o Hiperlaxitud Anormal
bull Cliacutenicas o Siacutendrome = Agrupacioacuten de diversos siacutentomas
DEFINICIOacuteN DE SIacuteNDROME DE
HIPERLAXITUD VAGINAL
Conjunto de siacutentomas que aparecen por un exceso
de laxitud vaginal debido a la alteracioacuten de la
estructura de la vagina y tejidos circundantes
Santiago Palacios 2017
29
VAGINAL TIGHTENING
bull Mejoria y uso en 360 grados
bull Remodelado del tejido vaginal y prevencion
INDICACIONES MAacuteS USUALES
bull ATROFIA VULVO-VAGINAL
bull INCONTINENDIA URINARIA DE STRESS
bull SINDROME DE HIPELAXITUD
bull PROLAPSO GENITAL
PROLAPSO GENITAL
bull Prolapso central no lateral Grado 1
y 2
bull Sesiones Como poco 5
)
Agenda
bull PRESENTE
bull FUTURO
bull - MEJORAR EL EFECTO
- PROTOCOLOS MAacuteS DEFINIDOS
-FUTURAS INDICACIONES
COLAGENO Y EDAD
EPHITELIUM AND LAMINA PROPIA
FUNCIONES DEL FIBROBLASTO
LAMINA PROPIA
Agenda
bull PRESENTE
bull FUTURO
bull - MEJORAR EL EFECTO
- PROTOCOLOS MAacuteS DEFINIDOS
- FUTURAS INDICACIONES
CO2RE
20-40 micras proporciona una mejora similar a la de un peeling quiacutemico pero
con un mayor control de la profundidad y menos efectos adversos
Moacutedulo Aesthetic ndash Modo Fraccionado Light
SELECCIOacuteN DE PACIENTES
bull Evaluacioacuten de los sintomas
bull Motivacioacuten y demanda del paciente
bull Abilidad y posibilidades del aparato laser
Agenda
bull PRESENTE
bull FUTURO
bull - MEJORAR EL EFECTO
- PROTOCOLOS MAacuteS DEFINIDOS
- FUTURAS INDICACIONES
NUEVAS PERSPECTIVAS
copy 2016 VIVEVE Not for publication or podium presentation 41
Dermatitis vulvares Dispareunia-vaginismo Retraccioacuten de cicatrices Recuperar la flora vaginal Problemas de las mallas Fisuras vulvares Vejiga hiperactiva Patologias conocidas ( infecciosas y tumorales)
VULVAR DERMATITIS
copy 2016 VIVEVE Not for publication or podium presentation 42
GRADOS DE DOLOR SUB-CLASIFICACIOacuteN DE
MI VISION DE FUTURO
1 Todas las mujeres despueacutes de tres meses del parto Para - Evitar laxitud vaginal
- Evitar incontinencia urinaria
- Volver a una tensioacuten vulvar y vaginal normal
2 En la menopausia y de forma anual para prevenir - Atrofia vulvo-vaginal
- Incontinencia urinaria
- Prolapso
LASER
Agenda
bull PRESENTE
bull FUTURO
bull - MEJORAR EL EFECTO
- PROTOCOLOS MAacuteS DEFINIDOS
- FUTURAS INDICACIONES
1 COEFFICIENTE DE ABSORCIOacuteN (ENERGIA DEL LASER Y AGUA)
2 FRACCIONADO
3 ABLACCIOacuteN Y EFECTOS TERMICOS
iquestPorqueacute el laser en vulva y
vagina
7
Immediately After the Treatment
Courtesy of Dr Alexandros Bader OBampGYN ndash Urogynecologist ndash Cosmetic Gynecologist London
OBJETIVOS 1
Proteccioacuten natural
ABLACION
NEOCOLAGENOGENESIS
absorcioacuten
OBJETIVOS 2
Proteccioacuten natural
ABLACION
NEOCOLAGENOGENESIS
absorcioacuten
OBJETIVOS 3
Proteccioacuten natural
ABLACION
NEOCOLAGENOGENESIS
absorcioacuten
11
Mechanism of Action - Phases
Phase 1(within 48-72 hr)
EARLY THERMAL EFFECT
- Edema
- Release of chemical mediators
- Shrinkage of collagen and elastic fibers
Phase 2 (in the following 30 days) PROLIFERATION
- Fibroblastic recruiting
- New extracellular matrix
- New collagen fibers
Phase 3 (After 30-40 days) REMODELLING
- Mature collagen fibers
- Increase of collagen fiber strain
- Neovascularization new blood vessel formation
- Improved lubrication pH (acidity)
VAGINAL MUCOSA PHYSIOLOGIC AND FUNCTIONAL RECOVERY
EFECTOS BIOLOacuteGICOS TEacuteRMICOS
Calentamiento (estimulacioacuten) 40-60degC
Activacioacuten o dantildeos menores y reversibles
Efectos metaboacutelicos (gt425degC) ndash Colageacutenesis
Coagulacioacuten (necrosis) 60-90degC
Dantildeos de reversibles a irreversibles
Rotura de viacutenculos quiacutemicos desnaturalizacioacuten de las proteiacutenas
Efectos metaboacutelicosndash Tensado
Ablacioacuten (evaporacioacuten) gt100degC
Dantildeos irreversibles evaporacioacuten de tejido
Efectos metaboacutelicosndash Ablacioacuten
CO2RE Indications for Use Path
CO2RE has received FDA clearance for more than 90 new indications for
use across a range of specialties including gynecology and genitourinary of a
wide range of indications See appendix of this PPT for full list of new indications
for use
bull FDA Letter to File for internal amp external handpieces ndash Mid-Feb2016
bull CE submission for vaginal atrophy and rejuvenation based on safety
and efficacy clinical studies ndash Jan 2016 Approval anticipated in Mar-Apr
2016
bull Health Canada submission after receipt of CE approval Approval can
take some months
bull Other countries ndash dependent on receipt of CE approval
bull FDA Indication for vaginal atrophy and SUI - will
require clinical data and traditional FDA 510K
submission
Agenda
bull PASADO-PRESENTE
-Condilomas vulvares
-Patologia cervical
-Toda cirugia suceptible de corte
coagulacioacuten o extirpacioacuten (evaporizacioacuten)
INDICACIONES MAacuteS USUALES
bull ATROFIA VULVO-VAGINAL
bull INCONTINENDIA URINARIA DE STRESS
bull SINDROME DE HIPERLAXITUD
bull PROLAPSO GENITAL
EFICACIA LASER EN LA ATROFIA VULVO-VAGINAL
bull Hay mucha evidencia de su eficacia tanto con erbio como con (CO 2) en la atrofia vulvo-vaginal de la mujer menopausica
Salvatore S Nappi RE Zerbinati N et al A 12-week treatmentwith fractional CO 2 laser for
vulvovaginal atrophy a pilot study Climacteric 2014 17 363 ndash 9
Salvatore S Nappi RE Parma M et al Sexual function after fractional microablative CO 2 laser in women with vulvovaginal atrophy Climacteric 2015 18 219 ndash 25
Salvatore S H istological study on the effects of microablative fractional CO 2 laser on atrophic vaginal tissue an ex vivo study Menopause 2015 22 845 ndash 9
Zerbinati N S erati M O rigoni M e t a l M icroscopic and ultrastructural modifi cations of postmenopausal atrophic vaginal mucosa after fractional carbon dioxide laser treatment Laser Med Sci 2015 30 429 ndash 36
Perino A Calligaro A Forlani F e t al Vulvo-vaginal atrophy a new treatment modality using thermo-ablative fractional CO 2 laser Maturitas 2015 80 296 ndash 301
ATROFIA VULVO-VAGINAL
Irradiaccion 360ordm circular haz completo Pases (3 to 5) Dosis 10 to 5 joules cm2
Irradiacioacuten en mapeo Pases (3) cubriendo vagina y vulva
Efectivo durante 6-12 meses
Se necesitan de 2-4 sesiones
Breast Cancer Increased risk of presenting
Genitourinary Syndrome
Natural or Induced Menopause Pharmaceuticals (Tamoxifen AIs ) Estrogenic contraindication Lubricants Moisturizers Dilating Therapy Botox Injections
Laser therapy (effectiveness at least equal to estrogen)
Cancer de mama y laser vaginal
Menopause 2017 Mar24(3)316-319 doi 101097GME0000000000000761
Vaginal erbium laser as second-generation thermotherapy for the genitourinary syndrome of menopause a pilot study in breast cancer survivors Gambacciani M1 Levancini M OBJECTIVE The aim of this study was to evaluate the efficacy and acceptability of a second generation of vaginal laser treatment the vaginal erbium laser as a nonablative photothermal therapy for the management of genitourinary syndrome of menopause in postmenopausal breast cancer survivors CONCLUSIONS This study suggests that the vaginal erbium laser is effective and safe for the treatment of genitourinary syndrome of menopause in breast cancer survivors
Menopause 2017 Dec 28 doi Fractional microablative CO2 laser in breast cancer survivors affected by iatrogenic vulvovaginal atrophy after failure of nonestrogenic local treatments a retrospective study Pagano T1 METHODS We treated 82 BC survivors with three cycles of CO2 laser after failure of topical nonestrogenic therapy The severity of symptoms was assessed with a visual analog scale (VAS) at baseline and after completion of laser therapy Differences in mean VAS scores of each symptom before and after treatment were assessed with multiple t tests for pairwise comparisons Multivariate analyses were used to adjust the final mean scores for the main confounding factors RESULTS Pre versus post-treatment differences in mean VAS scores were significant for sensitivity during sexual intercourse vaginal dryness itchingstinging dyspareunia and dysuria (P lt 0001 for all) bleeding (P = 0001) probe insertion (P = 0001) and movement-related pain (P = 0011) Multivariate analyses confirmed that results were significant irrespective of patients age and type of adjuvant therapy CONCLUSION This study shows that CO2 laser treatment is effective and safe in BC patients with iatrogenic menopause However the optimal number of cycles to administer and the need for retreatment remain to be defined Prospective trials are needed to compare CO2 laser therapy with therapeutic alternatives
INDICACIONES MAacuteS USUALES
bull ATROFIA VULVO-VAGINAL
bull INCONTINENDIA URINARIA DE STRESS
bull SINDROME DE HIPERLAXITUD
bull PROLAPSO GENITAL
22
INCONTINENCIA URINARIA
INCONTINENCIA URINARIA Contraccion del colageno suburetral Neocolagenosis suburetral Irradiaccioacuten angular fraccionada Pases (4 to 5) Dosis 10 A 5 JulIOs cm2 Radiacion 90-120ordm circular Sesiones (2 to 3) Leve-Moderate SUI (ICIQ_SF lt13)
PALACIOS INSTITUTE EXPERIENCE
bull Average age 526 years
bull 41 IUM 59 SUI
bull Average parity 2 children Average BMI
28
bull Average duration per session 19 minutes
bull Very good procedure tolerance
bull Adverse effects during the procedure
NO (32 local heat or slight stinging that
self-limited)
bull Adverse effects after the procedure NO
bull 100 were incorporated into their
activity in lt24 h
110 paTIENTS
1 month after the last session
NOT effective with the emergency component but YES of the effort component in the IUM (12) NOT effective in athletes Overall satisfaction 100 MP improves atrophy
INDICACIONES MAacuteS USUALES
bull ATROFIA VULVO-VAGINAL
bull INCONTINENDIA URINARIA DE STRESS
bull SINDROME DE HIPERLAXITUD
bull PROLAPSO GENITAL
TERMINOLOGIacuteA Y DEFINICIOacuteN iquestPOR QUEacute SIacuteNDROME DE HIPERLAXITUD VAGINAL
bull Anatoacutemicas y Fisioloacutegicas o Laxitud Normal
o Hiperlaxitud Anormal
bull Cliacutenicas o Siacutendrome = Agrupacioacuten de diversos siacutentomas
DEFINICIOacuteN DE SIacuteNDROME DE
HIPERLAXITUD VAGINAL
Conjunto de siacutentomas que aparecen por un exceso
de laxitud vaginal debido a la alteracioacuten de la
estructura de la vagina y tejidos circundantes
Santiago Palacios 2017
29
VAGINAL TIGHTENING
bull Mejoria y uso en 360 grados
bull Remodelado del tejido vaginal y prevencion
INDICACIONES MAacuteS USUALES
bull ATROFIA VULVO-VAGINAL
bull INCONTINENDIA URINARIA DE STRESS
bull SINDROME DE HIPELAXITUD
bull PROLAPSO GENITAL
PROLAPSO GENITAL
bull Prolapso central no lateral Grado 1
y 2
bull Sesiones Como poco 5
)
Agenda
bull PRESENTE
bull FUTURO
bull - MEJORAR EL EFECTO
- PROTOCOLOS MAacuteS DEFINIDOS
-FUTURAS INDICACIONES
COLAGENO Y EDAD
EPHITELIUM AND LAMINA PROPIA
FUNCIONES DEL FIBROBLASTO
LAMINA PROPIA
Agenda
bull PRESENTE
bull FUTURO
bull - MEJORAR EL EFECTO
- PROTOCOLOS MAacuteS DEFINIDOS
- FUTURAS INDICACIONES
CO2RE
20-40 micras proporciona una mejora similar a la de un peeling quiacutemico pero
con un mayor control de la profundidad y menos efectos adversos
Moacutedulo Aesthetic ndash Modo Fraccionado Light
SELECCIOacuteN DE PACIENTES
bull Evaluacioacuten de los sintomas
bull Motivacioacuten y demanda del paciente
bull Abilidad y posibilidades del aparato laser
Agenda
bull PRESENTE
bull FUTURO
bull - MEJORAR EL EFECTO
- PROTOCOLOS MAacuteS DEFINIDOS
- FUTURAS INDICACIONES
NUEVAS PERSPECTIVAS
copy 2016 VIVEVE Not for publication or podium presentation 41
Dermatitis vulvares Dispareunia-vaginismo Retraccioacuten de cicatrices Recuperar la flora vaginal Problemas de las mallas Fisuras vulvares Vejiga hiperactiva Patologias conocidas ( infecciosas y tumorales)
VULVAR DERMATITIS
copy 2016 VIVEVE Not for publication or podium presentation 42
GRADOS DE DOLOR SUB-CLASIFICACIOacuteN DE
MI VISION DE FUTURO
1 Todas las mujeres despueacutes de tres meses del parto Para - Evitar laxitud vaginal
- Evitar incontinencia urinaria
- Volver a una tensioacuten vulvar y vaginal normal
2 En la menopausia y de forma anual para prevenir - Atrofia vulvo-vaginal
- Incontinencia urinaria
- Prolapso
Agenda
bull PRESENTE
bull FUTURO
bull - MEJORAR EL EFECTO
- PROTOCOLOS MAacuteS DEFINIDOS
- FUTURAS INDICACIONES
1 COEFFICIENTE DE ABSORCIOacuteN (ENERGIA DEL LASER Y AGUA)
2 FRACCIONADO
3 ABLACCIOacuteN Y EFECTOS TERMICOS
iquestPorqueacute el laser en vulva y
vagina
7
Immediately After the Treatment
Courtesy of Dr Alexandros Bader OBampGYN ndash Urogynecologist ndash Cosmetic Gynecologist London
OBJETIVOS 1
Proteccioacuten natural
ABLACION
NEOCOLAGENOGENESIS
absorcioacuten
OBJETIVOS 2
Proteccioacuten natural
ABLACION
NEOCOLAGENOGENESIS
absorcioacuten
OBJETIVOS 3
Proteccioacuten natural
ABLACION
NEOCOLAGENOGENESIS
absorcioacuten
11
Mechanism of Action - Phases
Phase 1(within 48-72 hr)
EARLY THERMAL EFFECT
- Edema
- Release of chemical mediators
- Shrinkage of collagen and elastic fibers
Phase 2 (in the following 30 days) PROLIFERATION
- Fibroblastic recruiting
- New extracellular matrix
- New collagen fibers
Phase 3 (After 30-40 days) REMODELLING
- Mature collagen fibers
- Increase of collagen fiber strain
- Neovascularization new blood vessel formation
- Improved lubrication pH (acidity)
VAGINAL MUCOSA PHYSIOLOGIC AND FUNCTIONAL RECOVERY
EFECTOS BIOLOacuteGICOS TEacuteRMICOS
Calentamiento (estimulacioacuten) 40-60degC
Activacioacuten o dantildeos menores y reversibles
Efectos metaboacutelicos (gt425degC) ndash Colageacutenesis
Coagulacioacuten (necrosis) 60-90degC
Dantildeos de reversibles a irreversibles
Rotura de viacutenculos quiacutemicos desnaturalizacioacuten de las proteiacutenas
Efectos metaboacutelicosndash Tensado
Ablacioacuten (evaporacioacuten) gt100degC
Dantildeos irreversibles evaporacioacuten de tejido
Efectos metaboacutelicosndash Ablacioacuten
CO2RE Indications for Use Path
CO2RE has received FDA clearance for more than 90 new indications for
use across a range of specialties including gynecology and genitourinary of a
wide range of indications See appendix of this PPT for full list of new indications
for use
bull FDA Letter to File for internal amp external handpieces ndash Mid-Feb2016
bull CE submission for vaginal atrophy and rejuvenation based on safety
and efficacy clinical studies ndash Jan 2016 Approval anticipated in Mar-Apr
2016
bull Health Canada submission after receipt of CE approval Approval can
take some months
bull Other countries ndash dependent on receipt of CE approval
bull FDA Indication for vaginal atrophy and SUI - will
require clinical data and traditional FDA 510K
submission
Agenda
bull PASADO-PRESENTE
-Condilomas vulvares
-Patologia cervical
-Toda cirugia suceptible de corte
coagulacioacuten o extirpacioacuten (evaporizacioacuten)
INDICACIONES MAacuteS USUALES
bull ATROFIA VULVO-VAGINAL
bull INCONTINENDIA URINARIA DE STRESS
bull SINDROME DE HIPERLAXITUD
bull PROLAPSO GENITAL
EFICACIA LASER EN LA ATROFIA VULVO-VAGINAL
bull Hay mucha evidencia de su eficacia tanto con erbio como con (CO 2) en la atrofia vulvo-vaginal de la mujer menopausica
Salvatore S Nappi RE Zerbinati N et al A 12-week treatmentwith fractional CO 2 laser for
vulvovaginal atrophy a pilot study Climacteric 2014 17 363 ndash 9
Salvatore S Nappi RE Parma M et al Sexual function after fractional microablative CO 2 laser in women with vulvovaginal atrophy Climacteric 2015 18 219 ndash 25
Salvatore S H istological study on the effects of microablative fractional CO 2 laser on atrophic vaginal tissue an ex vivo study Menopause 2015 22 845 ndash 9
Zerbinati N S erati M O rigoni M e t a l M icroscopic and ultrastructural modifi cations of postmenopausal atrophic vaginal mucosa after fractional carbon dioxide laser treatment Laser Med Sci 2015 30 429 ndash 36
Perino A Calligaro A Forlani F e t al Vulvo-vaginal atrophy a new treatment modality using thermo-ablative fractional CO 2 laser Maturitas 2015 80 296 ndash 301
ATROFIA VULVO-VAGINAL
Irradiaccion 360ordm circular haz completo Pases (3 to 5) Dosis 10 to 5 joules cm2
Irradiacioacuten en mapeo Pases (3) cubriendo vagina y vulva
Efectivo durante 6-12 meses
Se necesitan de 2-4 sesiones
Breast Cancer Increased risk of presenting
Genitourinary Syndrome
Natural or Induced Menopause Pharmaceuticals (Tamoxifen AIs ) Estrogenic contraindication Lubricants Moisturizers Dilating Therapy Botox Injections
Laser therapy (effectiveness at least equal to estrogen)
Cancer de mama y laser vaginal
Menopause 2017 Mar24(3)316-319 doi 101097GME0000000000000761
Vaginal erbium laser as second-generation thermotherapy for the genitourinary syndrome of menopause a pilot study in breast cancer survivors Gambacciani M1 Levancini M OBJECTIVE The aim of this study was to evaluate the efficacy and acceptability of a second generation of vaginal laser treatment the vaginal erbium laser as a nonablative photothermal therapy for the management of genitourinary syndrome of menopause in postmenopausal breast cancer survivors CONCLUSIONS This study suggests that the vaginal erbium laser is effective and safe for the treatment of genitourinary syndrome of menopause in breast cancer survivors
Menopause 2017 Dec 28 doi Fractional microablative CO2 laser in breast cancer survivors affected by iatrogenic vulvovaginal atrophy after failure of nonestrogenic local treatments a retrospective study Pagano T1 METHODS We treated 82 BC survivors with three cycles of CO2 laser after failure of topical nonestrogenic therapy The severity of symptoms was assessed with a visual analog scale (VAS) at baseline and after completion of laser therapy Differences in mean VAS scores of each symptom before and after treatment were assessed with multiple t tests for pairwise comparisons Multivariate analyses were used to adjust the final mean scores for the main confounding factors RESULTS Pre versus post-treatment differences in mean VAS scores were significant for sensitivity during sexual intercourse vaginal dryness itchingstinging dyspareunia and dysuria (P lt 0001 for all) bleeding (P = 0001) probe insertion (P = 0001) and movement-related pain (P = 0011) Multivariate analyses confirmed that results were significant irrespective of patients age and type of adjuvant therapy CONCLUSION This study shows that CO2 laser treatment is effective and safe in BC patients with iatrogenic menopause However the optimal number of cycles to administer and the need for retreatment remain to be defined Prospective trials are needed to compare CO2 laser therapy with therapeutic alternatives
INDICACIONES MAacuteS USUALES
bull ATROFIA VULVO-VAGINAL
bull INCONTINENDIA URINARIA DE STRESS
bull SINDROME DE HIPERLAXITUD
bull PROLAPSO GENITAL
22
INCONTINENCIA URINARIA
INCONTINENCIA URINARIA Contraccion del colageno suburetral Neocolagenosis suburetral Irradiaccioacuten angular fraccionada Pases (4 to 5) Dosis 10 A 5 JulIOs cm2 Radiacion 90-120ordm circular Sesiones (2 to 3) Leve-Moderate SUI (ICIQ_SF lt13)
PALACIOS INSTITUTE EXPERIENCE
bull Average age 526 years
bull 41 IUM 59 SUI
bull Average parity 2 children Average BMI
28
bull Average duration per session 19 minutes
bull Very good procedure tolerance
bull Adverse effects during the procedure
NO (32 local heat or slight stinging that
self-limited)
bull Adverse effects after the procedure NO
bull 100 were incorporated into their
activity in lt24 h
110 paTIENTS
1 month after the last session
NOT effective with the emergency component but YES of the effort component in the IUM (12) NOT effective in athletes Overall satisfaction 100 MP improves atrophy
INDICACIONES MAacuteS USUALES
bull ATROFIA VULVO-VAGINAL
bull INCONTINENDIA URINARIA DE STRESS
bull SINDROME DE HIPERLAXITUD
bull PROLAPSO GENITAL
TERMINOLOGIacuteA Y DEFINICIOacuteN iquestPOR QUEacute SIacuteNDROME DE HIPERLAXITUD VAGINAL
bull Anatoacutemicas y Fisioloacutegicas o Laxitud Normal
o Hiperlaxitud Anormal
bull Cliacutenicas o Siacutendrome = Agrupacioacuten de diversos siacutentomas
DEFINICIOacuteN DE SIacuteNDROME DE
HIPERLAXITUD VAGINAL
Conjunto de siacutentomas que aparecen por un exceso
de laxitud vaginal debido a la alteracioacuten de la
estructura de la vagina y tejidos circundantes
Santiago Palacios 2017
29
VAGINAL TIGHTENING
bull Mejoria y uso en 360 grados
bull Remodelado del tejido vaginal y prevencion
INDICACIONES MAacuteS USUALES
bull ATROFIA VULVO-VAGINAL
bull INCONTINENDIA URINARIA DE STRESS
bull SINDROME DE HIPELAXITUD
bull PROLAPSO GENITAL
PROLAPSO GENITAL
bull Prolapso central no lateral Grado 1
y 2
bull Sesiones Como poco 5
)
Agenda
bull PRESENTE
bull FUTURO
bull - MEJORAR EL EFECTO
- PROTOCOLOS MAacuteS DEFINIDOS
-FUTURAS INDICACIONES
COLAGENO Y EDAD
EPHITELIUM AND LAMINA PROPIA
FUNCIONES DEL FIBROBLASTO
LAMINA PROPIA
Agenda
bull PRESENTE
bull FUTURO
bull - MEJORAR EL EFECTO
- PROTOCOLOS MAacuteS DEFINIDOS
- FUTURAS INDICACIONES
CO2RE
20-40 micras proporciona una mejora similar a la de un peeling quiacutemico pero
con un mayor control de la profundidad y menos efectos adversos
Moacutedulo Aesthetic ndash Modo Fraccionado Light
SELECCIOacuteN DE PACIENTES
bull Evaluacioacuten de los sintomas
bull Motivacioacuten y demanda del paciente
bull Abilidad y posibilidades del aparato laser
Agenda
bull PRESENTE
bull FUTURO
bull - MEJORAR EL EFECTO
- PROTOCOLOS MAacuteS DEFINIDOS
- FUTURAS INDICACIONES
NUEVAS PERSPECTIVAS
copy 2016 VIVEVE Not for publication or podium presentation 41
Dermatitis vulvares Dispareunia-vaginismo Retraccioacuten de cicatrices Recuperar la flora vaginal Problemas de las mallas Fisuras vulvares Vejiga hiperactiva Patologias conocidas ( infecciosas y tumorales)
VULVAR DERMATITIS
copy 2016 VIVEVE Not for publication or podium presentation 42
GRADOS DE DOLOR SUB-CLASIFICACIOacuteN DE
MI VISION DE FUTURO
1 Todas las mujeres despueacutes de tres meses del parto Para - Evitar laxitud vaginal
- Evitar incontinencia urinaria
- Volver a una tensioacuten vulvar y vaginal normal
2 En la menopausia y de forma anual para prevenir - Atrofia vulvo-vaginal
- Incontinencia urinaria
- Prolapso
1 COEFFICIENTE DE ABSORCIOacuteN (ENERGIA DEL LASER Y AGUA)
2 FRACCIONADO
3 ABLACCIOacuteN Y EFECTOS TERMICOS
iquestPorqueacute el laser en vulva y
vagina
7
Immediately After the Treatment
Courtesy of Dr Alexandros Bader OBampGYN ndash Urogynecologist ndash Cosmetic Gynecologist London
OBJETIVOS 1
Proteccioacuten natural
ABLACION
NEOCOLAGENOGENESIS
absorcioacuten
OBJETIVOS 2
Proteccioacuten natural
ABLACION
NEOCOLAGENOGENESIS
absorcioacuten
OBJETIVOS 3
Proteccioacuten natural
ABLACION
NEOCOLAGENOGENESIS
absorcioacuten
11
Mechanism of Action - Phases
Phase 1(within 48-72 hr)
EARLY THERMAL EFFECT
- Edema
- Release of chemical mediators
- Shrinkage of collagen and elastic fibers
Phase 2 (in the following 30 days) PROLIFERATION
- Fibroblastic recruiting
- New extracellular matrix
- New collagen fibers
Phase 3 (After 30-40 days) REMODELLING
- Mature collagen fibers
- Increase of collagen fiber strain
- Neovascularization new blood vessel formation
- Improved lubrication pH (acidity)
VAGINAL MUCOSA PHYSIOLOGIC AND FUNCTIONAL RECOVERY
EFECTOS BIOLOacuteGICOS TEacuteRMICOS
Calentamiento (estimulacioacuten) 40-60degC
Activacioacuten o dantildeos menores y reversibles
Efectos metaboacutelicos (gt425degC) ndash Colageacutenesis
Coagulacioacuten (necrosis) 60-90degC
Dantildeos de reversibles a irreversibles
Rotura de viacutenculos quiacutemicos desnaturalizacioacuten de las proteiacutenas
Efectos metaboacutelicosndash Tensado
Ablacioacuten (evaporacioacuten) gt100degC
Dantildeos irreversibles evaporacioacuten de tejido
Efectos metaboacutelicosndash Ablacioacuten
CO2RE Indications for Use Path
CO2RE has received FDA clearance for more than 90 new indications for
use across a range of specialties including gynecology and genitourinary of a
wide range of indications See appendix of this PPT for full list of new indications
for use
bull FDA Letter to File for internal amp external handpieces ndash Mid-Feb2016
bull CE submission for vaginal atrophy and rejuvenation based on safety
and efficacy clinical studies ndash Jan 2016 Approval anticipated in Mar-Apr
2016
bull Health Canada submission after receipt of CE approval Approval can
take some months
bull Other countries ndash dependent on receipt of CE approval
bull FDA Indication for vaginal atrophy and SUI - will
require clinical data and traditional FDA 510K
submission
Agenda
bull PASADO-PRESENTE
-Condilomas vulvares
-Patologia cervical
-Toda cirugia suceptible de corte
coagulacioacuten o extirpacioacuten (evaporizacioacuten)
INDICACIONES MAacuteS USUALES
bull ATROFIA VULVO-VAGINAL
bull INCONTINENDIA URINARIA DE STRESS
bull SINDROME DE HIPERLAXITUD
bull PROLAPSO GENITAL
EFICACIA LASER EN LA ATROFIA VULVO-VAGINAL
bull Hay mucha evidencia de su eficacia tanto con erbio como con (CO 2) en la atrofia vulvo-vaginal de la mujer menopausica
Salvatore S Nappi RE Zerbinati N et al A 12-week treatmentwith fractional CO 2 laser for
vulvovaginal atrophy a pilot study Climacteric 2014 17 363 ndash 9
Salvatore S Nappi RE Parma M et al Sexual function after fractional microablative CO 2 laser in women with vulvovaginal atrophy Climacteric 2015 18 219 ndash 25
Salvatore S H istological study on the effects of microablative fractional CO 2 laser on atrophic vaginal tissue an ex vivo study Menopause 2015 22 845 ndash 9
Zerbinati N S erati M O rigoni M e t a l M icroscopic and ultrastructural modifi cations of postmenopausal atrophic vaginal mucosa after fractional carbon dioxide laser treatment Laser Med Sci 2015 30 429 ndash 36
Perino A Calligaro A Forlani F e t al Vulvo-vaginal atrophy a new treatment modality using thermo-ablative fractional CO 2 laser Maturitas 2015 80 296 ndash 301
ATROFIA VULVO-VAGINAL
Irradiaccion 360ordm circular haz completo Pases (3 to 5) Dosis 10 to 5 joules cm2
Irradiacioacuten en mapeo Pases (3) cubriendo vagina y vulva
Efectivo durante 6-12 meses
Se necesitan de 2-4 sesiones
Breast Cancer Increased risk of presenting
Genitourinary Syndrome
Natural or Induced Menopause Pharmaceuticals (Tamoxifen AIs ) Estrogenic contraindication Lubricants Moisturizers Dilating Therapy Botox Injections
Laser therapy (effectiveness at least equal to estrogen)
Cancer de mama y laser vaginal
Menopause 2017 Mar24(3)316-319 doi 101097GME0000000000000761
Vaginal erbium laser as second-generation thermotherapy for the genitourinary syndrome of menopause a pilot study in breast cancer survivors Gambacciani M1 Levancini M OBJECTIVE The aim of this study was to evaluate the efficacy and acceptability of a second generation of vaginal laser treatment the vaginal erbium laser as a nonablative photothermal therapy for the management of genitourinary syndrome of menopause in postmenopausal breast cancer survivors CONCLUSIONS This study suggests that the vaginal erbium laser is effective and safe for the treatment of genitourinary syndrome of menopause in breast cancer survivors
Menopause 2017 Dec 28 doi Fractional microablative CO2 laser in breast cancer survivors affected by iatrogenic vulvovaginal atrophy after failure of nonestrogenic local treatments a retrospective study Pagano T1 METHODS We treated 82 BC survivors with three cycles of CO2 laser after failure of topical nonestrogenic therapy The severity of symptoms was assessed with a visual analog scale (VAS) at baseline and after completion of laser therapy Differences in mean VAS scores of each symptom before and after treatment were assessed with multiple t tests for pairwise comparisons Multivariate analyses were used to adjust the final mean scores for the main confounding factors RESULTS Pre versus post-treatment differences in mean VAS scores were significant for sensitivity during sexual intercourse vaginal dryness itchingstinging dyspareunia and dysuria (P lt 0001 for all) bleeding (P = 0001) probe insertion (P = 0001) and movement-related pain (P = 0011) Multivariate analyses confirmed that results were significant irrespective of patients age and type of adjuvant therapy CONCLUSION This study shows that CO2 laser treatment is effective and safe in BC patients with iatrogenic menopause However the optimal number of cycles to administer and the need for retreatment remain to be defined Prospective trials are needed to compare CO2 laser therapy with therapeutic alternatives
INDICACIONES MAacuteS USUALES
bull ATROFIA VULVO-VAGINAL
bull INCONTINENDIA URINARIA DE STRESS
bull SINDROME DE HIPERLAXITUD
bull PROLAPSO GENITAL
22
INCONTINENCIA URINARIA
INCONTINENCIA URINARIA Contraccion del colageno suburetral Neocolagenosis suburetral Irradiaccioacuten angular fraccionada Pases (4 to 5) Dosis 10 A 5 JulIOs cm2 Radiacion 90-120ordm circular Sesiones (2 to 3) Leve-Moderate SUI (ICIQ_SF lt13)
PALACIOS INSTITUTE EXPERIENCE
bull Average age 526 years
bull 41 IUM 59 SUI
bull Average parity 2 children Average BMI
28
bull Average duration per session 19 minutes
bull Very good procedure tolerance
bull Adverse effects during the procedure
NO (32 local heat or slight stinging that
self-limited)
bull Adverse effects after the procedure NO
bull 100 were incorporated into their
activity in lt24 h
110 paTIENTS
1 month after the last session
NOT effective with the emergency component but YES of the effort component in the IUM (12) NOT effective in athletes Overall satisfaction 100 MP improves atrophy
INDICACIONES MAacuteS USUALES
bull ATROFIA VULVO-VAGINAL
bull INCONTINENDIA URINARIA DE STRESS
bull SINDROME DE HIPERLAXITUD
bull PROLAPSO GENITAL
TERMINOLOGIacuteA Y DEFINICIOacuteN iquestPOR QUEacute SIacuteNDROME DE HIPERLAXITUD VAGINAL
bull Anatoacutemicas y Fisioloacutegicas o Laxitud Normal
o Hiperlaxitud Anormal
bull Cliacutenicas o Siacutendrome = Agrupacioacuten de diversos siacutentomas
DEFINICIOacuteN DE SIacuteNDROME DE
HIPERLAXITUD VAGINAL
Conjunto de siacutentomas que aparecen por un exceso
de laxitud vaginal debido a la alteracioacuten de la
estructura de la vagina y tejidos circundantes
Santiago Palacios 2017
29
VAGINAL TIGHTENING
bull Mejoria y uso en 360 grados
bull Remodelado del tejido vaginal y prevencion
INDICACIONES MAacuteS USUALES
bull ATROFIA VULVO-VAGINAL
bull INCONTINENDIA URINARIA DE STRESS
bull SINDROME DE HIPELAXITUD
bull PROLAPSO GENITAL
PROLAPSO GENITAL
bull Prolapso central no lateral Grado 1
y 2
bull Sesiones Como poco 5
)
Agenda
bull PRESENTE
bull FUTURO
bull - MEJORAR EL EFECTO
- PROTOCOLOS MAacuteS DEFINIDOS
-FUTURAS INDICACIONES
COLAGENO Y EDAD
EPHITELIUM AND LAMINA PROPIA
FUNCIONES DEL FIBROBLASTO
LAMINA PROPIA
Agenda
bull PRESENTE
bull FUTURO
bull - MEJORAR EL EFECTO
- PROTOCOLOS MAacuteS DEFINIDOS
- FUTURAS INDICACIONES
CO2RE
20-40 micras proporciona una mejora similar a la de un peeling quiacutemico pero
con un mayor control de la profundidad y menos efectos adversos
Moacutedulo Aesthetic ndash Modo Fraccionado Light
SELECCIOacuteN DE PACIENTES
bull Evaluacioacuten de los sintomas
bull Motivacioacuten y demanda del paciente
bull Abilidad y posibilidades del aparato laser
Agenda
bull PRESENTE
bull FUTURO
bull - MEJORAR EL EFECTO
- PROTOCOLOS MAacuteS DEFINIDOS
- FUTURAS INDICACIONES
NUEVAS PERSPECTIVAS
copy 2016 VIVEVE Not for publication or podium presentation 41
Dermatitis vulvares Dispareunia-vaginismo Retraccioacuten de cicatrices Recuperar la flora vaginal Problemas de las mallas Fisuras vulvares Vejiga hiperactiva Patologias conocidas ( infecciosas y tumorales)
VULVAR DERMATITIS
copy 2016 VIVEVE Not for publication or podium presentation 42
GRADOS DE DOLOR SUB-CLASIFICACIOacuteN DE
MI VISION DE FUTURO
1 Todas las mujeres despueacutes de tres meses del parto Para - Evitar laxitud vaginal
- Evitar incontinencia urinaria
- Volver a una tensioacuten vulvar y vaginal normal
2 En la menopausia y de forma anual para prevenir - Atrofia vulvo-vaginal
- Incontinencia urinaria
- Prolapso
7
Immediately After the Treatment
Courtesy of Dr Alexandros Bader OBampGYN ndash Urogynecologist ndash Cosmetic Gynecologist London
OBJETIVOS 1
Proteccioacuten natural
ABLACION
NEOCOLAGENOGENESIS
absorcioacuten
OBJETIVOS 2
Proteccioacuten natural
ABLACION
NEOCOLAGENOGENESIS
absorcioacuten
OBJETIVOS 3
Proteccioacuten natural
ABLACION
NEOCOLAGENOGENESIS
absorcioacuten
11
Mechanism of Action - Phases
Phase 1(within 48-72 hr)
EARLY THERMAL EFFECT
- Edema
- Release of chemical mediators
- Shrinkage of collagen and elastic fibers
Phase 2 (in the following 30 days) PROLIFERATION
- Fibroblastic recruiting
- New extracellular matrix
- New collagen fibers
Phase 3 (After 30-40 days) REMODELLING
- Mature collagen fibers
- Increase of collagen fiber strain
- Neovascularization new blood vessel formation
- Improved lubrication pH (acidity)
VAGINAL MUCOSA PHYSIOLOGIC AND FUNCTIONAL RECOVERY
EFECTOS BIOLOacuteGICOS TEacuteRMICOS
Calentamiento (estimulacioacuten) 40-60degC
Activacioacuten o dantildeos menores y reversibles
Efectos metaboacutelicos (gt425degC) ndash Colageacutenesis
Coagulacioacuten (necrosis) 60-90degC
Dantildeos de reversibles a irreversibles
Rotura de viacutenculos quiacutemicos desnaturalizacioacuten de las proteiacutenas
Efectos metaboacutelicosndash Tensado
Ablacioacuten (evaporacioacuten) gt100degC
Dantildeos irreversibles evaporacioacuten de tejido
Efectos metaboacutelicosndash Ablacioacuten
CO2RE Indications for Use Path
CO2RE has received FDA clearance for more than 90 new indications for
use across a range of specialties including gynecology and genitourinary of a
wide range of indications See appendix of this PPT for full list of new indications
for use
bull FDA Letter to File for internal amp external handpieces ndash Mid-Feb2016
bull CE submission for vaginal atrophy and rejuvenation based on safety
and efficacy clinical studies ndash Jan 2016 Approval anticipated in Mar-Apr
2016
bull Health Canada submission after receipt of CE approval Approval can
take some months
bull Other countries ndash dependent on receipt of CE approval
bull FDA Indication for vaginal atrophy and SUI - will
require clinical data and traditional FDA 510K
submission
Agenda
bull PASADO-PRESENTE
-Condilomas vulvares
-Patologia cervical
-Toda cirugia suceptible de corte
coagulacioacuten o extirpacioacuten (evaporizacioacuten)
INDICACIONES MAacuteS USUALES
bull ATROFIA VULVO-VAGINAL
bull INCONTINENDIA URINARIA DE STRESS
bull SINDROME DE HIPERLAXITUD
bull PROLAPSO GENITAL
EFICACIA LASER EN LA ATROFIA VULVO-VAGINAL
bull Hay mucha evidencia de su eficacia tanto con erbio como con (CO 2) en la atrofia vulvo-vaginal de la mujer menopausica
Salvatore S Nappi RE Zerbinati N et al A 12-week treatmentwith fractional CO 2 laser for
vulvovaginal atrophy a pilot study Climacteric 2014 17 363 ndash 9
Salvatore S Nappi RE Parma M et al Sexual function after fractional microablative CO 2 laser in women with vulvovaginal atrophy Climacteric 2015 18 219 ndash 25
Salvatore S H istological study on the effects of microablative fractional CO 2 laser on atrophic vaginal tissue an ex vivo study Menopause 2015 22 845 ndash 9
Zerbinati N S erati M O rigoni M e t a l M icroscopic and ultrastructural modifi cations of postmenopausal atrophic vaginal mucosa after fractional carbon dioxide laser treatment Laser Med Sci 2015 30 429 ndash 36
Perino A Calligaro A Forlani F e t al Vulvo-vaginal atrophy a new treatment modality using thermo-ablative fractional CO 2 laser Maturitas 2015 80 296 ndash 301
ATROFIA VULVO-VAGINAL
Irradiaccion 360ordm circular haz completo Pases (3 to 5) Dosis 10 to 5 joules cm2
Irradiacioacuten en mapeo Pases (3) cubriendo vagina y vulva
Efectivo durante 6-12 meses
Se necesitan de 2-4 sesiones
Breast Cancer Increased risk of presenting
Genitourinary Syndrome
Natural or Induced Menopause Pharmaceuticals (Tamoxifen AIs ) Estrogenic contraindication Lubricants Moisturizers Dilating Therapy Botox Injections
Laser therapy (effectiveness at least equal to estrogen)
Cancer de mama y laser vaginal
Menopause 2017 Mar24(3)316-319 doi 101097GME0000000000000761
Vaginal erbium laser as second-generation thermotherapy for the genitourinary syndrome of menopause a pilot study in breast cancer survivors Gambacciani M1 Levancini M OBJECTIVE The aim of this study was to evaluate the efficacy and acceptability of a second generation of vaginal laser treatment the vaginal erbium laser as a nonablative photothermal therapy for the management of genitourinary syndrome of menopause in postmenopausal breast cancer survivors CONCLUSIONS This study suggests that the vaginal erbium laser is effective and safe for the treatment of genitourinary syndrome of menopause in breast cancer survivors
Menopause 2017 Dec 28 doi Fractional microablative CO2 laser in breast cancer survivors affected by iatrogenic vulvovaginal atrophy after failure of nonestrogenic local treatments a retrospective study Pagano T1 METHODS We treated 82 BC survivors with three cycles of CO2 laser after failure of topical nonestrogenic therapy The severity of symptoms was assessed with a visual analog scale (VAS) at baseline and after completion of laser therapy Differences in mean VAS scores of each symptom before and after treatment were assessed with multiple t tests for pairwise comparisons Multivariate analyses were used to adjust the final mean scores for the main confounding factors RESULTS Pre versus post-treatment differences in mean VAS scores were significant for sensitivity during sexual intercourse vaginal dryness itchingstinging dyspareunia and dysuria (P lt 0001 for all) bleeding (P = 0001) probe insertion (P = 0001) and movement-related pain (P = 0011) Multivariate analyses confirmed that results were significant irrespective of patients age and type of adjuvant therapy CONCLUSION This study shows that CO2 laser treatment is effective and safe in BC patients with iatrogenic menopause However the optimal number of cycles to administer and the need for retreatment remain to be defined Prospective trials are needed to compare CO2 laser therapy with therapeutic alternatives
INDICACIONES MAacuteS USUALES
bull ATROFIA VULVO-VAGINAL
bull INCONTINENDIA URINARIA DE STRESS
bull SINDROME DE HIPERLAXITUD
bull PROLAPSO GENITAL
22
INCONTINENCIA URINARIA
INCONTINENCIA URINARIA Contraccion del colageno suburetral Neocolagenosis suburetral Irradiaccioacuten angular fraccionada Pases (4 to 5) Dosis 10 A 5 JulIOs cm2 Radiacion 90-120ordm circular Sesiones (2 to 3) Leve-Moderate SUI (ICIQ_SF lt13)
PALACIOS INSTITUTE EXPERIENCE
bull Average age 526 years
bull 41 IUM 59 SUI
bull Average parity 2 children Average BMI
28
bull Average duration per session 19 minutes
bull Very good procedure tolerance
bull Adverse effects during the procedure
NO (32 local heat or slight stinging that
self-limited)
bull Adverse effects after the procedure NO
bull 100 were incorporated into their
activity in lt24 h
110 paTIENTS
1 month after the last session
NOT effective with the emergency component but YES of the effort component in the IUM (12) NOT effective in athletes Overall satisfaction 100 MP improves atrophy
INDICACIONES MAacuteS USUALES
bull ATROFIA VULVO-VAGINAL
bull INCONTINENDIA URINARIA DE STRESS
bull SINDROME DE HIPERLAXITUD
bull PROLAPSO GENITAL
TERMINOLOGIacuteA Y DEFINICIOacuteN iquestPOR QUEacute SIacuteNDROME DE HIPERLAXITUD VAGINAL
bull Anatoacutemicas y Fisioloacutegicas o Laxitud Normal
o Hiperlaxitud Anormal
bull Cliacutenicas o Siacutendrome = Agrupacioacuten de diversos siacutentomas
DEFINICIOacuteN DE SIacuteNDROME DE
HIPERLAXITUD VAGINAL
Conjunto de siacutentomas que aparecen por un exceso
de laxitud vaginal debido a la alteracioacuten de la
estructura de la vagina y tejidos circundantes
Santiago Palacios 2017
29
VAGINAL TIGHTENING
bull Mejoria y uso en 360 grados
bull Remodelado del tejido vaginal y prevencion
INDICACIONES MAacuteS USUALES
bull ATROFIA VULVO-VAGINAL
bull INCONTINENDIA URINARIA DE STRESS
bull SINDROME DE HIPELAXITUD
bull PROLAPSO GENITAL
PROLAPSO GENITAL
bull Prolapso central no lateral Grado 1
y 2
bull Sesiones Como poco 5
)
Agenda
bull PRESENTE
bull FUTURO
bull - MEJORAR EL EFECTO
- PROTOCOLOS MAacuteS DEFINIDOS
-FUTURAS INDICACIONES
COLAGENO Y EDAD
EPHITELIUM AND LAMINA PROPIA
FUNCIONES DEL FIBROBLASTO
LAMINA PROPIA
Agenda
bull PRESENTE
bull FUTURO
bull - MEJORAR EL EFECTO
- PROTOCOLOS MAacuteS DEFINIDOS
- FUTURAS INDICACIONES
CO2RE
20-40 micras proporciona una mejora similar a la de un peeling quiacutemico pero
con un mayor control de la profundidad y menos efectos adversos
Moacutedulo Aesthetic ndash Modo Fraccionado Light
SELECCIOacuteN DE PACIENTES
bull Evaluacioacuten de los sintomas
bull Motivacioacuten y demanda del paciente
bull Abilidad y posibilidades del aparato laser
Agenda
bull PRESENTE
bull FUTURO
bull - MEJORAR EL EFECTO
- PROTOCOLOS MAacuteS DEFINIDOS
- FUTURAS INDICACIONES
NUEVAS PERSPECTIVAS
copy 2016 VIVEVE Not for publication or podium presentation 41
Dermatitis vulvares Dispareunia-vaginismo Retraccioacuten de cicatrices Recuperar la flora vaginal Problemas de las mallas Fisuras vulvares Vejiga hiperactiva Patologias conocidas ( infecciosas y tumorales)
VULVAR DERMATITIS
copy 2016 VIVEVE Not for publication or podium presentation 42
GRADOS DE DOLOR SUB-CLASIFICACIOacuteN DE
MI VISION DE FUTURO
1 Todas las mujeres despueacutes de tres meses del parto Para - Evitar laxitud vaginal
- Evitar incontinencia urinaria
- Volver a una tensioacuten vulvar y vaginal normal
2 En la menopausia y de forma anual para prevenir - Atrofia vulvo-vaginal
- Incontinencia urinaria
- Prolapso
OBJETIVOS 1
Proteccioacuten natural
ABLACION
NEOCOLAGENOGENESIS
absorcioacuten
OBJETIVOS 2
Proteccioacuten natural
ABLACION
NEOCOLAGENOGENESIS
absorcioacuten
OBJETIVOS 3
Proteccioacuten natural
ABLACION
NEOCOLAGENOGENESIS
absorcioacuten
11
Mechanism of Action - Phases
Phase 1(within 48-72 hr)
EARLY THERMAL EFFECT
- Edema
- Release of chemical mediators
- Shrinkage of collagen and elastic fibers
Phase 2 (in the following 30 days) PROLIFERATION
- Fibroblastic recruiting
- New extracellular matrix
- New collagen fibers
Phase 3 (After 30-40 days) REMODELLING
- Mature collagen fibers
- Increase of collagen fiber strain
- Neovascularization new blood vessel formation
- Improved lubrication pH (acidity)
VAGINAL MUCOSA PHYSIOLOGIC AND FUNCTIONAL RECOVERY
EFECTOS BIOLOacuteGICOS TEacuteRMICOS
Calentamiento (estimulacioacuten) 40-60degC
Activacioacuten o dantildeos menores y reversibles
Efectos metaboacutelicos (gt425degC) ndash Colageacutenesis
Coagulacioacuten (necrosis) 60-90degC
Dantildeos de reversibles a irreversibles
Rotura de viacutenculos quiacutemicos desnaturalizacioacuten de las proteiacutenas
Efectos metaboacutelicosndash Tensado
Ablacioacuten (evaporacioacuten) gt100degC
Dantildeos irreversibles evaporacioacuten de tejido
Efectos metaboacutelicosndash Ablacioacuten
CO2RE Indications for Use Path
CO2RE has received FDA clearance for more than 90 new indications for
use across a range of specialties including gynecology and genitourinary of a
wide range of indications See appendix of this PPT for full list of new indications
for use
bull FDA Letter to File for internal amp external handpieces ndash Mid-Feb2016
bull CE submission for vaginal atrophy and rejuvenation based on safety
and efficacy clinical studies ndash Jan 2016 Approval anticipated in Mar-Apr
2016
bull Health Canada submission after receipt of CE approval Approval can
take some months
bull Other countries ndash dependent on receipt of CE approval
bull FDA Indication for vaginal atrophy and SUI - will
require clinical data and traditional FDA 510K
submission
Agenda
bull PASADO-PRESENTE
-Condilomas vulvares
-Patologia cervical
-Toda cirugia suceptible de corte
coagulacioacuten o extirpacioacuten (evaporizacioacuten)
INDICACIONES MAacuteS USUALES
bull ATROFIA VULVO-VAGINAL
bull INCONTINENDIA URINARIA DE STRESS
bull SINDROME DE HIPERLAXITUD
bull PROLAPSO GENITAL
EFICACIA LASER EN LA ATROFIA VULVO-VAGINAL
bull Hay mucha evidencia de su eficacia tanto con erbio como con (CO 2) en la atrofia vulvo-vaginal de la mujer menopausica
Salvatore S Nappi RE Zerbinati N et al A 12-week treatmentwith fractional CO 2 laser for
vulvovaginal atrophy a pilot study Climacteric 2014 17 363 ndash 9
Salvatore S Nappi RE Parma M et al Sexual function after fractional microablative CO 2 laser in women with vulvovaginal atrophy Climacteric 2015 18 219 ndash 25
Salvatore S H istological study on the effects of microablative fractional CO 2 laser on atrophic vaginal tissue an ex vivo study Menopause 2015 22 845 ndash 9
Zerbinati N S erati M O rigoni M e t a l M icroscopic and ultrastructural modifi cations of postmenopausal atrophic vaginal mucosa after fractional carbon dioxide laser treatment Laser Med Sci 2015 30 429 ndash 36
Perino A Calligaro A Forlani F e t al Vulvo-vaginal atrophy a new treatment modality using thermo-ablative fractional CO 2 laser Maturitas 2015 80 296 ndash 301
ATROFIA VULVO-VAGINAL
Irradiaccion 360ordm circular haz completo Pases (3 to 5) Dosis 10 to 5 joules cm2
Irradiacioacuten en mapeo Pases (3) cubriendo vagina y vulva
Efectivo durante 6-12 meses
Se necesitan de 2-4 sesiones
Breast Cancer Increased risk of presenting
Genitourinary Syndrome
Natural or Induced Menopause Pharmaceuticals (Tamoxifen AIs ) Estrogenic contraindication Lubricants Moisturizers Dilating Therapy Botox Injections
Laser therapy (effectiveness at least equal to estrogen)
Cancer de mama y laser vaginal
Menopause 2017 Mar24(3)316-319 doi 101097GME0000000000000761
Vaginal erbium laser as second-generation thermotherapy for the genitourinary syndrome of menopause a pilot study in breast cancer survivors Gambacciani M1 Levancini M OBJECTIVE The aim of this study was to evaluate the efficacy and acceptability of a second generation of vaginal laser treatment the vaginal erbium laser as a nonablative photothermal therapy for the management of genitourinary syndrome of menopause in postmenopausal breast cancer survivors CONCLUSIONS This study suggests that the vaginal erbium laser is effective and safe for the treatment of genitourinary syndrome of menopause in breast cancer survivors
Menopause 2017 Dec 28 doi Fractional microablative CO2 laser in breast cancer survivors affected by iatrogenic vulvovaginal atrophy after failure of nonestrogenic local treatments a retrospective study Pagano T1 METHODS We treated 82 BC survivors with three cycles of CO2 laser after failure of topical nonestrogenic therapy The severity of symptoms was assessed with a visual analog scale (VAS) at baseline and after completion of laser therapy Differences in mean VAS scores of each symptom before and after treatment were assessed with multiple t tests for pairwise comparisons Multivariate analyses were used to adjust the final mean scores for the main confounding factors RESULTS Pre versus post-treatment differences in mean VAS scores were significant for sensitivity during sexual intercourse vaginal dryness itchingstinging dyspareunia and dysuria (P lt 0001 for all) bleeding (P = 0001) probe insertion (P = 0001) and movement-related pain (P = 0011) Multivariate analyses confirmed that results were significant irrespective of patients age and type of adjuvant therapy CONCLUSION This study shows that CO2 laser treatment is effective and safe in BC patients with iatrogenic menopause However the optimal number of cycles to administer and the need for retreatment remain to be defined Prospective trials are needed to compare CO2 laser therapy with therapeutic alternatives
INDICACIONES MAacuteS USUALES
bull ATROFIA VULVO-VAGINAL
bull INCONTINENDIA URINARIA DE STRESS
bull SINDROME DE HIPERLAXITUD
bull PROLAPSO GENITAL
22
INCONTINENCIA URINARIA
INCONTINENCIA URINARIA Contraccion del colageno suburetral Neocolagenosis suburetral Irradiaccioacuten angular fraccionada Pases (4 to 5) Dosis 10 A 5 JulIOs cm2 Radiacion 90-120ordm circular Sesiones (2 to 3) Leve-Moderate SUI (ICIQ_SF lt13)
PALACIOS INSTITUTE EXPERIENCE
bull Average age 526 years
bull 41 IUM 59 SUI
bull Average parity 2 children Average BMI
28
bull Average duration per session 19 minutes
bull Very good procedure tolerance
bull Adverse effects during the procedure
NO (32 local heat or slight stinging that
self-limited)
bull Adverse effects after the procedure NO
bull 100 were incorporated into their
activity in lt24 h
110 paTIENTS
1 month after the last session
NOT effective with the emergency component but YES of the effort component in the IUM (12) NOT effective in athletes Overall satisfaction 100 MP improves atrophy
INDICACIONES MAacuteS USUALES
bull ATROFIA VULVO-VAGINAL
bull INCONTINENDIA URINARIA DE STRESS
bull SINDROME DE HIPERLAXITUD
bull PROLAPSO GENITAL
TERMINOLOGIacuteA Y DEFINICIOacuteN iquestPOR QUEacute SIacuteNDROME DE HIPERLAXITUD VAGINAL
bull Anatoacutemicas y Fisioloacutegicas o Laxitud Normal
o Hiperlaxitud Anormal
bull Cliacutenicas o Siacutendrome = Agrupacioacuten de diversos siacutentomas
DEFINICIOacuteN DE SIacuteNDROME DE
HIPERLAXITUD VAGINAL
Conjunto de siacutentomas que aparecen por un exceso
de laxitud vaginal debido a la alteracioacuten de la
estructura de la vagina y tejidos circundantes
Santiago Palacios 2017
29
VAGINAL TIGHTENING
bull Mejoria y uso en 360 grados
bull Remodelado del tejido vaginal y prevencion
INDICACIONES MAacuteS USUALES
bull ATROFIA VULVO-VAGINAL
bull INCONTINENDIA URINARIA DE STRESS
bull SINDROME DE HIPELAXITUD
bull PROLAPSO GENITAL
PROLAPSO GENITAL
bull Prolapso central no lateral Grado 1
y 2
bull Sesiones Como poco 5
)
Agenda
bull PRESENTE
bull FUTURO
bull - MEJORAR EL EFECTO
- PROTOCOLOS MAacuteS DEFINIDOS
-FUTURAS INDICACIONES
COLAGENO Y EDAD
EPHITELIUM AND LAMINA PROPIA
FUNCIONES DEL FIBROBLASTO
LAMINA PROPIA
Agenda
bull PRESENTE
bull FUTURO
bull - MEJORAR EL EFECTO
- PROTOCOLOS MAacuteS DEFINIDOS
- FUTURAS INDICACIONES
CO2RE
20-40 micras proporciona una mejora similar a la de un peeling quiacutemico pero
con un mayor control de la profundidad y menos efectos adversos
Moacutedulo Aesthetic ndash Modo Fraccionado Light
SELECCIOacuteN DE PACIENTES
bull Evaluacioacuten de los sintomas
bull Motivacioacuten y demanda del paciente
bull Abilidad y posibilidades del aparato laser
Agenda
bull PRESENTE
bull FUTURO
bull - MEJORAR EL EFECTO
- PROTOCOLOS MAacuteS DEFINIDOS
- FUTURAS INDICACIONES
NUEVAS PERSPECTIVAS
copy 2016 VIVEVE Not for publication or podium presentation 41
Dermatitis vulvares Dispareunia-vaginismo Retraccioacuten de cicatrices Recuperar la flora vaginal Problemas de las mallas Fisuras vulvares Vejiga hiperactiva Patologias conocidas ( infecciosas y tumorales)
VULVAR DERMATITIS
copy 2016 VIVEVE Not for publication or podium presentation 42
GRADOS DE DOLOR SUB-CLASIFICACIOacuteN DE
MI VISION DE FUTURO
1 Todas las mujeres despueacutes de tres meses del parto Para - Evitar laxitud vaginal
- Evitar incontinencia urinaria
- Volver a una tensioacuten vulvar y vaginal normal
2 En la menopausia y de forma anual para prevenir - Atrofia vulvo-vaginal
- Incontinencia urinaria
- Prolapso
OBJETIVOS 2
Proteccioacuten natural
ABLACION
NEOCOLAGENOGENESIS
absorcioacuten
OBJETIVOS 3
Proteccioacuten natural
ABLACION
NEOCOLAGENOGENESIS
absorcioacuten
11
Mechanism of Action - Phases
Phase 1(within 48-72 hr)
EARLY THERMAL EFFECT
- Edema
- Release of chemical mediators
- Shrinkage of collagen and elastic fibers
Phase 2 (in the following 30 days) PROLIFERATION
- Fibroblastic recruiting
- New extracellular matrix
- New collagen fibers
Phase 3 (After 30-40 days) REMODELLING
- Mature collagen fibers
- Increase of collagen fiber strain
- Neovascularization new blood vessel formation
- Improved lubrication pH (acidity)
VAGINAL MUCOSA PHYSIOLOGIC AND FUNCTIONAL RECOVERY
EFECTOS BIOLOacuteGICOS TEacuteRMICOS
Calentamiento (estimulacioacuten) 40-60degC
Activacioacuten o dantildeos menores y reversibles
Efectos metaboacutelicos (gt425degC) ndash Colageacutenesis
Coagulacioacuten (necrosis) 60-90degC
Dantildeos de reversibles a irreversibles
Rotura de viacutenculos quiacutemicos desnaturalizacioacuten de las proteiacutenas
Efectos metaboacutelicosndash Tensado
Ablacioacuten (evaporacioacuten) gt100degC
Dantildeos irreversibles evaporacioacuten de tejido
Efectos metaboacutelicosndash Ablacioacuten
CO2RE Indications for Use Path
CO2RE has received FDA clearance for more than 90 new indications for
use across a range of specialties including gynecology and genitourinary of a
wide range of indications See appendix of this PPT for full list of new indications
for use
bull FDA Letter to File for internal amp external handpieces ndash Mid-Feb2016
bull CE submission for vaginal atrophy and rejuvenation based on safety
and efficacy clinical studies ndash Jan 2016 Approval anticipated in Mar-Apr
2016
bull Health Canada submission after receipt of CE approval Approval can
take some months
bull Other countries ndash dependent on receipt of CE approval
bull FDA Indication for vaginal atrophy and SUI - will
require clinical data and traditional FDA 510K
submission
Agenda
bull PASADO-PRESENTE
-Condilomas vulvares
-Patologia cervical
-Toda cirugia suceptible de corte
coagulacioacuten o extirpacioacuten (evaporizacioacuten)
INDICACIONES MAacuteS USUALES
bull ATROFIA VULVO-VAGINAL
bull INCONTINENDIA URINARIA DE STRESS
bull SINDROME DE HIPERLAXITUD
bull PROLAPSO GENITAL
EFICACIA LASER EN LA ATROFIA VULVO-VAGINAL
bull Hay mucha evidencia de su eficacia tanto con erbio como con (CO 2) en la atrofia vulvo-vaginal de la mujer menopausica
Salvatore S Nappi RE Zerbinati N et al A 12-week treatmentwith fractional CO 2 laser for
vulvovaginal atrophy a pilot study Climacteric 2014 17 363 ndash 9
Salvatore S Nappi RE Parma M et al Sexual function after fractional microablative CO 2 laser in women with vulvovaginal atrophy Climacteric 2015 18 219 ndash 25
Salvatore S H istological study on the effects of microablative fractional CO 2 laser on atrophic vaginal tissue an ex vivo study Menopause 2015 22 845 ndash 9
Zerbinati N S erati M O rigoni M e t a l M icroscopic and ultrastructural modifi cations of postmenopausal atrophic vaginal mucosa after fractional carbon dioxide laser treatment Laser Med Sci 2015 30 429 ndash 36
Perino A Calligaro A Forlani F e t al Vulvo-vaginal atrophy a new treatment modality using thermo-ablative fractional CO 2 laser Maturitas 2015 80 296 ndash 301
ATROFIA VULVO-VAGINAL
Irradiaccion 360ordm circular haz completo Pases (3 to 5) Dosis 10 to 5 joules cm2
Irradiacioacuten en mapeo Pases (3) cubriendo vagina y vulva
Efectivo durante 6-12 meses
Se necesitan de 2-4 sesiones
Breast Cancer Increased risk of presenting
Genitourinary Syndrome
Natural or Induced Menopause Pharmaceuticals (Tamoxifen AIs ) Estrogenic contraindication Lubricants Moisturizers Dilating Therapy Botox Injections
Laser therapy (effectiveness at least equal to estrogen)
Cancer de mama y laser vaginal
Menopause 2017 Mar24(3)316-319 doi 101097GME0000000000000761
Vaginal erbium laser as second-generation thermotherapy for the genitourinary syndrome of menopause a pilot study in breast cancer survivors Gambacciani M1 Levancini M OBJECTIVE The aim of this study was to evaluate the efficacy and acceptability of a second generation of vaginal laser treatment the vaginal erbium laser as a nonablative photothermal therapy for the management of genitourinary syndrome of menopause in postmenopausal breast cancer survivors CONCLUSIONS This study suggests that the vaginal erbium laser is effective and safe for the treatment of genitourinary syndrome of menopause in breast cancer survivors
Menopause 2017 Dec 28 doi Fractional microablative CO2 laser in breast cancer survivors affected by iatrogenic vulvovaginal atrophy after failure of nonestrogenic local treatments a retrospective study Pagano T1 METHODS We treated 82 BC survivors with three cycles of CO2 laser after failure of topical nonestrogenic therapy The severity of symptoms was assessed with a visual analog scale (VAS) at baseline and after completion of laser therapy Differences in mean VAS scores of each symptom before and after treatment were assessed with multiple t tests for pairwise comparisons Multivariate analyses were used to adjust the final mean scores for the main confounding factors RESULTS Pre versus post-treatment differences in mean VAS scores were significant for sensitivity during sexual intercourse vaginal dryness itchingstinging dyspareunia and dysuria (P lt 0001 for all) bleeding (P = 0001) probe insertion (P = 0001) and movement-related pain (P = 0011) Multivariate analyses confirmed that results were significant irrespective of patients age and type of adjuvant therapy CONCLUSION This study shows that CO2 laser treatment is effective and safe in BC patients with iatrogenic menopause However the optimal number of cycles to administer and the need for retreatment remain to be defined Prospective trials are needed to compare CO2 laser therapy with therapeutic alternatives
INDICACIONES MAacuteS USUALES
bull ATROFIA VULVO-VAGINAL
bull INCONTINENDIA URINARIA DE STRESS
bull SINDROME DE HIPERLAXITUD
bull PROLAPSO GENITAL
22
INCONTINENCIA URINARIA
INCONTINENCIA URINARIA Contraccion del colageno suburetral Neocolagenosis suburetral Irradiaccioacuten angular fraccionada Pases (4 to 5) Dosis 10 A 5 JulIOs cm2 Radiacion 90-120ordm circular Sesiones (2 to 3) Leve-Moderate SUI (ICIQ_SF lt13)
PALACIOS INSTITUTE EXPERIENCE
bull Average age 526 years
bull 41 IUM 59 SUI
bull Average parity 2 children Average BMI
28
bull Average duration per session 19 minutes
bull Very good procedure tolerance
bull Adverse effects during the procedure
NO (32 local heat or slight stinging that
self-limited)
bull Adverse effects after the procedure NO
bull 100 were incorporated into their
activity in lt24 h
110 paTIENTS
1 month after the last session
NOT effective with the emergency component but YES of the effort component in the IUM (12) NOT effective in athletes Overall satisfaction 100 MP improves atrophy
INDICACIONES MAacuteS USUALES
bull ATROFIA VULVO-VAGINAL
bull INCONTINENDIA URINARIA DE STRESS
bull SINDROME DE HIPERLAXITUD
bull PROLAPSO GENITAL
TERMINOLOGIacuteA Y DEFINICIOacuteN iquestPOR QUEacute SIacuteNDROME DE HIPERLAXITUD VAGINAL
bull Anatoacutemicas y Fisioloacutegicas o Laxitud Normal
o Hiperlaxitud Anormal
bull Cliacutenicas o Siacutendrome = Agrupacioacuten de diversos siacutentomas
DEFINICIOacuteN DE SIacuteNDROME DE
HIPERLAXITUD VAGINAL
Conjunto de siacutentomas que aparecen por un exceso
de laxitud vaginal debido a la alteracioacuten de la
estructura de la vagina y tejidos circundantes
Santiago Palacios 2017
29
VAGINAL TIGHTENING
bull Mejoria y uso en 360 grados
bull Remodelado del tejido vaginal y prevencion
INDICACIONES MAacuteS USUALES
bull ATROFIA VULVO-VAGINAL
bull INCONTINENDIA URINARIA DE STRESS
bull SINDROME DE HIPELAXITUD
bull PROLAPSO GENITAL
PROLAPSO GENITAL
bull Prolapso central no lateral Grado 1
y 2
bull Sesiones Como poco 5
)
Agenda
bull PRESENTE
bull FUTURO
bull - MEJORAR EL EFECTO
- PROTOCOLOS MAacuteS DEFINIDOS
-FUTURAS INDICACIONES
COLAGENO Y EDAD
EPHITELIUM AND LAMINA PROPIA
FUNCIONES DEL FIBROBLASTO
LAMINA PROPIA
Agenda
bull PRESENTE
bull FUTURO
bull - MEJORAR EL EFECTO
- PROTOCOLOS MAacuteS DEFINIDOS
- FUTURAS INDICACIONES
CO2RE
20-40 micras proporciona una mejora similar a la de un peeling quiacutemico pero
con un mayor control de la profundidad y menos efectos adversos
Moacutedulo Aesthetic ndash Modo Fraccionado Light
SELECCIOacuteN DE PACIENTES
bull Evaluacioacuten de los sintomas
bull Motivacioacuten y demanda del paciente
bull Abilidad y posibilidades del aparato laser
Agenda
bull PRESENTE
bull FUTURO
bull - MEJORAR EL EFECTO
- PROTOCOLOS MAacuteS DEFINIDOS
- FUTURAS INDICACIONES
NUEVAS PERSPECTIVAS
copy 2016 VIVEVE Not for publication or podium presentation 41
Dermatitis vulvares Dispareunia-vaginismo Retraccioacuten de cicatrices Recuperar la flora vaginal Problemas de las mallas Fisuras vulvares Vejiga hiperactiva Patologias conocidas ( infecciosas y tumorales)
VULVAR DERMATITIS
copy 2016 VIVEVE Not for publication or podium presentation 42
GRADOS DE DOLOR SUB-CLASIFICACIOacuteN DE
MI VISION DE FUTURO
1 Todas las mujeres despueacutes de tres meses del parto Para - Evitar laxitud vaginal
- Evitar incontinencia urinaria
- Volver a una tensioacuten vulvar y vaginal normal
2 En la menopausia y de forma anual para prevenir - Atrofia vulvo-vaginal
- Incontinencia urinaria
- Prolapso
OBJETIVOS 3
Proteccioacuten natural
ABLACION
NEOCOLAGENOGENESIS
absorcioacuten
11
Mechanism of Action - Phases
Phase 1(within 48-72 hr)
EARLY THERMAL EFFECT
- Edema
- Release of chemical mediators
- Shrinkage of collagen and elastic fibers
Phase 2 (in the following 30 days) PROLIFERATION
- Fibroblastic recruiting
- New extracellular matrix
- New collagen fibers
Phase 3 (After 30-40 days) REMODELLING
- Mature collagen fibers
- Increase of collagen fiber strain
- Neovascularization new blood vessel formation
- Improved lubrication pH (acidity)
VAGINAL MUCOSA PHYSIOLOGIC AND FUNCTIONAL RECOVERY
EFECTOS BIOLOacuteGICOS TEacuteRMICOS
Calentamiento (estimulacioacuten) 40-60degC
Activacioacuten o dantildeos menores y reversibles
Efectos metaboacutelicos (gt425degC) ndash Colageacutenesis
Coagulacioacuten (necrosis) 60-90degC
Dantildeos de reversibles a irreversibles
Rotura de viacutenculos quiacutemicos desnaturalizacioacuten de las proteiacutenas
Efectos metaboacutelicosndash Tensado
Ablacioacuten (evaporacioacuten) gt100degC
Dantildeos irreversibles evaporacioacuten de tejido
Efectos metaboacutelicosndash Ablacioacuten
CO2RE Indications for Use Path
CO2RE has received FDA clearance for more than 90 new indications for
use across a range of specialties including gynecology and genitourinary of a
wide range of indications See appendix of this PPT for full list of new indications
for use
bull FDA Letter to File for internal amp external handpieces ndash Mid-Feb2016
bull CE submission for vaginal atrophy and rejuvenation based on safety
and efficacy clinical studies ndash Jan 2016 Approval anticipated in Mar-Apr
2016
bull Health Canada submission after receipt of CE approval Approval can
take some months
bull Other countries ndash dependent on receipt of CE approval
bull FDA Indication for vaginal atrophy and SUI - will
require clinical data and traditional FDA 510K
submission
Agenda
bull PASADO-PRESENTE
-Condilomas vulvares
-Patologia cervical
-Toda cirugia suceptible de corte
coagulacioacuten o extirpacioacuten (evaporizacioacuten)
INDICACIONES MAacuteS USUALES
bull ATROFIA VULVO-VAGINAL
bull INCONTINENDIA URINARIA DE STRESS
bull SINDROME DE HIPERLAXITUD
bull PROLAPSO GENITAL
EFICACIA LASER EN LA ATROFIA VULVO-VAGINAL
bull Hay mucha evidencia de su eficacia tanto con erbio como con (CO 2) en la atrofia vulvo-vaginal de la mujer menopausica
Salvatore S Nappi RE Zerbinati N et al A 12-week treatmentwith fractional CO 2 laser for
vulvovaginal atrophy a pilot study Climacteric 2014 17 363 ndash 9
Salvatore S Nappi RE Parma M et al Sexual function after fractional microablative CO 2 laser in women with vulvovaginal atrophy Climacteric 2015 18 219 ndash 25
Salvatore S H istological study on the effects of microablative fractional CO 2 laser on atrophic vaginal tissue an ex vivo study Menopause 2015 22 845 ndash 9
Zerbinati N S erati M O rigoni M e t a l M icroscopic and ultrastructural modifi cations of postmenopausal atrophic vaginal mucosa after fractional carbon dioxide laser treatment Laser Med Sci 2015 30 429 ndash 36
Perino A Calligaro A Forlani F e t al Vulvo-vaginal atrophy a new treatment modality using thermo-ablative fractional CO 2 laser Maturitas 2015 80 296 ndash 301
ATROFIA VULVO-VAGINAL
Irradiaccion 360ordm circular haz completo Pases (3 to 5) Dosis 10 to 5 joules cm2
Irradiacioacuten en mapeo Pases (3) cubriendo vagina y vulva
Efectivo durante 6-12 meses
Se necesitan de 2-4 sesiones
Breast Cancer Increased risk of presenting
Genitourinary Syndrome
Natural or Induced Menopause Pharmaceuticals (Tamoxifen AIs ) Estrogenic contraindication Lubricants Moisturizers Dilating Therapy Botox Injections
Laser therapy (effectiveness at least equal to estrogen)
Cancer de mama y laser vaginal
Menopause 2017 Mar24(3)316-319 doi 101097GME0000000000000761
Vaginal erbium laser as second-generation thermotherapy for the genitourinary syndrome of menopause a pilot study in breast cancer survivors Gambacciani M1 Levancini M OBJECTIVE The aim of this study was to evaluate the efficacy and acceptability of a second generation of vaginal laser treatment the vaginal erbium laser as a nonablative photothermal therapy for the management of genitourinary syndrome of menopause in postmenopausal breast cancer survivors CONCLUSIONS This study suggests that the vaginal erbium laser is effective and safe for the treatment of genitourinary syndrome of menopause in breast cancer survivors
Menopause 2017 Dec 28 doi Fractional microablative CO2 laser in breast cancer survivors affected by iatrogenic vulvovaginal atrophy after failure of nonestrogenic local treatments a retrospective study Pagano T1 METHODS We treated 82 BC survivors with three cycles of CO2 laser after failure of topical nonestrogenic therapy The severity of symptoms was assessed with a visual analog scale (VAS) at baseline and after completion of laser therapy Differences in mean VAS scores of each symptom before and after treatment were assessed with multiple t tests for pairwise comparisons Multivariate analyses were used to adjust the final mean scores for the main confounding factors RESULTS Pre versus post-treatment differences in mean VAS scores were significant for sensitivity during sexual intercourse vaginal dryness itchingstinging dyspareunia and dysuria (P lt 0001 for all) bleeding (P = 0001) probe insertion (P = 0001) and movement-related pain (P = 0011) Multivariate analyses confirmed that results were significant irrespective of patients age and type of adjuvant therapy CONCLUSION This study shows that CO2 laser treatment is effective and safe in BC patients with iatrogenic menopause However the optimal number of cycles to administer and the need for retreatment remain to be defined Prospective trials are needed to compare CO2 laser therapy with therapeutic alternatives
INDICACIONES MAacuteS USUALES
bull ATROFIA VULVO-VAGINAL
bull INCONTINENDIA URINARIA DE STRESS
bull SINDROME DE HIPERLAXITUD
bull PROLAPSO GENITAL
22
INCONTINENCIA URINARIA
INCONTINENCIA URINARIA Contraccion del colageno suburetral Neocolagenosis suburetral Irradiaccioacuten angular fraccionada Pases (4 to 5) Dosis 10 A 5 JulIOs cm2 Radiacion 90-120ordm circular Sesiones (2 to 3) Leve-Moderate SUI (ICIQ_SF lt13)
PALACIOS INSTITUTE EXPERIENCE
bull Average age 526 years
bull 41 IUM 59 SUI
bull Average parity 2 children Average BMI
28
bull Average duration per session 19 minutes
bull Very good procedure tolerance
bull Adverse effects during the procedure
NO (32 local heat or slight stinging that
self-limited)
bull Adverse effects after the procedure NO
bull 100 were incorporated into their
activity in lt24 h
110 paTIENTS
1 month after the last session
NOT effective with the emergency component but YES of the effort component in the IUM (12) NOT effective in athletes Overall satisfaction 100 MP improves atrophy
INDICACIONES MAacuteS USUALES
bull ATROFIA VULVO-VAGINAL
bull INCONTINENDIA URINARIA DE STRESS
bull SINDROME DE HIPERLAXITUD
bull PROLAPSO GENITAL
TERMINOLOGIacuteA Y DEFINICIOacuteN iquestPOR QUEacute SIacuteNDROME DE HIPERLAXITUD VAGINAL
bull Anatoacutemicas y Fisioloacutegicas o Laxitud Normal
o Hiperlaxitud Anormal
bull Cliacutenicas o Siacutendrome = Agrupacioacuten de diversos siacutentomas
DEFINICIOacuteN DE SIacuteNDROME DE
HIPERLAXITUD VAGINAL
Conjunto de siacutentomas que aparecen por un exceso
de laxitud vaginal debido a la alteracioacuten de la
estructura de la vagina y tejidos circundantes
Santiago Palacios 2017
29
VAGINAL TIGHTENING
bull Mejoria y uso en 360 grados
bull Remodelado del tejido vaginal y prevencion
INDICACIONES MAacuteS USUALES
bull ATROFIA VULVO-VAGINAL
bull INCONTINENDIA URINARIA DE STRESS
bull SINDROME DE HIPELAXITUD
bull PROLAPSO GENITAL
PROLAPSO GENITAL
bull Prolapso central no lateral Grado 1
y 2
bull Sesiones Como poco 5
)
Agenda
bull PRESENTE
bull FUTURO
bull - MEJORAR EL EFECTO
- PROTOCOLOS MAacuteS DEFINIDOS
-FUTURAS INDICACIONES
COLAGENO Y EDAD
EPHITELIUM AND LAMINA PROPIA
FUNCIONES DEL FIBROBLASTO
LAMINA PROPIA
Agenda
bull PRESENTE
bull FUTURO
bull - MEJORAR EL EFECTO
- PROTOCOLOS MAacuteS DEFINIDOS
- FUTURAS INDICACIONES
CO2RE
20-40 micras proporciona una mejora similar a la de un peeling quiacutemico pero
con un mayor control de la profundidad y menos efectos adversos
Moacutedulo Aesthetic ndash Modo Fraccionado Light
SELECCIOacuteN DE PACIENTES
bull Evaluacioacuten de los sintomas
bull Motivacioacuten y demanda del paciente
bull Abilidad y posibilidades del aparato laser
Agenda
bull PRESENTE
bull FUTURO
bull - MEJORAR EL EFECTO
- PROTOCOLOS MAacuteS DEFINIDOS
- FUTURAS INDICACIONES
NUEVAS PERSPECTIVAS
copy 2016 VIVEVE Not for publication or podium presentation 41
Dermatitis vulvares Dispareunia-vaginismo Retraccioacuten de cicatrices Recuperar la flora vaginal Problemas de las mallas Fisuras vulvares Vejiga hiperactiva Patologias conocidas ( infecciosas y tumorales)
VULVAR DERMATITIS
copy 2016 VIVEVE Not for publication or podium presentation 42
GRADOS DE DOLOR SUB-CLASIFICACIOacuteN DE
MI VISION DE FUTURO
1 Todas las mujeres despueacutes de tres meses del parto Para - Evitar laxitud vaginal
- Evitar incontinencia urinaria
- Volver a una tensioacuten vulvar y vaginal normal
2 En la menopausia y de forma anual para prevenir - Atrofia vulvo-vaginal
- Incontinencia urinaria
- Prolapso
11
Mechanism of Action - Phases
Phase 1(within 48-72 hr)
EARLY THERMAL EFFECT
- Edema
- Release of chemical mediators
- Shrinkage of collagen and elastic fibers
Phase 2 (in the following 30 days) PROLIFERATION
- Fibroblastic recruiting
- New extracellular matrix
- New collagen fibers
Phase 3 (After 30-40 days) REMODELLING
- Mature collagen fibers
- Increase of collagen fiber strain
- Neovascularization new blood vessel formation
- Improved lubrication pH (acidity)
VAGINAL MUCOSA PHYSIOLOGIC AND FUNCTIONAL RECOVERY
EFECTOS BIOLOacuteGICOS TEacuteRMICOS
Calentamiento (estimulacioacuten) 40-60degC
Activacioacuten o dantildeos menores y reversibles
Efectos metaboacutelicos (gt425degC) ndash Colageacutenesis
Coagulacioacuten (necrosis) 60-90degC
Dantildeos de reversibles a irreversibles
Rotura de viacutenculos quiacutemicos desnaturalizacioacuten de las proteiacutenas
Efectos metaboacutelicosndash Tensado
Ablacioacuten (evaporacioacuten) gt100degC
Dantildeos irreversibles evaporacioacuten de tejido
Efectos metaboacutelicosndash Ablacioacuten
CO2RE Indications for Use Path
CO2RE has received FDA clearance for more than 90 new indications for
use across a range of specialties including gynecology and genitourinary of a
wide range of indications See appendix of this PPT for full list of new indications
for use
bull FDA Letter to File for internal amp external handpieces ndash Mid-Feb2016
bull CE submission for vaginal atrophy and rejuvenation based on safety
and efficacy clinical studies ndash Jan 2016 Approval anticipated in Mar-Apr
2016
bull Health Canada submission after receipt of CE approval Approval can
take some months
bull Other countries ndash dependent on receipt of CE approval
bull FDA Indication for vaginal atrophy and SUI - will
require clinical data and traditional FDA 510K
submission
Agenda
bull PASADO-PRESENTE
-Condilomas vulvares
-Patologia cervical
-Toda cirugia suceptible de corte
coagulacioacuten o extirpacioacuten (evaporizacioacuten)
INDICACIONES MAacuteS USUALES
bull ATROFIA VULVO-VAGINAL
bull INCONTINENDIA URINARIA DE STRESS
bull SINDROME DE HIPERLAXITUD
bull PROLAPSO GENITAL
EFICACIA LASER EN LA ATROFIA VULVO-VAGINAL
bull Hay mucha evidencia de su eficacia tanto con erbio como con (CO 2) en la atrofia vulvo-vaginal de la mujer menopausica
Salvatore S Nappi RE Zerbinati N et al A 12-week treatmentwith fractional CO 2 laser for
vulvovaginal atrophy a pilot study Climacteric 2014 17 363 ndash 9
Salvatore S Nappi RE Parma M et al Sexual function after fractional microablative CO 2 laser in women with vulvovaginal atrophy Climacteric 2015 18 219 ndash 25
Salvatore S H istological study on the effects of microablative fractional CO 2 laser on atrophic vaginal tissue an ex vivo study Menopause 2015 22 845 ndash 9
Zerbinati N S erati M O rigoni M e t a l M icroscopic and ultrastructural modifi cations of postmenopausal atrophic vaginal mucosa after fractional carbon dioxide laser treatment Laser Med Sci 2015 30 429 ndash 36
Perino A Calligaro A Forlani F e t al Vulvo-vaginal atrophy a new treatment modality using thermo-ablative fractional CO 2 laser Maturitas 2015 80 296 ndash 301
ATROFIA VULVO-VAGINAL
Irradiaccion 360ordm circular haz completo Pases (3 to 5) Dosis 10 to 5 joules cm2
Irradiacioacuten en mapeo Pases (3) cubriendo vagina y vulva
Efectivo durante 6-12 meses
Se necesitan de 2-4 sesiones
Breast Cancer Increased risk of presenting
Genitourinary Syndrome
Natural or Induced Menopause Pharmaceuticals (Tamoxifen AIs ) Estrogenic contraindication Lubricants Moisturizers Dilating Therapy Botox Injections
Laser therapy (effectiveness at least equal to estrogen)
Cancer de mama y laser vaginal
Menopause 2017 Mar24(3)316-319 doi 101097GME0000000000000761
Vaginal erbium laser as second-generation thermotherapy for the genitourinary syndrome of menopause a pilot study in breast cancer survivors Gambacciani M1 Levancini M OBJECTIVE The aim of this study was to evaluate the efficacy and acceptability of a second generation of vaginal laser treatment the vaginal erbium laser as a nonablative photothermal therapy for the management of genitourinary syndrome of menopause in postmenopausal breast cancer survivors CONCLUSIONS This study suggests that the vaginal erbium laser is effective and safe for the treatment of genitourinary syndrome of menopause in breast cancer survivors
Menopause 2017 Dec 28 doi Fractional microablative CO2 laser in breast cancer survivors affected by iatrogenic vulvovaginal atrophy after failure of nonestrogenic local treatments a retrospective study Pagano T1 METHODS We treated 82 BC survivors with three cycles of CO2 laser after failure of topical nonestrogenic therapy The severity of symptoms was assessed with a visual analog scale (VAS) at baseline and after completion of laser therapy Differences in mean VAS scores of each symptom before and after treatment were assessed with multiple t tests for pairwise comparisons Multivariate analyses were used to adjust the final mean scores for the main confounding factors RESULTS Pre versus post-treatment differences in mean VAS scores were significant for sensitivity during sexual intercourse vaginal dryness itchingstinging dyspareunia and dysuria (P lt 0001 for all) bleeding (P = 0001) probe insertion (P = 0001) and movement-related pain (P = 0011) Multivariate analyses confirmed that results were significant irrespective of patients age and type of adjuvant therapy CONCLUSION This study shows that CO2 laser treatment is effective and safe in BC patients with iatrogenic menopause However the optimal number of cycles to administer and the need for retreatment remain to be defined Prospective trials are needed to compare CO2 laser therapy with therapeutic alternatives
INDICACIONES MAacuteS USUALES
bull ATROFIA VULVO-VAGINAL
bull INCONTINENDIA URINARIA DE STRESS
bull SINDROME DE HIPERLAXITUD
bull PROLAPSO GENITAL
22
INCONTINENCIA URINARIA
INCONTINENCIA URINARIA Contraccion del colageno suburetral Neocolagenosis suburetral Irradiaccioacuten angular fraccionada Pases (4 to 5) Dosis 10 A 5 JulIOs cm2 Radiacion 90-120ordm circular Sesiones (2 to 3) Leve-Moderate SUI (ICIQ_SF lt13)
PALACIOS INSTITUTE EXPERIENCE
bull Average age 526 years
bull 41 IUM 59 SUI
bull Average parity 2 children Average BMI
28
bull Average duration per session 19 minutes
bull Very good procedure tolerance
bull Adverse effects during the procedure
NO (32 local heat or slight stinging that
self-limited)
bull Adverse effects after the procedure NO
bull 100 were incorporated into their
activity in lt24 h
110 paTIENTS
1 month after the last session
NOT effective with the emergency component but YES of the effort component in the IUM (12) NOT effective in athletes Overall satisfaction 100 MP improves atrophy
INDICACIONES MAacuteS USUALES
bull ATROFIA VULVO-VAGINAL
bull INCONTINENDIA URINARIA DE STRESS
bull SINDROME DE HIPERLAXITUD
bull PROLAPSO GENITAL
TERMINOLOGIacuteA Y DEFINICIOacuteN iquestPOR QUEacute SIacuteNDROME DE HIPERLAXITUD VAGINAL
bull Anatoacutemicas y Fisioloacutegicas o Laxitud Normal
o Hiperlaxitud Anormal
bull Cliacutenicas o Siacutendrome = Agrupacioacuten de diversos siacutentomas
DEFINICIOacuteN DE SIacuteNDROME DE
HIPERLAXITUD VAGINAL
Conjunto de siacutentomas que aparecen por un exceso
de laxitud vaginal debido a la alteracioacuten de la
estructura de la vagina y tejidos circundantes
Santiago Palacios 2017
29
VAGINAL TIGHTENING
bull Mejoria y uso en 360 grados
bull Remodelado del tejido vaginal y prevencion
INDICACIONES MAacuteS USUALES
bull ATROFIA VULVO-VAGINAL
bull INCONTINENDIA URINARIA DE STRESS
bull SINDROME DE HIPELAXITUD
bull PROLAPSO GENITAL
PROLAPSO GENITAL
bull Prolapso central no lateral Grado 1
y 2
bull Sesiones Como poco 5
)
Agenda
bull PRESENTE
bull FUTURO
bull - MEJORAR EL EFECTO
- PROTOCOLOS MAacuteS DEFINIDOS
-FUTURAS INDICACIONES
COLAGENO Y EDAD
EPHITELIUM AND LAMINA PROPIA
FUNCIONES DEL FIBROBLASTO
LAMINA PROPIA
Agenda
bull PRESENTE
bull FUTURO
bull - MEJORAR EL EFECTO
- PROTOCOLOS MAacuteS DEFINIDOS
- FUTURAS INDICACIONES
CO2RE
20-40 micras proporciona una mejora similar a la de un peeling quiacutemico pero
con un mayor control de la profundidad y menos efectos adversos
Moacutedulo Aesthetic ndash Modo Fraccionado Light
SELECCIOacuteN DE PACIENTES
bull Evaluacioacuten de los sintomas
bull Motivacioacuten y demanda del paciente
bull Abilidad y posibilidades del aparato laser
Agenda
bull PRESENTE
bull FUTURO
bull - MEJORAR EL EFECTO
- PROTOCOLOS MAacuteS DEFINIDOS
- FUTURAS INDICACIONES
NUEVAS PERSPECTIVAS
copy 2016 VIVEVE Not for publication or podium presentation 41
Dermatitis vulvares Dispareunia-vaginismo Retraccioacuten de cicatrices Recuperar la flora vaginal Problemas de las mallas Fisuras vulvares Vejiga hiperactiva Patologias conocidas ( infecciosas y tumorales)
VULVAR DERMATITIS
copy 2016 VIVEVE Not for publication or podium presentation 42
GRADOS DE DOLOR SUB-CLASIFICACIOacuteN DE
MI VISION DE FUTURO
1 Todas las mujeres despueacutes de tres meses del parto Para - Evitar laxitud vaginal
- Evitar incontinencia urinaria
- Volver a una tensioacuten vulvar y vaginal normal
2 En la menopausia y de forma anual para prevenir - Atrofia vulvo-vaginal
- Incontinencia urinaria
- Prolapso
EFECTOS BIOLOacuteGICOS TEacuteRMICOS
Calentamiento (estimulacioacuten) 40-60degC
Activacioacuten o dantildeos menores y reversibles
Efectos metaboacutelicos (gt425degC) ndash Colageacutenesis
Coagulacioacuten (necrosis) 60-90degC
Dantildeos de reversibles a irreversibles
Rotura de viacutenculos quiacutemicos desnaturalizacioacuten de las proteiacutenas
Efectos metaboacutelicosndash Tensado
Ablacioacuten (evaporacioacuten) gt100degC
Dantildeos irreversibles evaporacioacuten de tejido
Efectos metaboacutelicosndash Ablacioacuten
CO2RE Indications for Use Path
CO2RE has received FDA clearance for more than 90 new indications for
use across a range of specialties including gynecology and genitourinary of a
wide range of indications See appendix of this PPT for full list of new indications
for use
bull FDA Letter to File for internal amp external handpieces ndash Mid-Feb2016
bull CE submission for vaginal atrophy and rejuvenation based on safety
and efficacy clinical studies ndash Jan 2016 Approval anticipated in Mar-Apr
2016
bull Health Canada submission after receipt of CE approval Approval can
take some months
bull Other countries ndash dependent on receipt of CE approval
bull FDA Indication for vaginal atrophy and SUI - will
require clinical data and traditional FDA 510K
submission
Agenda
bull PASADO-PRESENTE
-Condilomas vulvares
-Patologia cervical
-Toda cirugia suceptible de corte
coagulacioacuten o extirpacioacuten (evaporizacioacuten)
INDICACIONES MAacuteS USUALES
bull ATROFIA VULVO-VAGINAL
bull INCONTINENDIA URINARIA DE STRESS
bull SINDROME DE HIPERLAXITUD
bull PROLAPSO GENITAL
EFICACIA LASER EN LA ATROFIA VULVO-VAGINAL
bull Hay mucha evidencia de su eficacia tanto con erbio como con (CO 2) en la atrofia vulvo-vaginal de la mujer menopausica
Salvatore S Nappi RE Zerbinati N et al A 12-week treatmentwith fractional CO 2 laser for
vulvovaginal atrophy a pilot study Climacteric 2014 17 363 ndash 9
Salvatore S Nappi RE Parma M et al Sexual function after fractional microablative CO 2 laser in women with vulvovaginal atrophy Climacteric 2015 18 219 ndash 25
Salvatore S H istological study on the effects of microablative fractional CO 2 laser on atrophic vaginal tissue an ex vivo study Menopause 2015 22 845 ndash 9
Zerbinati N S erati M O rigoni M e t a l M icroscopic and ultrastructural modifi cations of postmenopausal atrophic vaginal mucosa after fractional carbon dioxide laser treatment Laser Med Sci 2015 30 429 ndash 36
Perino A Calligaro A Forlani F e t al Vulvo-vaginal atrophy a new treatment modality using thermo-ablative fractional CO 2 laser Maturitas 2015 80 296 ndash 301
ATROFIA VULVO-VAGINAL
Irradiaccion 360ordm circular haz completo Pases (3 to 5) Dosis 10 to 5 joules cm2
Irradiacioacuten en mapeo Pases (3) cubriendo vagina y vulva
Efectivo durante 6-12 meses
Se necesitan de 2-4 sesiones
Breast Cancer Increased risk of presenting
Genitourinary Syndrome
Natural or Induced Menopause Pharmaceuticals (Tamoxifen AIs ) Estrogenic contraindication Lubricants Moisturizers Dilating Therapy Botox Injections
Laser therapy (effectiveness at least equal to estrogen)
Cancer de mama y laser vaginal
Menopause 2017 Mar24(3)316-319 doi 101097GME0000000000000761
Vaginal erbium laser as second-generation thermotherapy for the genitourinary syndrome of menopause a pilot study in breast cancer survivors Gambacciani M1 Levancini M OBJECTIVE The aim of this study was to evaluate the efficacy and acceptability of a second generation of vaginal laser treatment the vaginal erbium laser as a nonablative photothermal therapy for the management of genitourinary syndrome of menopause in postmenopausal breast cancer survivors CONCLUSIONS This study suggests that the vaginal erbium laser is effective and safe for the treatment of genitourinary syndrome of menopause in breast cancer survivors
Menopause 2017 Dec 28 doi Fractional microablative CO2 laser in breast cancer survivors affected by iatrogenic vulvovaginal atrophy after failure of nonestrogenic local treatments a retrospective study Pagano T1 METHODS We treated 82 BC survivors with three cycles of CO2 laser after failure of topical nonestrogenic therapy The severity of symptoms was assessed with a visual analog scale (VAS) at baseline and after completion of laser therapy Differences in mean VAS scores of each symptom before and after treatment were assessed with multiple t tests for pairwise comparisons Multivariate analyses were used to adjust the final mean scores for the main confounding factors RESULTS Pre versus post-treatment differences in mean VAS scores were significant for sensitivity during sexual intercourse vaginal dryness itchingstinging dyspareunia and dysuria (P lt 0001 for all) bleeding (P = 0001) probe insertion (P = 0001) and movement-related pain (P = 0011) Multivariate analyses confirmed that results were significant irrespective of patients age and type of adjuvant therapy CONCLUSION This study shows that CO2 laser treatment is effective and safe in BC patients with iatrogenic menopause However the optimal number of cycles to administer and the need for retreatment remain to be defined Prospective trials are needed to compare CO2 laser therapy with therapeutic alternatives
INDICACIONES MAacuteS USUALES
bull ATROFIA VULVO-VAGINAL
bull INCONTINENDIA URINARIA DE STRESS
bull SINDROME DE HIPERLAXITUD
bull PROLAPSO GENITAL
22
INCONTINENCIA URINARIA
INCONTINENCIA URINARIA Contraccion del colageno suburetral Neocolagenosis suburetral Irradiaccioacuten angular fraccionada Pases (4 to 5) Dosis 10 A 5 JulIOs cm2 Radiacion 90-120ordm circular Sesiones (2 to 3) Leve-Moderate SUI (ICIQ_SF lt13)
PALACIOS INSTITUTE EXPERIENCE
bull Average age 526 years
bull 41 IUM 59 SUI
bull Average parity 2 children Average BMI
28
bull Average duration per session 19 minutes
bull Very good procedure tolerance
bull Adverse effects during the procedure
NO (32 local heat or slight stinging that
self-limited)
bull Adverse effects after the procedure NO
bull 100 were incorporated into their
activity in lt24 h
110 paTIENTS
1 month after the last session
NOT effective with the emergency component but YES of the effort component in the IUM (12) NOT effective in athletes Overall satisfaction 100 MP improves atrophy
INDICACIONES MAacuteS USUALES
bull ATROFIA VULVO-VAGINAL
bull INCONTINENDIA URINARIA DE STRESS
bull SINDROME DE HIPERLAXITUD
bull PROLAPSO GENITAL
TERMINOLOGIacuteA Y DEFINICIOacuteN iquestPOR QUEacute SIacuteNDROME DE HIPERLAXITUD VAGINAL
bull Anatoacutemicas y Fisioloacutegicas o Laxitud Normal
o Hiperlaxitud Anormal
bull Cliacutenicas o Siacutendrome = Agrupacioacuten de diversos siacutentomas
DEFINICIOacuteN DE SIacuteNDROME DE
HIPERLAXITUD VAGINAL
Conjunto de siacutentomas que aparecen por un exceso
de laxitud vaginal debido a la alteracioacuten de la
estructura de la vagina y tejidos circundantes
Santiago Palacios 2017
29
VAGINAL TIGHTENING
bull Mejoria y uso en 360 grados
bull Remodelado del tejido vaginal y prevencion
INDICACIONES MAacuteS USUALES
bull ATROFIA VULVO-VAGINAL
bull INCONTINENDIA URINARIA DE STRESS
bull SINDROME DE HIPELAXITUD
bull PROLAPSO GENITAL
PROLAPSO GENITAL
bull Prolapso central no lateral Grado 1
y 2
bull Sesiones Como poco 5
)
Agenda
bull PRESENTE
bull FUTURO
bull - MEJORAR EL EFECTO
- PROTOCOLOS MAacuteS DEFINIDOS
-FUTURAS INDICACIONES
COLAGENO Y EDAD
EPHITELIUM AND LAMINA PROPIA
FUNCIONES DEL FIBROBLASTO
LAMINA PROPIA
Agenda
bull PRESENTE
bull FUTURO
bull - MEJORAR EL EFECTO
- PROTOCOLOS MAacuteS DEFINIDOS
- FUTURAS INDICACIONES
CO2RE
20-40 micras proporciona una mejora similar a la de un peeling quiacutemico pero
con un mayor control de la profundidad y menos efectos adversos
Moacutedulo Aesthetic ndash Modo Fraccionado Light
SELECCIOacuteN DE PACIENTES
bull Evaluacioacuten de los sintomas
bull Motivacioacuten y demanda del paciente
bull Abilidad y posibilidades del aparato laser
Agenda
bull PRESENTE
bull FUTURO
bull - MEJORAR EL EFECTO
- PROTOCOLOS MAacuteS DEFINIDOS
- FUTURAS INDICACIONES
NUEVAS PERSPECTIVAS
copy 2016 VIVEVE Not for publication or podium presentation 41
Dermatitis vulvares Dispareunia-vaginismo Retraccioacuten de cicatrices Recuperar la flora vaginal Problemas de las mallas Fisuras vulvares Vejiga hiperactiva Patologias conocidas ( infecciosas y tumorales)
VULVAR DERMATITIS
copy 2016 VIVEVE Not for publication or podium presentation 42
GRADOS DE DOLOR SUB-CLASIFICACIOacuteN DE
MI VISION DE FUTURO
1 Todas las mujeres despueacutes de tres meses del parto Para - Evitar laxitud vaginal
- Evitar incontinencia urinaria
- Volver a una tensioacuten vulvar y vaginal normal
2 En la menopausia y de forma anual para prevenir - Atrofia vulvo-vaginal
- Incontinencia urinaria
- Prolapso
CO2RE Indications for Use Path
CO2RE has received FDA clearance for more than 90 new indications for
use across a range of specialties including gynecology and genitourinary of a
wide range of indications See appendix of this PPT for full list of new indications
for use
bull FDA Letter to File for internal amp external handpieces ndash Mid-Feb2016
bull CE submission for vaginal atrophy and rejuvenation based on safety
and efficacy clinical studies ndash Jan 2016 Approval anticipated in Mar-Apr
2016
bull Health Canada submission after receipt of CE approval Approval can
take some months
bull Other countries ndash dependent on receipt of CE approval
bull FDA Indication for vaginal atrophy and SUI - will
require clinical data and traditional FDA 510K
submission
Agenda
bull PASADO-PRESENTE
-Condilomas vulvares
-Patologia cervical
-Toda cirugia suceptible de corte
coagulacioacuten o extirpacioacuten (evaporizacioacuten)
INDICACIONES MAacuteS USUALES
bull ATROFIA VULVO-VAGINAL
bull INCONTINENDIA URINARIA DE STRESS
bull SINDROME DE HIPERLAXITUD
bull PROLAPSO GENITAL
EFICACIA LASER EN LA ATROFIA VULVO-VAGINAL
bull Hay mucha evidencia de su eficacia tanto con erbio como con (CO 2) en la atrofia vulvo-vaginal de la mujer menopausica
Salvatore S Nappi RE Zerbinati N et al A 12-week treatmentwith fractional CO 2 laser for
vulvovaginal atrophy a pilot study Climacteric 2014 17 363 ndash 9
Salvatore S Nappi RE Parma M et al Sexual function after fractional microablative CO 2 laser in women with vulvovaginal atrophy Climacteric 2015 18 219 ndash 25
Salvatore S H istological study on the effects of microablative fractional CO 2 laser on atrophic vaginal tissue an ex vivo study Menopause 2015 22 845 ndash 9
Zerbinati N S erati M O rigoni M e t a l M icroscopic and ultrastructural modifi cations of postmenopausal atrophic vaginal mucosa after fractional carbon dioxide laser treatment Laser Med Sci 2015 30 429 ndash 36
Perino A Calligaro A Forlani F e t al Vulvo-vaginal atrophy a new treatment modality using thermo-ablative fractional CO 2 laser Maturitas 2015 80 296 ndash 301
ATROFIA VULVO-VAGINAL
Irradiaccion 360ordm circular haz completo Pases (3 to 5) Dosis 10 to 5 joules cm2
Irradiacioacuten en mapeo Pases (3) cubriendo vagina y vulva
Efectivo durante 6-12 meses
Se necesitan de 2-4 sesiones
Breast Cancer Increased risk of presenting
Genitourinary Syndrome
Natural or Induced Menopause Pharmaceuticals (Tamoxifen AIs ) Estrogenic contraindication Lubricants Moisturizers Dilating Therapy Botox Injections
Laser therapy (effectiveness at least equal to estrogen)
Cancer de mama y laser vaginal
Menopause 2017 Mar24(3)316-319 doi 101097GME0000000000000761
Vaginal erbium laser as second-generation thermotherapy for the genitourinary syndrome of menopause a pilot study in breast cancer survivors Gambacciani M1 Levancini M OBJECTIVE The aim of this study was to evaluate the efficacy and acceptability of a second generation of vaginal laser treatment the vaginal erbium laser as a nonablative photothermal therapy for the management of genitourinary syndrome of menopause in postmenopausal breast cancer survivors CONCLUSIONS This study suggests that the vaginal erbium laser is effective and safe for the treatment of genitourinary syndrome of menopause in breast cancer survivors
Menopause 2017 Dec 28 doi Fractional microablative CO2 laser in breast cancer survivors affected by iatrogenic vulvovaginal atrophy after failure of nonestrogenic local treatments a retrospective study Pagano T1 METHODS We treated 82 BC survivors with three cycles of CO2 laser after failure of topical nonestrogenic therapy The severity of symptoms was assessed with a visual analog scale (VAS) at baseline and after completion of laser therapy Differences in mean VAS scores of each symptom before and after treatment were assessed with multiple t tests for pairwise comparisons Multivariate analyses were used to adjust the final mean scores for the main confounding factors RESULTS Pre versus post-treatment differences in mean VAS scores were significant for sensitivity during sexual intercourse vaginal dryness itchingstinging dyspareunia and dysuria (P lt 0001 for all) bleeding (P = 0001) probe insertion (P = 0001) and movement-related pain (P = 0011) Multivariate analyses confirmed that results were significant irrespective of patients age and type of adjuvant therapy CONCLUSION This study shows that CO2 laser treatment is effective and safe in BC patients with iatrogenic menopause However the optimal number of cycles to administer and the need for retreatment remain to be defined Prospective trials are needed to compare CO2 laser therapy with therapeutic alternatives
INDICACIONES MAacuteS USUALES
bull ATROFIA VULVO-VAGINAL
bull INCONTINENDIA URINARIA DE STRESS
bull SINDROME DE HIPERLAXITUD
bull PROLAPSO GENITAL
22
INCONTINENCIA URINARIA
INCONTINENCIA URINARIA Contraccion del colageno suburetral Neocolagenosis suburetral Irradiaccioacuten angular fraccionada Pases (4 to 5) Dosis 10 A 5 JulIOs cm2 Radiacion 90-120ordm circular Sesiones (2 to 3) Leve-Moderate SUI (ICIQ_SF lt13)
PALACIOS INSTITUTE EXPERIENCE
bull Average age 526 years
bull 41 IUM 59 SUI
bull Average parity 2 children Average BMI
28
bull Average duration per session 19 minutes
bull Very good procedure tolerance
bull Adverse effects during the procedure
NO (32 local heat or slight stinging that
self-limited)
bull Adverse effects after the procedure NO
bull 100 were incorporated into their
activity in lt24 h
110 paTIENTS
1 month after the last session
NOT effective with the emergency component but YES of the effort component in the IUM (12) NOT effective in athletes Overall satisfaction 100 MP improves atrophy
INDICACIONES MAacuteS USUALES
bull ATROFIA VULVO-VAGINAL
bull INCONTINENDIA URINARIA DE STRESS
bull SINDROME DE HIPERLAXITUD
bull PROLAPSO GENITAL
TERMINOLOGIacuteA Y DEFINICIOacuteN iquestPOR QUEacute SIacuteNDROME DE HIPERLAXITUD VAGINAL
bull Anatoacutemicas y Fisioloacutegicas o Laxitud Normal
o Hiperlaxitud Anormal
bull Cliacutenicas o Siacutendrome = Agrupacioacuten de diversos siacutentomas
DEFINICIOacuteN DE SIacuteNDROME DE
HIPERLAXITUD VAGINAL
Conjunto de siacutentomas que aparecen por un exceso
de laxitud vaginal debido a la alteracioacuten de la
estructura de la vagina y tejidos circundantes
Santiago Palacios 2017
29
VAGINAL TIGHTENING
bull Mejoria y uso en 360 grados
bull Remodelado del tejido vaginal y prevencion
INDICACIONES MAacuteS USUALES
bull ATROFIA VULVO-VAGINAL
bull INCONTINENDIA URINARIA DE STRESS
bull SINDROME DE HIPELAXITUD
bull PROLAPSO GENITAL
PROLAPSO GENITAL
bull Prolapso central no lateral Grado 1
y 2
bull Sesiones Como poco 5
)
Agenda
bull PRESENTE
bull FUTURO
bull - MEJORAR EL EFECTO
- PROTOCOLOS MAacuteS DEFINIDOS
-FUTURAS INDICACIONES
COLAGENO Y EDAD
EPHITELIUM AND LAMINA PROPIA
FUNCIONES DEL FIBROBLASTO
LAMINA PROPIA
Agenda
bull PRESENTE
bull FUTURO
bull - MEJORAR EL EFECTO
- PROTOCOLOS MAacuteS DEFINIDOS
- FUTURAS INDICACIONES
CO2RE
20-40 micras proporciona una mejora similar a la de un peeling quiacutemico pero
con un mayor control de la profundidad y menos efectos adversos
Moacutedulo Aesthetic ndash Modo Fraccionado Light
SELECCIOacuteN DE PACIENTES
bull Evaluacioacuten de los sintomas
bull Motivacioacuten y demanda del paciente
bull Abilidad y posibilidades del aparato laser
Agenda
bull PRESENTE
bull FUTURO
bull - MEJORAR EL EFECTO
- PROTOCOLOS MAacuteS DEFINIDOS
- FUTURAS INDICACIONES
NUEVAS PERSPECTIVAS
copy 2016 VIVEVE Not for publication or podium presentation 41
Dermatitis vulvares Dispareunia-vaginismo Retraccioacuten de cicatrices Recuperar la flora vaginal Problemas de las mallas Fisuras vulvares Vejiga hiperactiva Patologias conocidas ( infecciosas y tumorales)
VULVAR DERMATITIS
copy 2016 VIVEVE Not for publication or podium presentation 42
GRADOS DE DOLOR SUB-CLASIFICACIOacuteN DE
MI VISION DE FUTURO
1 Todas las mujeres despueacutes de tres meses del parto Para - Evitar laxitud vaginal
- Evitar incontinencia urinaria
- Volver a una tensioacuten vulvar y vaginal normal
2 En la menopausia y de forma anual para prevenir - Atrofia vulvo-vaginal
- Incontinencia urinaria
- Prolapso
Agenda
bull PASADO-PRESENTE
-Condilomas vulvares
-Patologia cervical
-Toda cirugia suceptible de corte
coagulacioacuten o extirpacioacuten (evaporizacioacuten)
INDICACIONES MAacuteS USUALES
bull ATROFIA VULVO-VAGINAL
bull INCONTINENDIA URINARIA DE STRESS
bull SINDROME DE HIPERLAXITUD
bull PROLAPSO GENITAL
EFICACIA LASER EN LA ATROFIA VULVO-VAGINAL
bull Hay mucha evidencia de su eficacia tanto con erbio como con (CO 2) en la atrofia vulvo-vaginal de la mujer menopausica
Salvatore S Nappi RE Zerbinati N et al A 12-week treatmentwith fractional CO 2 laser for
vulvovaginal atrophy a pilot study Climacteric 2014 17 363 ndash 9
Salvatore S Nappi RE Parma M et al Sexual function after fractional microablative CO 2 laser in women with vulvovaginal atrophy Climacteric 2015 18 219 ndash 25
Salvatore S H istological study on the effects of microablative fractional CO 2 laser on atrophic vaginal tissue an ex vivo study Menopause 2015 22 845 ndash 9
Zerbinati N S erati M O rigoni M e t a l M icroscopic and ultrastructural modifi cations of postmenopausal atrophic vaginal mucosa after fractional carbon dioxide laser treatment Laser Med Sci 2015 30 429 ndash 36
Perino A Calligaro A Forlani F e t al Vulvo-vaginal atrophy a new treatment modality using thermo-ablative fractional CO 2 laser Maturitas 2015 80 296 ndash 301
ATROFIA VULVO-VAGINAL
Irradiaccion 360ordm circular haz completo Pases (3 to 5) Dosis 10 to 5 joules cm2
Irradiacioacuten en mapeo Pases (3) cubriendo vagina y vulva
Efectivo durante 6-12 meses
Se necesitan de 2-4 sesiones
Breast Cancer Increased risk of presenting
Genitourinary Syndrome
Natural or Induced Menopause Pharmaceuticals (Tamoxifen AIs ) Estrogenic contraindication Lubricants Moisturizers Dilating Therapy Botox Injections
Laser therapy (effectiveness at least equal to estrogen)
Cancer de mama y laser vaginal
Menopause 2017 Mar24(3)316-319 doi 101097GME0000000000000761
Vaginal erbium laser as second-generation thermotherapy for the genitourinary syndrome of menopause a pilot study in breast cancer survivors Gambacciani M1 Levancini M OBJECTIVE The aim of this study was to evaluate the efficacy and acceptability of a second generation of vaginal laser treatment the vaginal erbium laser as a nonablative photothermal therapy for the management of genitourinary syndrome of menopause in postmenopausal breast cancer survivors CONCLUSIONS This study suggests that the vaginal erbium laser is effective and safe for the treatment of genitourinary syndrome of menopause in breast cancer survivors
Menopause 2017 Dec 28 doi Fractional microablative CO2 laser in breast cancer survivors affected by iatrogenic vulvovaginal atrophy after failure of nonestrogenic local treatments a retrospective study Pagano T1 METHODS We treated 82 BC survivors with three cycles of CO2 laser after failure of topical nonestrogenic therapy The severity of symptoms was assessed with a visual analog scale (VAS) at baseline and after completion of laser therapy Differences in mean VAS scores of each symptom before and after treatment were assessed with multiple t tests for pairwise comparisons Multivariate analyses were used to adjust the final mean scores for the main confounding factors RESULTS Pre versus post-treatment differences in mean VAS scores were significant for sensitivity during sexual intercourse vaginal dryness itchingstinging dyspareunia and dysuria (P lt 0001 for all) bleeding (P = 0001) probe insertion (P = 0001) and movement-related pain (P = 0011) Multivariate analyses confirmed that results were significant irrespective of patients age and type of adjuvant therapy CONCLUSION This study shows that CO2 laser treatment is effective and safe in BC patients with iatrogenic menopause However the optimal number of cycles to administer and the need for retreatment remain to be defined Prospective trials are needed to compare CO2 laser therapy with therapeutic alternatives
INDICACIONES MAacuteS USUALES
bull ATROFIA VULVO-VAGINAL
bull INCONTINENDIA URINARIA DE STRESS
bull SINDROME DE HIPERLAXITUD
bull PROLAPSO GENITAL
22
INCONTINENCIA URINARIA
INCONTINENCIA URINARIA Contraccion del colageno suburetral Neocolagenosis suburetral Irradiaccioacuten angular fraccionada Pases (4 to 5) Dosis 10 A 5 JulIOs cm2 Radiacion 90-120ordm circular Sesiones (2 to 3) Leve-Moderate SUI (ICIQ_SF lt13)
PALACIOS INSTITUTE EXPERIENCE
bull Average age 526 years
bull 41 IUM 59 SUI
bull Average parity 2 children Average BMI
28
bull Average duration per session 19 minutes
bull Very good procedure tolerance
bull Adverse effects during the procedure
NO (32 local heat or slight stinging that
self-limited)
bull Adverse effects after the procedure NO
bull 100 were incorporated into their
activity in lt24 h
110 paTIENTS
1 month after the last session
NOT effective with the emergency component but YES of the effort component in the IUM (12) NOT effective in athletes Overall satisfaction 100 MP improves atrophy
INDICACIONES MAacuteS USUALES
bull ATROFIA VULVO-VAGINAL
bull INCONTINENDIA URINARIA DE STRESS
bull SINDROME DE HIPERLAXITUD
bull PROLAPSO GENITAL
TERMINOLOGIacuteA Y DEFINICIOacuteN iquestPOR QUEacute SIacuteNDROME DE HIPERLAXITUD VAGINAL
bull Anatoacutemicas y Fisioloacutegicas o Laxitud Normal
o Hiperlaxitud Anormal
bull Cliacutenicas o Siacutendrome = Agrupacioacuten de diversos siacutentomas
DEFINICIOacuteN DE SIacuteNDROME DE
HIPERLAXITUD VAGINAL
Conjunto de siacutentomas que aparecen por un exceso
de laxitud vaginal debido a la alteracioacuten de la
estructura de la vagina y tejidos circundantes
Santiago Palacios 2017
29
VAGINAL TIGHTENING
bull Mejoria y uso en 360 grados
bull Remodelado del tejido vaginal y prevencion
INDICACIONES MAacuteS USUALES
bull ATROFIA VULVO-VAGINAL
bull INCONTINENDIA URINARIA DE STRESS
bull SINDROME DE HIPELAXITUD
bull PROLAPSO GENITAL
PROLAPSO GENITAL
bull Prolapso central no lateral Grado 1
y 2
bull Sesiones Como poco 5
)
Agenda
bull PRESENTE
bull FUTURO
bull - MEJORAR EL EFECTO
- PROTOCOLOS MAacuteS DEFINIDOS
-FUTURAS INDICACIONES
COLAGENO Y EDAD
EPHITELIUM AND LAMINA PROPIA
FUNCIONES DEL FIBROBLASTO
LAMINA PROPIA
Agenda
bull PRESENTE
bull FUTURO
bull - MEJORAR EL EFECTO
- PROTOCOLOS MAacuteS DEFINIDOS
- FUTURAS INDICACIONES
CO2RE
20-40 micras proporciona una mejora similar a la de un peeling quiacutemico pero
con un mayor control de la profundidad y menos efectos adversos
Moacutedulo Aesthetic ndash Modo Fraccionado Light
SELECCIOacuteN DE PACIENTES
bull Evaluacioacuten de los sintomas
bull Motivacioacuten y demanda del paciente
bull Abilidad y posibilidades del aparato laser
Agenda
bull PRESENTE
bull FUTURO
bull - MEJORAR EL EFECTO
- PROTOCOLOS MAacuteS DEFINIDOS
- FUTURAS INDICACIONES
NUEVAS PERSPECTIVAS
copy 2016 VIVEVE Not for publication or podium presentation 41
Dermatitis vulvares Dispareunia-vaginismo Retraccioacuten de cicatrices Recuperar la flora vaginal Problemas de las mallas Fisuras vulvares Vejiga hiperactiva Patologias conocidas ( infecciosas y tumorales)
VULVAR DERMATITIS
copy 2016 VIVEVE Not for publication or podium presentation 42
GRADOS DE DOLOR SUB-CLASIFICACIOacuteN DE
MI VISION DE FUTURO
1 Todas las mujeres despueacutes de tres meses del parto Para - Evitar laxitud vaginal
- Evitar incontinencia urinaria
- Volver a una tensioacuten vulvar y vaginal normal
2 En la menopausia y de forma anual para prevenir - Atrofia vulvo-vaginal
- Incontinencia urinaria
- Prolapso
INDICACIONES MAacuteS USUALES
bull ATROFIA VULVO-VAGINAL
bull INCONTINENDIA URINARIA DE STRESS
bull SINDROME DE HIPERLAXITUD
bull PROLAPSO GENITAL
EFICACIA LASER EN LA ATROFIA VULVO-VAGINAL
bull Hay mucha evidencia de su eficacia tanto con erbio como con (CO 2) en la atrofia vulvo-vaginal de la mujer menopausica
Salvatore S Nappi RE Zerbinati N et al A 12-week treatmentwith fractional CO 2 laser for
vulvovaginal atrophy a pilot study Climacteric 2014 17 363 ndash 9
Salvatore S Nappi RE Parma M et al Sexual function after fractional microablative CO 2 laser in women with vulvovaginal atrophy Climacteric 2015 18 219 ndash 25
Salvatore S H istological study on the effects of microablative fractional CO 2 laser on atrophic vaginal tissue an ex vivo study Menopause 2015 22 845 ndash 9
Zerbinati N S erati M O rigoni M e t a l M icroscopic and ultrastructural modifi cations of postmenopausal atrophic vaginal mucosa after fractional carbon dioxide laser treatment Laser Med Sci 2015 30 429 ndash 36
Perino A Calligaro A Forlani F e t al Vulvo-vaginal atrophy a new treatment modality using thermo-ablative fractional CO 2 laser Maturitas 2015 80 296 ndash 301
ATROFIA VULVO-VAGINAL
Irradiaccion 360ordm circular haz completo Pases (3 to 5) Dosis 10 to 5 joules cm2
Irradiacioacuten en mapeo Pases (3) cubriendo vagina y vulva
Efectivo durante 6-12 meses
Se necesitan de 2-4 sesiones
Breast Cancer Increased risk of presenting
Genitourinary Syndrome
Natural or Induced Menopause Pharmaceuticals (Tamoxifen AIs ) Estrogenic contraindication Lubricants Moisturizers Dilating Therapy Botox Injections
Laser therapy (effectiveness at least equal to estrogen)
Cancer de mama y laser vaginal
Menopause 2017 Mar24(3)316-319 doi 101097GME0000000000000761
Vaginal erbium laser as second-generation thermotherapy for the genitourinary syndrome of menopause a pilot study in breast cancer survivors Gambacciani M1 Levancini M OBJECTIVE The aim of this study was to evaluate the efficacy and acceptability of a second generation of vaginal laser treatment the vaginal erbium laser as a nonablative photothermal therapy for the management of genitourinary syndrome of menopause in postmenopausal breast cancer survivors CONCLUSIONS This study suggests that the vaginal erbium laser is effective and safe for the treatment of genitourinary syndrome of menopause in breast cancer survivors
Menopause 2017 Dec 28 doi Fractional microablative CO2 laser in breast cancer survivors affected by iatrogenic vulvovaginal atrophy after failure of nonestrogenic local treatments a retrospective study Pagano T1 METHODS We treated 82 BC survivors with three cycles of CO2 laser after failure of topical nonestrogenic therapy The severity of symptoms was assessed with a visual analog scale (VAS) at baseline and after completion of laser therapy Differences in mean VAS scores of each symptom before and after treatment were assessed with multiple t tests for pairwise comparisons Multivariate analyses were used to adjust the final mean scores for the main confounding factors RESULTS Pre versus post-treatment differences in mean VAS scores were significant for sensitivity during sexual intercourse vaginal dryness itchingstinging dyspareunia and dysuria (P lt 0001 for all) bleeding (P = 0001) probe insertion (P = 0001) and movement-related pain (P = 0011) Multivariate analyses confirmed that results were significant irrespective of patients age and type of adjuvant therapy CONCLUSION This study shows that CO2 laser treatment is effective and safe in BC patients with iatrogenic menopause However the optimal number of cycles to administer and the need for retreatment remain to be defined Prospective trials are needed to compare CO2 laser therapy with therapeutic alternatives
INDICACIONES MAacuteS USUALES
bull ATROFIA VULVO-VAGINAL
bull INCONTINENDIA URINARIA DE STRESS
bull SINDROME DE HIPERLAXITUD
bull PROLAPSO GENITAL
22
INCONTINENCIA URINARIA
INCONTINENCIA URINARIA Contraccion del colageno suburetral Neocolagenosis suburetral Irradiaccioacuten angular fraccionada Pases (4 to 5) Dosis 10 A 5 JulIOs cm2 Radiacion 90-120ordm circular Sesiones (2 to 3) Leve-Moderate SUI (ICIQ_SF lt13)
PALACIOS INSTITUTE EXPERIENCE
bull Average age 526 years
bull 41 IUM 59 SUI
bull Average parity 2 children Average BMI
28
bull Average duration per session 19 minutes
bull Very good procedure tolerance
bull Adverse effects during the procedure
NO (32 local heat or slight stinging that
self-limited)
bull Adverse effects after the procedure NO
bull 100 were incorporated into their
activity in lt24 h
110 paTIENTS
1 month after the last session
NOT effective with the emergency component but YES of the effort component in the IUM (12) NOT effective in athletes Overall satisfaction 100 MP improves atrophy
INDICACIONES MAacuteS USUALES
bull ATROFIA VULVO-VAGINAL
bull INCONTINENDIA URINARIA DE STRESS
bull SINDROME DE HIPERLAXITUD
bull PROLAPSO GENITAL
TERMINOLOGIacuteA Y DEFINICIOacuteN iquestPOR QUEacute SIacuteNDROME DE HIPERLAXITUD VAGINAL
bull Anatoacutemicas y Fisioloacutegicas o Laxitud Normal
o Hiperlaxitud Anormal
bull Cliacutenicas o Siacutendrome = Agrupacioacuten de diversos siacutentomas
DEFINICIOacuteN DE SIacuteNDROME DE
HIPERLAXITUD VAGINAL
Conjunto de siacutentomas que aparecen por un exceso
de laxitud vaginal debido a la alteracioacuten de la
estructura de la vagina y tejidos circundantes
Santiago Palacios 2017
29
VAGINAL TIGHTENING
bull Mejoria y uso en 360 grados
bull Remodelado del tejido vaginal y prevencion
INDICACIONES MAacuteS USUALES
bull ATROFIA VULVO-VAGINAL
bull INCONTINENDIA URINARIA DE STRESS
bull SINDROME DE HIPELAXITUD
bull PROLAPSO GENITAL
PROLAPSO GENITAL
bull Prolapso central no lateral Grado 1
y 2
bull Sesiones Como poco 5
)
Agenda
bull PRESENTE
bull FUTURO
bull - MEJORAR EL EFECTO
- PROTOCOLOS MAacuteS DEFINIDOS
-FUTURAS INDICACIONES
COLAGENO Y EDAD
EPHITELIUM AND LAMINA PROPIA
FUNCIONES DEL FIBROBLASTO
LAMINA PROPIA
Agenda
bull PRESENTE
bull FUTURO
bull - MEJORAR EL EFECTO
- PROTOCOLOS MAacuteS DEFINIDOS
- FUTURAS INDICACIONES
CO2RE
20-40 micras proporciona una mejora similar a la de un peeling quiacutemico pero
con un mayor control de la profundidad y menos efectos adversos
Moacutedulo Aesthetic ndash Modo Fraccionado Light
SELECCIOacuteN DE PACIENTES
bull Evaluacioacuten de los sintomas
bull Motivacioacuten y demanda del paciente
bull Abilidad y posibilidades del aparato laser
Agenda
bull PRESENTE
bull FUTURO
bull - MEJORAR EL EFECTO
- PROTOCOLOS MAacuteS DEFINIDOS
- FUTURAS INDICACIONES
NUEVAS PERSPECTIVAS
copy 2016 VIVEVE Not for publication or podium presentation 41
Dermatitis vulvares Dispareunia-vaginismo Retraccioacuten de cicatrices Recuperar la flora vaginal Problemas de las mallas Fisuras vulvares Vejiga hiperactiva Patologias conocidas ( infecciosas y tumorales)
VULVAR DERMATITIS
copy 2016 VIVEVE Not for publication or podium presentation 42
GRADOS DE DOLOR SUB-CLASIFICACIOacuteN DE
MI VISION DE FUTURO
1 Todas las mujeres despueacutes de tres meses del parto Para - Evitar laxitud vaginal
- Evitar incontinencia urinaria
- Volver a una tensioacuten vulvar y vaginal normal
2 En la menopausia y de forma anual para prevenir - Atrofia vulvo-vaginal
- Incontinencia urinaria
- Prolapso
EFICACIA LASER EN LA ATROFIA VULVO-VAGINAL
bull Hay mucha evidencia de su eficacia tanto con erbio como con (CO 2) en la atrofia vulvo-vaginal de la mujer menopausica
Salvatore S Nappi RE Zerbinati N et al A 12-week treatmentwith fractional CO 2 laser for
vulvovaginal atrophy a pilot study Climacteric 2014 17 363 ndash 9
Salvatore S Nappi RE Parma M et al Sexual function after fractional microablative CO 2 laser in women with vulvovaginal atrophy Climacteric 2015 18 219 ndash 25
Salvatore S H istological study on the effects of microablative fractional CO 2 laser on atrophic vaginal tissue an ex vivo study Menopause 2015 22 845 ndash 9
Zerbinati N S erati M O rigoni M e t a l M icroscopic and ultrastructural modifi cations of postmenopausal atrophic vaginal mucosa after fractional carbon dioxide laser treatment Laser Med Sci 2015 30 429 ndash 36
Perino A Calligaro A Forlani F e t al Vulvo-vaginal atrophy a new treatment modality using thermo-ablative fractional CO 2 laser Maturitas 2015 80 296 ndash 301
ATROFIA VULVO-VAGINAL
Irradiaccion 360ordm circular haz completo Pases (3 to 5) Dosis 10 to 5 joules cm2
Irradiacioacuten en mapeo Pases (3) cubriendo vagina y vulva
Efectivo durante 6-12 meses
Se necesitan de 2-4 sesiones
Breast Cancer Increased risk of presenting
Genitourinary Syndrome
Natural or Induced Menopause Pharmaceuticals (Tamoxifen AIs ) Estrogenic contraindication Lubricants Moisturizers Dilating Therapy Botox Injections
Laser therapy (effectiveness at least equal to estrogen)
Cancer de mama y laser vaginal
Menopause 2017 Mar24(3)316-319 doi 101097GME0000000000000761
Vaginal erbium laser as second-generation thermotherapy for the genitourinary syndrome of menopause a pilot study in breast cancer survivors Gambacciani M1 Levancini M OBJECTIVE The aim of this study was to evaluate the efficacy and acceptability of a second generation of vaginal laser treatment the vaginal erbium laser as a nonablative photothermal therapy for the management of genitourinary syndrome of menopause in postmenopausal breast cancer survivors CONCLUSIONS This study suggests that the vaginal erbium laser is effective and safe for the treatment of genitourinary syndrome of menopause in breast cancer survivors
Menopause 2017 Dec 28 doi Fractional microablative CO2 laser in breast cancer survivors affected by iatrogenic vulvovaginal atrophy after failure of nonestrogenic local treatments a retrospective study Pagano T1 METHODS We treated 82 BC survivors with three cycles of CO2 laser after failure of topical nonestrogenic therapy The severity of symptoms was assessed with a visual analog scale (VAS) at baseline and after completion of laser therapy Differences in mean VAS scores of each symptom before and after treatment were assessed with multiple t tests for pairwise comparisons Multivariate analyses were used to adjust the final mean scores for the main confounding factors RESULTS Pre versus post-treatment differences in mean VAS scores were significant for sensitivity during sexual intercourse vaginal dryness itchingstinging dyspareunia and dysuria (P lt 0001 for all) bleeding (P = 0001) probe insertion (P = 0001) and movement-related pain (P = 0011) Multivariate analyses confirmed that results were significant irrespective of patients age and type of adjuvant therapy CONCLUSION This study shows that CO2 laser treatment is effective and safe in BC patients with iatrogenic menopause However the optimal number of cycles to administer and the need for retreatment remain to be defined Prospective trials are needed to compare CO2 laser therapy with therapeutic alternatives
INDICACIONES MAacuteS USUALES
bull ATROFIA VULVO-VAGINAL
bull INCONTINENDIA URINARIA DE STRESS
bull SINDROME DE HIPERLAXITUD
bull PROLAPSO GENITAL
22
INCONTINENCIA URINARIA
INCONTINENCIA URINARIA Contraccion del colageno suburetral Neocolagenosis suburetral Irradiaccioacuten angular fraccionada Pases (4 to 5) Dosis 10 A 5 JulIOs cm2 Radiacion 90-120ordm circular Sesiones (2 to 3) Leve-Moderate SUI (ICIQ_SF lt13)
PALACIOS INSTITUTE EXPERIENCE
bull Average age 526 years
bull 41 IUM 59 SUI
bull Average parity 2 children Average BMI
28
bull Average duration per session 19 minutes
bull Very good procedure tolerance
bull Adverse effects during the procedure
NO (32 local heat or slight stinging that
self-limited)
bull Adverse effects after the procedure NO
bull 100 were incorporated into their
activity in lt24 h
110 paTIENTS
1 month after the last session
NOT effective with the emergency component but YES of the effort component in the IUM (12) NOT effective in athletes Overall satisfaction 100 MP improves atrophy
INDICACIONES MAacuteS USUALES
bull ATROFIA VULVO-VAGINAL
bull INCONTINENDIA URINARIA DE STRESS
bull SINDROME DE HIPERLAXITUD
bull PROLAPSO GENITAL
TERMINOLOGIacuteA Y DEFINICIOacuteN iquestPOR QUEacute SIacuteNDROME DE HIPERLAXITUD VAGINAL
bull Anatoacutemicas y Fisioloacutegicas o Laxitud Normal
o Hiperlaxitud Anormal
bull Cliacutenicas o Siacutendrome = Agrupacioacuten de diversos siacutentomas
DEFINICIOacuteN DE SIacuteNDROME DE
HIPERLAXITUD VAGINAL
Conjunto de siacutentomas que aparecen por un exceso
de laxitud vaginal debido a la alteracioacuten de la
estructura de la vagina y tejidos circundantes
Santiago Palacios 2017
29
VAGINAL TIGHTENING
bull Mejoria y uso en 360 grados
bull Remodelado del tejido vaginal y prevencion
INDICACIONES MAacuteS USUALES
bull ATROFIA VULVO-VAGINAL
bull INCONTINENDIA URINARIA DE STRESS
bull SINDROME DE HIPELAXITUD
bull PROLAPSO GENITAL
PROLAPSO GENITAL
bull Prolapso central no lateral Grado 1
y 2
bull Sesiones Como poco 5
)
Agenda
bull PRESENTE
bull FUTURO
bull - MEJORAR EL EFECTO
- PROTOCOLOS MAacuteS DEFINIDOS
-FUTURAS INDICACIONES
COLAGENO Y EDAD
EPHITELIUM AND LAMINA PROPIA
FUNCIONES DEL FIBROBLASTO
LAMINA PROPIA
Agenda
bull PRESENTE
bull FUTURO
bull - MEJORAR EL EFECTO
- PROTOCOLOS MAacuteS DEFINIDOS
- FUTURAS INDICACIONES
CO2RE
20-40 micras proporciona una mejora similar a la de un peeling quiacutemico pero
con un mayor control de la profundidad y menos efectos adversos
Moacutedulo Aesthetic ndash Modo Fraccionado Light
SELECCIOacuteN DE PACIENTES
bull Evaluacioacuten de los sintomas
bull Motivacioacuten y demanda del paciente
bull Abilidad y posibilidades del aparato laser
Agenda
bull PRESENTE
bull FUTURO
bull - MEJORAR EL EFECTO
- PROTOCOLOS MAacuteS DEFINIDOS
- FUTURAS INDICACIONES
NUEVAS PERSPECTIVAS
copy 2016 VIVEVE Not for publication or podium presentation 41
Dermatitis vulvares Dispareunia-vaginismo Retraccioacuten de cicatrices Recuperar la flora vaginal Problemas de las mallas Fisuras vulvares Vejiga hiperactiva Patologias conocidas ( infecciosas y tumorales)
VULVAR DERMATITIS
copy 2016 VIVEVE Not for publication or podium presentation 42
GRADOS DE DOLOR SUB-CLASIFICACIOacuteN DE
MI VISION DE FUTURO
1 Todas las mujeres despueacutes de tres meses del parto Para - Evitar laxitud vaginal
- Evitar incontinencia urinaria
- Volver a una tensioacuten vulvar y vaginal normal
2 En la menopausia y de forma anual para prevenir - Atrofia vulvo-vaginal
- Incontinencia urinaria
- Prolapso
ATROFIA VULVO-VAGINAL
Irradiaccion 360ordm circular haz completo Pases (3 to 5) Dosis 10 to 5 joules cm2
Irradiacioacuten en mapeo Pases (3) cubriendo vagina y vulva
Efectivo durante 6-12 meses
Se necesitan de 2-4 sesiones
Breast Cancer Increased risk of presenting
Genitourinary Syndrome
Natural or Induced Menopause Pharmaceuticals (Tamoxifen AIs ) Estrogenic contraindication Lubricants Moisturizers Dilating Therapy Botox Injections
Laser therapy (effectiveness at least equal to estrogen)
Cancer de mama y laser vaginal
Menopause 2017 Mar24(3)316-319 doi 101097GME0000000000000761
Vaginal erbium laser as second-generation thermotherapy for the genitourinary syndrome of menopause a pilot study in breast cancer survivors Gambacciani M1 Levancini M OBJECTIVE The aim of this study was to evaluate the efficacy and acceptability of a second generation of vaginal laser treatment the vaginal erbium laser as a nonablative photothermal therapy for the management of genitourinary syndrome of menopause in postmenopausal breast cancer survivors CONCLUSIONS This study suggests that the vaginal erbium laser is effective and safe for the treatment of genitourinary syndrome of menopause in breast cancer survivors
Menopause 2017 Dec 28 doi Fractional microablative CO2 laser in breast cancer survivors affected by iatrogenic vulvovaginal atrophy after failure of nonestrogenic local treatments a retrospective study Pagano T1 METHODS We treated 82 BC survivors with three cycles of CO2 laser after failure of topical nonestrogenic therapy The severity of symptoms was assessed with a visual analog scale (VAS) at baseline and after completion of laser therapy Differences in mean VAS scores of each symptom before and after treatment were assessed with multiple t tests for pairwise comparisons Multivariate analyses were used to adjust the final mean scores for the main confounding factors RESULTS Pre versus post-treatment differences in mean VAS scores were significant for sensitivity during sexual intercourse vaginal dryness itchingstinging dyspareunia and dysuria (P lt 0001 for all) bleeding (P = 0001) probe insertion (P = 0001) and movement-related pain (P = 0011) Multivariate analyses confirmed that results were significant irrespective of patients age and type of adjuvant therapy CONCLUSION This study shows that CO2 laser treatment is effective and safe in BC patients with iatrogenic menopause However the optimal number of cycles to administer and the need for retreatment remain to be defined Prospective trials are needed to compare CO2 laser therapy with therapeutic alternatives
INDICACIONES MAacuteS USUALES
bull ATROFIA VULVO-VAGINAL
bull INCONTINENDIA URINARIA DE STRESS
bull SINDROME DE HIPERLAXITUD
bull PROLAPSO GENITAL
22
INCONTINENCIA URINARIA
INCONTINENCIA URINARIA Contraccion del colageno suburetral Neocolagenosis suburetral Irradiaccioacuten angular fraccionada Pases (4 to 5) Dosis 10 A 5 JulIOs cm2 Radiacion 90-120ordm circular Sesiones (2 to 3) Leve-Moderate SUI (ICIQ_SF lt13)
PALACIOS INSTITUTE EXPERIENCE
bull Average age 526 years
bull 41 IUM 59 SUI
bull Average parity 2 children Average BMI
28
bull Average duration per session 19 minutes
bull Very good procedure tolerance
bull Adverse effects during the procedure
NO (32 local heat or slight stinging that
self-limited)
bull Adverse effects after the procedure NO
bull 100 were incorporated into their
activity in lt24 h
110 paTIENTS
1 month after the last session
NOT effective with the emergency component but YES of the effort component in the IUM (12) NOT effective in athletes Overall satisfaction 100 MP improves atrophy
INDICACIONES MAacuteS USUALES
bull ATROFIA VULVO-VAGINAL
bull INCONTINENDIA URINARIA DE STRESS
bull SINDROME DE HIPERLAXITUD
bull PROLAPSO GENITAL
TERMINOLOGIacuteA Y DEFINICIOacuteN iquestPOR QUEacute SIacuteNDROME DE HIPERLAXITUD VAGINAL
bull Anatoacutemicas y Fisioloacutegicas o Laxitud Normal
o Hiperlaxitud Anormal
bull Cliacutenicas o Siacutendrome = Agrupacioacuten de diversos siacutentomas
DEFINICIOacuteN DE SIacuteNDROME DE
HIPERLAXITUD VAGINAL
Conjunto de siacutentomas que aparecen por un exceso
de laxitud vaginal debido a la alteracioacuten de la
estructura de la vagina y tejidos circundantes
Santiago Palacios 2017
29
VAGINAL TIGHTENING
bull Mejoria y uso en 360 grados
bull Remodelado del tejido vaginal y prevencion
INDICACIONES MAacuteS USUALES
bull ATROFIA VULVO-VAGINAL
bull INCONTINENDIA URINARIA DE STRESS
bull SINDROME DE HIPELAXITUD
bull PROLAPSO GENITAL
PROLAPSO GENITAL
bull Prolapso central no lateral Grado 1
y 2
bull Sesiones Como poco 5
)
Agenda
bull PRESENTE
bull FUTURO
bull - MEJORAR EL EFECTO
- PROTOCOLOS MAacuteS DEFINIDOS
-FUTURAS INDICACIONES
COLAGENO Y EDAD
EPHITELIUM AND LAMINA PROPIA
FUNCIONES DEL FIBROBLASTO
LAMINA PROPIA
Agenda
bull PRESENTE
bull FUTURO
bull - MEJORAR EL EFECTO
- PROTOCOLOS MAacuteS DEFINIDOS
- FUTURAS INDICACIONES
CO2RE
20-40 micras proporciona una mejora similar a la de un peeling quiacutemico pero
con un mayor control de la profundidad y menos efectos adversos
Moacutedulo Aesthetic ndash Modo Fraccionado Light
SELECCIOacuteN DE PACIENTES
bull Evaluacioacuten de los sintomas
bull Motivacioacuten y demanda del paciente
bull Abilidad y posibilidades del aparato laser
Agenda
bull PRESENTE
bull FUTURO
bull - MEJORAR EL EFECTO
- PROTOCOLOS MAacuteS DEFINIDOS
- FUTURAS INDICACIONES
NUEVAS PERSPECTIVAS
copy 2016 VIVEVE Not for publication or podium presentation 41
Dermatitis vulvares Dispareunia-vaginismo Retraccioacuten de cicatrices Recuperar la flora vaginal Problemas de las mallas Fisuras vulvares Vejiga hiperactiva Patologias conocidas ( infecciosas y tumorales)
VULVAR DERMATITIS
copy 2016 VIVEVE Not for publication or podium presentation 42
GRADOS DE DOLOR SUB-CLASIFICACIOacuteN DE
MI VISION DE FUTURO
1 Todas las mujeres despueacutes de tres meses del parto Para - Evitar laxitud vaginal
- Evitar incontinencia urinaria
- Volver a una tensioacuten vulvar y vaginal normal
2 En la menopausia y de forma anual para prevenir - Atrofia vulvo-vaginal
- Incontinencia urinaria
- Prolapso
Breast Cancer Increased risk of presenting
Genitourinary Syndrome
Natural or Induced Menopause Pharmaceuticals (Tamoxifen AIs ) Estrogenic contraindication Lubricants Moisturizers Dilating Therapy Botox Injections
Laser therapy (effectiveness at least equal to estrogen)
Cancer de mama y laser vaginal
Menopause 2017 Mar24(3)316-319 doi 101097GME0000000000000761
Vaginal erbium laser as second-generation thermotherapy for the genitourinary syndrome of menopause a pilot study in breast cancer survivors Gambacciani M1 Levancini M OBJECTIVE The aim of this study was to evaluate the efficacy and acceptability of a second generation of vaginal laser treatment the vaginal erbium laser as a nonablative photothermal therapy for the management of genitourinary syndrome of menopause in postmenopausal breast cancer survivors CONCLUSIONS This study suggests that the vaginal erbium laser is effective and safe for the treatment of genitourinary syndrome of menopause in breast cancer survivors
Menopause 2017 Dec 28 doi Fractional microablative CO2 laser in breast cancer survivors affected by iatrogenic vulvovaginal atrophy after failure of nonestrogenic local treatments a retrospective study Pagano T1 METHODS We treated 82 BC survivors with three cycles of CO2 laser after failure of topical nonestrogenic therapy The severity of symptoms was assessed with a visual analog scale (VAS) at baseline and after completion of laser therapy Differences in mean VAS scores of each symptom before and after treatment were assessed with multiple t tests for pairwise comparisons Multivariate analyses were used to adjust the final mean scores for the main confounding factors RESULTS Pre versus post-treatment differences in mean VAS scores were significant for sensitivity during sexual intercourse vaginal dryness itchingstinging dyspareunia and dysuria (P lt 0001 for all) bleeding (P = 0001) probe insertion (P = 0001) and movement-related pain (P = 0011) Multivariate analyses confirmed that results were significant irrespective of patients age and type of adjuvant therapy CONCLUSION This study shows that CO2 laser treatment is effective and safe in BC patients with iatrogenic menopause However the optimal number of cycles to administer and the need for retreatment remain to be defined Prospective trials are needed to compare CO2 laser therapy with therapeutic alternatives
INDICACIONES MAacuteS USUALES
bull ATROFIA VULVO-VAGINAL
bull INCONTINENDIA URINARIA DE STRESS
bull SINDROME DE HIPERLAXITUD
bull PROLAPSO GENITAL
22
INCONTINENCIA URINARIA
INCONTINENCIA URINARIA Contraccion del colageno suburetral Neocolagenosis suburetral Irradiaccioacuten angular fraccionada Pases (4 to 5) Dosis 10 A 5 JulIOs cm2 Radiacion 90-120ordm circular Sesiones (2 to 3) Leve-Moderate SUI (ICIQ_SF lt13)
PALACIOS INSTITUTE EXPERIENCE
bull Average age 526 years
bull 41 IUM 59 SUI
bull Average parity 2 children Average BMI
28
bull Average duration per session 19 minutes
bull Very good procedure tolerance
bull Adverse effects during the procedure
NO (32 local heat or slight stinging that
self-limited)
bull Adverse effects after the procedure NO
bull 100 were incorporated into their
activity in lt24 h
110 paTIENTS
1 month after the last session
NOT effective with the emergency component but YES of the effort component in the IUM (12) NOT effective in athletes Overall satisfaction 100 MP improves atrophy
INDICACIONES MAacuteS USUALES
bull ATROFIA VULVO-VAGINAL
bull INCONTINENDIA URINARIA DE STRESS
bull SINDROME DE HIPERLAXITUD
bull PROLAPSO GENITAL
TERMINOLOGIacuteA Y DEFINICIOacuteN iquestPOR QUEacute SIacuteNDROME DE HIPERLAXITUD VAGINAL
bull Anatoacutemicas y Fisioloacutegicas o Laxitud Normal
o Hiperlaxitud Anormal
bull Cliacutenicas o Siacutendrome = Agrupacioacuten de diversos siacutentomas
DEFINICIOacuteN DE SIacuteNDROME DE
HIPERLAXITUD VAGINAL
Conjunto de siacutentomas que aparecen por un exceso
de laxitud vaginal debido a la alteracioacuten de la
estructura de la vagina y tejidos circundantes
Santiago Palacios 2017
29
VAGINAL TIGHTENING
bull Mejoria y uso en 360 grados
bull Remodelado del tejido vaginal y prevencion
INDICACIONES MAacuteS USUALES
bull ATROFIA VULVO-VAGINAL
bull INCONTINENDIA URINARIA DE STRESS
bull SINDROME DE HIPELAXITUD
bull PROLAPSO GENITAL
PROLAPSO GENITAL
bull Prolapso central no lateral Grado 1
y 2
bull Sesiones Como poco 5
)
Agenda
bull PRESENTE
bull FUTURO
bull - MEJORAR EL EFECTO
- PROTOCOLOS MAacuteS DEFINIDOS
-FUTURAS INDICACIONES
COLAGENO Y EDAD
EPHITELIUM AND LAMINA PROPIA
FUNCIONES DEL FIBROBLASTO
LAMINA PROPIA
Agenda
bull PRESENTE
bull FUTURO
bull - MEJORAR EL EFECTO
- PROTOCOLOS MAacuteS DEFINIDOS
- FUTURAS INDICACIONES
CO2RE
20-40 micras proporciona una mejora similar a la de un peeling quiacutemico pero
con un mayor control de la profundidad y menos efectos adversos
Moacutedulo Aesthetic ndash Modo Fraccionado Light
SELECCIOacuteN DE PACIENTES
bull Evaluacioacuten de los sintomas
bull Motivacioacuten y demanda del paciente
bull Abilidad y posibilidades del aparato laser
Agenda
bull PRESENTE
bull FUTURO
bull - MEJORAR EL EFECTO
- PROTOCOLOS MAacuteS DEFINIDOS
- FUTURAS INDICACIONES
NUEVAS PERSPECTIVAS
copy 2016 VIVEVE Not for publication or podium presentation 41
Dermatitis vulvares Dispareunia-vaginismo Retraccioacuten de cicatrices Recuperar la flora vaginal Problemas de las mallas Fisuras vulvares Vejiga hiperactiva Patologias conocidas ( infecciosas y tumorales)
VULVAR DERMATITIS
copy 2016 VIVEVE Not for publication or podium presentation 42
GRADOS DE DOLOR SUB-CLASIFICACIOacuteN DE
MI VISION DE FUTURO
1 Todas las mujeres despueacutes de tres meses del parto Para - Evitar laxitud vaginal
- Evitar incontinencia urinaria
- Volver a una tensioacuten vulvar y vaginal normal
2 En la menopausia y de forma anual para prevenir - Atrofia vulvo-vaginal
- Incontinencia urinaria
- Prolapso
Cancer de mama y laser vaginal
Menopause 2017 Mar24(3)316-319 doi 101097GME0000000000000761
Vaginal erbium laser as second-generation thermotherapy for the genitourinary syndrome of menopause a pilot study in breast cancer survivors Gambacciani M1 Levancini M OBJECTIVE The aim of this study was to evaluate the efficacy and acceptability of a second generation of vaginal laser treatment the vaginal erbium laser as a nonablative photothermal therapy for the management of genitourinary syndrome of menopause in postmenopausal breast cancer survivors CONCLUSIONS This study suggests that the vaginal erbium laser is effective and safe for the treatment of genitourinary syndrome of menopause in breast cancer survivors
Menopause 2017 Dec 28 doi Fractional microablative CO2 laser in breast cancer survivors affected by iatrogenic vulvovaginal atrophy after failure of nonestrogenic local treatments a retrospective study Pagano T1 METHODS We treated 82 BC survivors with three cycles of CO2 laser after failure of topical nonestrogenic therapy The severity of symptoms was assessed with a visual analog scale (VAS) at baseline and after completion of laser therapy Differences in mean VAS scores of each symptom before and after treatment were assessed with multiple t tests for pairwise comparisons Multivariate analyses were used to adjust the final mean scores for the main confounding factors RESULTS Pre versus post-treatment differences in mean VAS scores were significant for sensitivity during sexual intercourse vaginal dryness itchingstinging dyspareunia and dysuria (P lt 0001 for all) bleeding (P = 0001) probe insertion (P = 0001) and movement-related pain (P = 0011) Multivariate analyses confirmed that results were significant irrespective of patients age and type of adjuvant therapy CONCLUSION This study shows that CO2 laser treatment is effective and safe in BC patients with iatrogenic menopause However the optimal number of cycles to administer and the need for retreatment remain to be defined Prospective trials are needed to compare CO2 laser therapy with therapeutic alternatives
INDICACIONES MAacuteS USUALES
bull ATROFIA VULVO-VAGINAL
bull INCONTINENDIA URINARIA DE STRESS
bull SINDROME DE HIPERLAXITUD
bull PROLAPSO GENITAL
22
INCONTINENCIA URINARIA
INCONTINENCIA URINARIA Contraccion del colageno suburetral Neocolagenosis suburetral Irradiaccioacuten angular fraccionada Pases (4 to 5) Dosis 10 A 5 JulIOs cm2 Radiacion 90-120ordm circular Sesiones (2 to 3) Leve-Moderate SUI (ICIQ_SF lt13)
PALACIOS INSTITUTE EXPERIENCE
bull Average age 526 years
bull 41 IUM 59 SUI
bull Average parity 2 children Average BMI
28
bull Average duration per session 19 minutes
bull Very good procedure tolerance
bull Adverse effects during the procedure
NO (32 local heat or slight stinging that
self-limited)
bull Adverse effects after the procedure NO
bull 100 were incorporated into their
activity in lt24 h
110 paTIENTS
1 month after the last session
NOT effective with the emergency component but YES of the effort component in the IUM (12) NOT effective in athletes Overall satisfaction 100 MP improves atrophy
INDICACIONES MAacuteS USUALES
bull ATROFIA VULVO-VAGINAL
bull INCONTINENDIA URINARIA DE STRESS
bull SINDROME DE HIPERLAXITUD
bull PROLAPSO GENITAL
TERMINOLOGIacuteA Y DEFINICIOacuteN iquestPOR QUEacute SIacuteNDROME DE HIPERLAXITUD VAGINAL
bull Anatoacutemicas y Fisioloacutegicas o Laxitud Normal
o Hiperlaxitud Anormal
bull Cliacutenicas o Siacutendrome = Agrupacioacuten de diversos siacutentomas
DEFINICIOacuteN DE SIacuteNDROME DE
HIPERLAXITUD VAGINAL
Conjunto de siacutentomas que aparecen por un exceso
de laxitud vaginal debido a la alteracioacuten de la
estructura de la vagina y tejidos circundantes
Santiago Palacios 2017
29
VAGINAL TIGHTENING
bull Mejoria y uso en 360 grados
bull Remodelado del tejido vaginal y prevencion
INDICACIONES MAacuteS USUALES
bull ATROFIA VULVO-VAGINAL
bull INCONTINENDIA URINARIA DE STRESS
bull SINDROME DE HIPELAXITUD
bull PROLAPSO GENITAL
PROLAPSO GENITAL
bull Prolapso central no lateral Grado 1
y 2
bull Sesiones Como poco 5
)
Agenda
bull PRESENTE
bull FUTURO
bull - MEJORAR EL EFECTO
- PROTOCOLOS MAacuteS DEFINIDOS
-FUTURAS INDICACIONES
COLAGENO Y EDAD
EPHITELIUM AND LAMINA PROPIA
FUNCIONES DEL FIBROBLASTO
LAMINA PROPIA
Agenda
bull PRESENTE
bull FUTURO
bull - MEJORAR EL EFECTO
- PROTOCOLOS MAacuteS DEFINIDOS
- FUTURAS INDICACIONES
CO2RE
20-40 micras proporciona una mejora similar a la de un peeling quiacutemico pero
con un mayor control de la profundidad y menos efectos adversos
Moacutedulo Aesthetic ndash Modo Fraccionado Light
SELECCIOacuteN DE PACIENTES
bull Evaluacioacuten de los sintomas
bull Motivacioacuten y demanda del paciente
bull Abilidad y posibilidades del aparato laser
Agenda
bull PRESENTE
bull FUTURO
bull - MEJORAR EL EFECTO
- PROTOCOLOS MAacuteS DEFINIDOS
- FUTURAS INDICACIONES
NUEVAS PERSPECTIVAS
copy 2016 VIVEVE Not for publication or podium presentation 41
Dermatitis vulvares Dispareunia-vaginismo Retraccioacuten de cicatrices Recuperar la flora vaginal Problemas de las mallas Fisuras vulvares Vejiga hiperactiva Patologias conocidas ( infecciosas y tumorales)
VULVAR DERMATITIS
copy 2016 VIVEVE Not for publication or podium presentation 42
GRADOS DE DOLOR SUB-CLASIFICACIOacuteN DE
MI VISION DE FUTURO
1 Todas las mujeres despueacutes de tres meses del parto Para - Evitar laxitud vaginal
- Evitar incontinencia urinaria
- Volver a una tensioacuten vulvar y vaginal normal
2 En la menopausia y de forma anual para prevenir - Atrofia vulvo-vaginal
- Incontinencia urinaria
- Prolapso
Menopause 2017 Dec 28 doi Fractional microablative CO2 laser in breast cancer survivors affected by iatrogenic vulvovaginal atrophy after failure of nonestrogenic local treatments a retrospective study Pagano T1 METHODS We treated 82 BC survivors with three cycles of CO2 laser after failure of topical nonestrogenic therapy The severity of symptoms was assessed with a visual analog scale (VAS) at baseline and after completion of laser therapy Differences in mean VAS scores of each symptom before and after treatment were assessed with multiple t tests for pairwise comparisons Multivariate analyses were used to adjust the final mean scores for the main confounding factors RESULTS Pre versus post-treatment differences in mean VAS scores were significant for sensitivity during sexual intercourse vaginal dryness itchingstinging dyspareunia and dysuria (P lt 0001 for all) bleeding (P = 0001) probe insertion (P = 0001) and movement-related pain (P = 0011) Multivariate analyses confirmed that results were significant irrespective of patients age and type of adjuvant therapy CONCLUSION This study shows that CO2 laser treatment is effective and safe in BC patients with iatrogenic menopause However the optimal number of cycles to administer and the need for retreatment remain to be defined Prospective trials are needed to compare CO2 laser therapy with therapeutic alternatives
INDICACIONES MAacuteS USUALES
bull ATROFIA VULVO-VAGINAL
bull INCONTINENDIA URINARIA DE STRESS
bull SINDROME DE HIPERLAXITUD
bull PROLAPSO GENITAL
22
INCONTINENCIA URINARIA
INCONTINENCIA URINARIA Contraccion del colageno suburetral Neocolagenosis suburetral Irradiaccioacuten angular fraccionada Pases (4 to 5) Dosis 10 A 5 JulIOs cm2 Radiacion 90-120ordm circular Sesiones (2 to 3) Leve-Moderate SUI (ICIQ_SF lt13)
PALACIOS INSTITUTE EXPERIENCE
bull Average age 526 years
bull 41 IUM 59 SUI
bull Average parity 2 children Average BMI
28
bull Average duration per session 19 minutes
bull Very good procedure tolerance
bull Adverse effects during the procedure
NO (32 local heat or slight stinging that
self-limited)
bull Adverse effects after the procedure NO
bull 100 were incorporated into their
activity in lt24 h
110 paTIENTS
1 month after the last session
NOT effective with the emergency component but YES of the effort component in the IUM (12) NOT effective in athletes Overall satisfaction 100 MP improves atrophy
INDICACIONES MAacuteS USUALES
bull ATROFIA VULVO-VAGINAL
bull INCONTINENDIA URINARIA DE STRESS
bull SINDROME DE HIPERLAXITUD
bull PROLAPSO GENITAL
TERMINOLOGIacuteA Y DEFINICIOacuteN iquestPOR QUEacute SIacuteNDROME DE HIPERLAXITUD VAGINAL
bull Anatoacutemicas y Fisioloacutegicas o Laxitud Normal
o Hiperlaxitud Anormal
bull Cliacutenicas o Siacutendrome = Agrupacioacuten de diversos siacutentomas
DEFINICIOacuteN DE SIacuteNDROME DE
HIPERLAXITUD VAGINAL
Conjunto de siacutentomas que aparecen por un exceso
de laxitud vaginal debido a la alteracioacuten de la
estructura de la vagina y tejidos circundantes
Santiago Palacios 2017
29
VAGINAL TIGHTENING
bull Mejoria y uso en 360 grados
bull Remodelado del tejido vaginal y prevencion
INDICACIONES MAacuteS USUALES
bull ATROFIA VULVO-VAGINAL
bull INCONTINENDIA URINARIA DE STRESS
bull SINDROME DE HIPELAXITUD
bull PROLAPSO GENITAL
PROLAPSO GENITAL
bull Prolapso central no lateral Grado 1
y 2
bull Sesiones Como poco 5
)
Agenda
bull PRESENTE
bull FUTURO
bull - MEJORAR EL EFECTO
- PROTOCOLOS MAacuteS DEFINIDOS
-FUTURAS INDICACIONES
COLAGENO Y EDAD
EPHITELIUM AND LAMINA PROPIA
FUNCIONES DEL FIBROBLASTO
LAMINA PROPIA
Agenda
bull PRESENTE
bull FUTURO
bull - MEJORAR EL EFECTO
- PROTOCOLOS MAacuteS DEFINIDOS
- FUTURAS INDICACIONES
CO2RE
20-40 micras proporciona una mejora similar a la de un peeling quiacutemico pero
con un mayor control de la profundidad y menos efectos adversos
Moacutedulo Aesthetic ndash Modo Fraccionado Light
SELECCIOacuteN DE PACIENTES
bull Evaluacioacuten de los sintomas
bull Motivacioacuten y demanda del paciente
bull Abilidad y posibilidades del aparato laser
Agenda
bull PRESENTE
bull FUTURO
bull - MEJORAR EL EFECTO
- PROTOCOLOS MAacuteS DEFINIDOS
- FUTURAS INDICACIONES
NUEVAS PERSPECTIVAS
copy 2016 VIVEVE Not for publication or podium presentation 41
Dermatitis vulvares Dispareunia-vaginismo Retraccioacuten de cicatrices Recuperar la flora vaginal Problemas de las mallas Fisuras vulvares Vejiga hiperactiva Patologias conocidas ( infecciosas y tumorales)
VULVAR DERMATITIS
copy 2016 VIVEVE Not for publication or podium presentation 42
GRADOS DE DOLOR SUB-CLASIFICACIOacuteN DE
MI VISION DE FUTURO
1 Todas las mujeres despueacutes de tres meses del parto Para - Evitar laxitud vaginal
- Evitar incontinencia urinaria
- Volver a una tensioacuten vulvar y vaginal normal
2 En la menopausia y de forma anual para prevenir - Atrofia vulvo-vaginal
- Incontinencia urinaria
- Prolapso
INDICACIONES MAacuteS USUALES
bull ATROFIA VULVO-VAGINAL
bull INCONTINENDIA URINARIA DE STRESS
bull SINDROME DE HIPERLAXITUD
bull PROLAPSO GENITAL
22
INCONTINENCIA URINARIA
INCONTINENCIA URINARIA Contraccion del colageno suburetral Neocolagenosis suburetral Irradiaccioacuten angular fraccionada Pases (4 to 5) Dosis 10 A 5 JulIOs cm2 Radiacion 90-120ordm circular Sesiones (2 to 3) Leve-Moderate SUI (ICIQ_SF lt13)
PALACIOS INSTITUTE EXPERIENCE
bull Average age 526 years
bull 41 IUM 59 SUI
bull Average parity 2 children Average BMI
28
bull Average duration per session 19 minutes
bull Very good procedure tolerance
bull Adverse effects during the procedure
NO (32 local heat or slight stinging that
self-limited)
bull Adverse effects after the procedure NO
bull 100 were incorporated into their
activity in lt24 h
110 paTIENTS
1 month after the last session
NOT effective with the emergency component but YES of the effort component in the IUM (12) NOT effective in athletes Overall satisfaction 100 MP improves atrophy
INDICACIONES MAacuteS USUALES
bull ATROFIA VULVO-VAGINAL
bull INCONTINENDIA URINARIA DE STRESS
bull SINDROME DE HIPERLAXITUD
bull PROLAPSO GENITAL
TERMINOLOGIacuteA Y DEFINICIOacuteN iquestPOR QUEacute SIacuteNDROME DE HIPERLAXITUD VAGINAL
bull Anatoacutemicas y Fisioloacutegicas o Laxitud Normal
o Hiperlaxitud Anormal
bull Cliacutenicas o Siacutendrome = Agrupacioacuten de diversos siacutentomas
DEFINICIOacuteN DE SIacuteNDROME DE
HIPERLAXITUD VAGINAL
Conjunto de siacutentomas que aparecen por un exceso
de laxitud vaginal debido a la alteracioacuten de la
estructura de la vagina y tejidos circundantes
Santiago Palacios 2017
29
VAGINAL TIGHTENING
bull Mejoria y uso en 360 grados
bull Remodelado del tejido vaginal y prevencion
INDICACIONES MAacuteS USUALES
bull ATROFIA VULVO-VAGINAL
bull INCONTINENDIA URINARIA DE STRESS
bull SINDROME DE HIPELAXITUD
bull PROLAPSO GENITAL
PROLAPSO GENITAL
bull Prolapso central no lateral Grado 1
y 2
bull Sesiones Como poco 5
)
Agenda
bull PRESENTE
bull FUTURO
bull - MEJORAR EL EFECTO
- PROTOCOLOS MAacuteS DEFINIDOS
-FUTURAS INDICACIONES
COLAGENO Y EDAD
EPHITELIUM AND LAMINA PROPIA
FUNCIONES DEL FIBROBLASTO
LAMINA PROPIA
Agenda
bull PRESENTE
bull FUTURO
bull - MEJORAR EL EFECTO
- PROTOCOLOS MAacuteS DEFINIDOS
- FUTURAS INDICACIONES
CO2RE
20-40 micras proporciona una mejora similar a la de un peeling quiacutemico pero
con un mayor control de la profundidad y menos efectos adversos
Moacutedulo Aesthetic ndash Modo Fraccionado Light
SELECCIOacuteN DE PACIENTES
bull Evaluacioacuten de los sintomas
bull Motivacioacuten y demanda del paciente
bull Abilidad y posibilidades del aparato laser
Agenda
bull PRESENTE
bull FUTURO
bull - MEJORAR EL EFECTO
- PROTOCOLOS MAacuteS DEFINIDOS
- FUTURAS INDICACIONES
NUEVAS PERSPECTIVAS
copy 2016 VIVEVE Not for publication or podium presentation 41
Dermatitis vulvares Dispareunia-vaginismo Retraccioacuten de cicatrices Recuperar la flora vaginal Problemas de las mallas Fisuras vulvares Vejiga hiperactiva Patologias conocidas ( infecciosas y tumorales)
VULVAR DERMATITIS
copy 2016 VIVEVE Not for publication or podium presentation 42
GRADOS DE DOLOR SUB-CLASIFICACIOacuteN DE
MI VISION DE FUTURO
1 Todas las mujeres despueacutes de tres meses del parto Para - Evitar laxitud vaginal
- Evitar incontinencia urinaria
- Volver a una tensioacuten vulvar y vaginal normal
2 En la menopausia y de forma anual para prevenir - Atrofia vulvo-vaginal
- Incontinencia urinaria
- Prolapso
22
INCONTINENCIA URINARIA
INCONTINENCIA URINARIA Contraccion del colageno suburetral Neocolagenosis suburetral Irradiaccioacuten angular fraccionada Pases (4 to 5) Dosis 10 A 5 JulIOs cm2 Radiacion 90-120ordm circular Sesiones (2 to 3) Leve-Moderate SUI (ICIQ_SF lt13)
PALACIOS INSTITUTE EXPERIENCE
bull Average age 526 years
bull 41 IUM 59 SUI
bull Average parity 2 children Average BMI
28
bull Average duration per session 19 minutes
bull Very good procedure tolerance
bull Adverse effects during the procedure
NO (32 local heat or slight stinging that
self-limited)
bull Adverse effects after the procedure NO
bull 100 were incorporated into their
activity in lt24 h
110 paTIENTS
1 month after the last session
NOT effective with the emergency component but YES of the effort component in the IUM (12) NOT effective in athletes Overall satisfaction 100 MP improves atrophy
INDICACIONES MAacuteS USUALES
bull ATROFIA VULVO-VAGINAL
bull INCONTINENDIA URINARIA DE STRESS
bull SINDROME DE HIPERLAXITUD
bull PROLAPSO GENITAL
TERMINOLOGIacuteA Y DEFINICIOacuteN iquestPOR QUEacute SIacuteNDROME DE HIPERLAXITUD VAGINAL
bull Anatoacutemicas y Fisioloacutegicas o Laxitud Normal
o Hiperlaxitud Anormal
bull Cliacutenicas o Siacutendrome = Agrupacioacuten de diversos siacutentomas
DEFINICIOacuteN DE SIacuteNDROME DE
HIPERLAXITUD VAGINAL
Conjunto de siacutentomas que aparecen por un exceso
de laxitud vaginal debido a la alteracioacuten de la
estructura de la vagina y tejidos circundantes
Santiago Palacios 2017
29
VAGINAL TIGHTENING
bull Mejoria y uso en 360 grados
bull Remodelado del tejido vaginal y prevencion
INDICACIONES MAacuteS USUALES
bull ATROFIA VULVO-VAGINAL
bull INCONTINENDIA URINARIA DE STRESS
bull SINDROME DE HIPELAXITUD
bull PROLAPSO GENITAL
PROLAPSO GENITAL
bull Prolapso central no lateral Grado 1
y 2
bull Sesiones Como poco 5
)
Agenda
bull PRESENTE
bull FUTURO
bull - MEJORAR EL EFECTO
- PROTOCOLOS MAacuteS DEFINIDOS
-FUTURAS INDICACIONES
COLAGENO Y EDAD
EPHITELIUM AND LAMINA PROPIA
FUNCIONES DEL FIBROBLASTO
LAMINA PROPIA
Agenda
bull PRESENTE
bull FUTURO
bull - MEJORAR EL EFECTO
- PROTOCOLOS MAacuteS DEFINIDOS
- FUTURAS INDICACIONES
CO2RE
20-40 micras proporciona una mejora similar a la de un peeling quiacutemico pero
con un mayor control de la profundidad y menos efectos adversos
Moacutedulo Aesthetic ndash Modo Fraccionado Light
SELECCIOacuteN DE PACIENTES
bull Evaluacioacuten de los sintomas
bull Motivacioacuten y demanda del paciente
bull Abilidad y posibilidades del aparato laser
Agenda
bull PRESENTE
bull FUTURO
bull - MEJORAR EL EFECTO
- PROTOCOLOS MAacuteS DEFINIDOS
- FUTURAS INDICACIONES
NUEVAS PERSPECTIVAS
copy 2016 VIVEVE Not for publication or podium presentation 41
Dermatitis vulvares Dispareunia-vaginismo Retraccioacuten de cicatrices Recuperar la flora vaginal Problemas de las mallas Fisuras vulvares Vejiga hiperactiva Patologias conocidas ( infecciosas y tumorales)
VULVAR DERMATITIS
copy 2016 VIVEVE Not for publication or podium presentation 42
GRADOS DE DOLOR SUB-CLASIFICACIOacuteN DE
MI VISION DE FUTURO
1 Todas las mujeres despueacutes de tres meses del parto Para - Evitar laxitud vaginal
- Evitar incontinencia urinaria
- Volver a una tensioacuten vulvar y vaginal normal
2 En la menopausia y de forma anual para prevenir - Atrofia vulvo-vaginal
- Incontinencia urinaria
- Prolapso
INCONTINENCIA URINARIA Contraccion del colageno suburetral Neocolagenosis suburetral Irradiaccioacuten angular fraccionada Pases (4 to 5) Dosis 10 A 5 JulIOs cm2 Radiacion 90-120ordm circular Sesiones (2 to 3) Leve-Moderate SUI (ICIQ_SF lt13)
PALACIOS INSTITUTE EXPERIENCE
bull Average age 526 years
bull 41 IUM 59 SUI
bull Average parity 2 children Average BMI
28
bull Average duration per session 19 minutes
bull Very good procedure tolerance
bull Adverse effects during the procedure
NO (32 local heat or slight stinging that
self-limited)
bull Adverse effects after the procedure NO
bull 100 were incorporated into their
activity in lt24 h
110 paTIENTS
1 month after the last session
NOT effective with the emergency component but YES of the effort component in the IUM (12) NOT effective in athletes Overall satisfaction 100 MP improves atrophy
INDICACIONES MAacuteS USUALES
bull ATROFIA VULVO-VAGINAL
bull INCONTINENDIA URINARIA DE STRESS
bull SINDROME DE HIPERLAXITUD
bull PROLAPSO GENITAL
TERMINOLOGIacuteA Y DEFINICIOacuteN iquestPOR QUEacute SIacuteNDROME DE HIPERLAXITUD VAGINAL
bull Anatoacutemicas y Fisioloacutegicas o Laxitud Normal
o Hiperlaxitud Anormal
bull Cliacutenicas o Siacutendrome = Agrupacioacuten de diversos siacutentomas
DEFINICIOacuteN DE SIacuteNDROME DE
HIPERLAXITUD VAGINAL
Conjunto de siacutentomas que aparecen por un exceso
de laxitud vaginal debido a la alteracioacuten de la
estructura de la vagina y tejidos circundantes
Santiago Palacios 2017
29
VAGINAL TIGHTENING
bull Mejoria y uso en 360 grados
bull Remodelado del tejido vaginal y prevencion
INDICACIONES MAacuteS USUALES
bull ATROFIA VULVO-VAGINAL
bull INCONTINENDIA URINARIA DE STRESS
bull SINDROME DE HIPELAXITUD
bull PROLAPSO GENITAL
PROLAPSO GENITAL
bull Prolapso central no lateral Grado 1
y 2
bull Sesiones Como poco 5
)
Agenda
bull PRESENTE
bull FUTURO
bull - MEJORAR EL EFECTO
- PROTOCOLOS MAacuteS DEFINIDOS
-FUTURAS INDICACIONES
COLAGENO Y EDAD
EPHITELIUM AND LAMINA PROPIA
FUNCIONES DEL FIBROBLASTO
LAMINA PROPIA
Agenda
bull PRESENTE
bull FUTURO
bull - MEJORAR EL EFECTO
- PROTOCOLOS MAacuteS DEFINIDOS
- FUTURAS INDICACIONES
CO2RE
20-40 micras proporciona una mejora similar a la de un peeling quiacutemico pero
con un mayor control de la profundidad y menos efectos adversos
Moacutedulo Aesthetic ndash Modo Fraccionado Light
SELECCIOacuteN DE PACIENTES
bull Evaluacioacuten de los sintomas
bull Motivacioacuten y demanda del paciente
bull Abilidad y posibilidades del aparato laser
Agenda
bull PRESENTE
bull FUTURO
bull - MEJORAR EL EFECTO
- PROTOCOLOS MAacuteS DEFINIDOS
- FUTURAS INDICACIONES
NUEVAS PERSPECTIVAS
copy 2016 VIVEVE Not for publication or podium presentation 41
Dermatitis vulvares Dispareunia-vaginismo Retraccioacuten de cicatrices Recuperar la flora vaginal Problemas de las mallas Fisuras vulvares Vejiga hiperactiva Patologias conocidas ( infecciosas y tumorales)
VULVAR DERMATITIS
copy 2016 VIVEVE Not for publication or podium presentation 42
GRADOS DE DOLOR SUB-CLASIFICACIOacuteN DE
MI VISION DE FUTURO
1 Todas las mujeres despueacutes de tres meses del parto Para - Evitar laxitud vaginal
- Evitar incontinencia urinaria
- Volver a una tensioacuten vulvar y vaginal normal
2 En la menopausia y de forma anual para prevenir - Atrofia vulvo-vaginal
- Incontinencia urinaria
- Prolapso
PALACIOS INSTITUTE EXPERIENCE
bull Average age 526 years
bull 41 IUM 59 SUI
bull Average parity 2 children Average BMI
28
bull Average duration per session 19 minutes
bull Very good procedure tolerance
bull Adverse effects during the procedure
NO (32 local heat or slight stinging that
self-limited)
bull Adverse effects after the procedure NO
bull 100 were incorporated into their
activity in lt24 h
110 paTIENTS
1 month after the last session
NOT effective with the emergency component but YES of the effort component in the IUM (12) NOT effective in athletes Overall satisfaction 100 MP improves atrophy
INDICACIONES MAacuteS USUALES
bull ATROFIA VULVO-VAGINAL
bull INCONTINENDIA URINARIA DE STRESS
bull SINDROME DE HIPERLAXITUD
bull PROLAPSO GENITAL
TERMINOLOGIacuteA Y DEFINICIOacuteN iquestPOR QUEacute SIacuteNDROME DE HIPERLAXITUD VAGINAL
bull Anatoacutemicas y Fisioloacutegicas o Laxitud Normal
o Hiperlaxitud Anormal
bull Cliacutenicas o Siacutendrome = Agrupacioacuten de diversos siacutentomas
DEFINICIOacuteN DE SIacuteNDROME DE
HIPERLAXITUD VAGINAL
Conjunto de siacutentomas que aparecen por un exceso
de laxitud vaginal debido a la alteracioacuten de la
estructura de la vagina y tejidos circundantes
Santiago Palacios 2017
29
VAGINAL TIGHTENING
bull Mejoria y uso en 360 grados
bull Remodelado del tejido vaginal y prevencion
INDICACIONES MAacuteS USUALES
bull ATROFIA VULVO-VAGINAL
bull INCONTINENDIA URINARIA DE STRESS
bull SINDROME DE HIPELAXITUD
bull PROLAPSO GENITAL
PROLAPSO GENITAL
bull Prolapso central no lateral Grado 1
y 2
bull Sesiones Como poco 5
)
Agenda
bull PRESENTE
bull FUTURO
bull - MEJORAR EL EFECTO
- PROTOCOLOS MAacuteS DEFINIDOS
-FUTURAS INDICACIONES
COLAGENO Y EDAD
EPHITELIUM AND LAMINA PROPIA
FUNCIONES DEL FIBROBLASTO
LAMINA PROPIA
Agenda
bull PRESENTE
bull FUTURO
bull - MEJORAR EL EFECTO
- PROTOCOLOS MAacuteS DEFINIDOS
- FUTURAS INDICACIONES
CO2RE
20-40 micras proporciona una mejora similar a la de un peeling quiacutemico pero
con un mayor control de la profundidad y menos efectos adversos
Moacutedulo Aesthetic ndash Modo Fraccionado Light
SELECCIOacuteN DE PACIENTES
bull Evaluacioacuten de los sintomas
bull Motivacioacuten y demanda del paciente
bull Abilidad y posibilidades del aparato laser
Agenda
bull PRESENTE
bull FUTURO
bull - MEJORAR EL EFECTO
- PROTOCOLOS MAacuteS DEFINIDOS
- FUTURAS INDICACIONES
NUEVAS PERSPECTIVAS
copy 2016 VIVEVE Not for publication or podium presentation 41
Dermatitis vulvares Dispareunia-vaginismo Retraccioacuten de cicatrices Recuperar la flora vaginal Problemas de las mallas Fisuras vulvares Vejiga hiperactiva Patologias conocidas ( infecciosas y tumorales)
VULVAR DERMATITIS
copy 2016 VIVEVE Not for publication or podium presentation 42
GRADOS DE DOLOR SUB-CLASIFICACIOacuteN DE
MI VISION DE FUTURO
1 Todas las mujeres despueacutes de tres meses del parto Para - Evitar laxitud vaginal
- Evitar incontinencia urinaria
- Volver a una tensioacuten vulvar y vaginal normal
2 En la menopausia y de forma anual para prevenir - Atrofia vulvo-vaginal
- Incontinencia urinaria
- Prolapso
INDICACIONES MAacuteS USUALES
bull ATROFIA VULVO-VAGINAL
bull INCONTINENDIA URINARIA DE STRESS
bull SINDROME DE HIPERLAXITUD
bull PROLAPSO GENITAL
TERMINOLOGIacuteA Y DEFINICIOacuteN iquestPOR QUEacute SIacuteNDROME DE HIPERLAXITUD VAGINAL
bull Anatoacutemicas y Fisioloacutegicas o Laxitud Normal
o Hiperlaxitud Anormal
bull Cliacutenicas o Siacutendrome = Agrupacioacuten de diversos siacutentomas
DEFINICIOacuteN DE SIacuteNDROME DE
HIPERLAXITUD VAGINAL
Conjunto de siacutentomas que aparecen por un exceso
de laxitud vaginal debido a la alteracioacuten de la
estructura de la vagina y tejidos circundantes
Santiago Palacios 2017
29
VAGINAL TIGHTENING
bull Mejoria y uso en 360 grados
bull Remodelado del tejido vaginal y prevencion
INDICACIONES MAacuteS USUALES
bull ATROFIA VULVO-VAGINAL
bull INCONTINENDIA URINARIA DE STRESS
bull SINDROME DE HIPELAXITUD
bull PROLAPSO GENITAL
PROLAPSO GENITAL
bull Prolapso central no lateral Grado 1
y 2
bull Sesiones Como poco 5
)
Agenda
bull PRESENTE
bull FUTURO
bull - MEJORAR EL EFECTO
- PROTOCOLOS MAacuteS DEFINIDOS
-FUTURAS INDICACIONES
COLAGENO Y EDAD
EPHITELIUM AND LAMINA PROPIA
FUNCIONES DEL FIBROBLASTO
LAMINA PROPIA
Agenda
bull PRESENTE
bull FUTURO
bull - MEJORAR EL EFECTO
- PROTOCOLOS MAacuteS DEFINIDOS
- FUTURAS INDICACIONES
CO2RE
20-40 micras proporciona una mejora similar a la de un peeling quiacutemico pero
con un mayor control de la profundidad y menos efectos adversos
Moacutedulo Aesthetic ndash Modo Fraccionado Light
SELECCIOacuteN DE PACIENTES
bull Evaluacioacuten de los sintomas
bull Motivacioacuten y demanda del paciente
bull Abilidad y posibilidades del aparato laser
Agenda
bull PRESENTE
bull FUTURO
bull - MEJORAR EL EFECTO
- PROTOCOLOS MAacuteS DEFINIDOS
- FUTURAS INDICACIONES
NUEVAS PERSPECTIVAS
copy 2016 VIVEVE Not for publication or podium presentation 41
Dermatitis vulvares Dispareunia-vaginismo Retraccioacuten de cicatrices Recuperar la flora vaginal Problemas de las mallas Fisuras vulvares Vejiga hiperactiva Patologias conocidas ( infecciosas y tumorales)
VULVAR DERMATITIS
copy 2016 VIVEVE Not for publication or podium presentation 42
GRADOS DE DOLOR SUB-CLASIFICACIOacuteN DE
MI VISION DE FUTURO
1 Todas las mujeres despueacutes de tres meses del parto Para - Evitar laxitud vaginal
- Evitar incontinencia urinaria
- Volver a una tensioacuten vulvar y vaginal normal
2 En la menopausia y de forma anual para prevenir - Atrofia vulvo-vaginal
- Incontinencia urinaria
- Prolapso
TERMINOLOGIacuteA Y DEFINICIOacuteN iquestPOR QUEacute SIacuteNDROME DE HIPERLAXITUD VAGINAL
bull Anatoacutemicas y Fisioloacutegicas o Laxitud Normal
o Hiperlaxitud Anormal
bull Cliacutenicas o Siacutendrome = Agrupacioacuten de diversos siacutentomas
DEFINICIOacuteN DE SIacuteNDROME DE
HIPERLAXITUD VAGINAL
Conjunto de siacutentomas que aparecen por un exceso
de laxitud vaginal debido a la alteracioacuten de la
estructura de la vagina y tejidos circundantes
Santiago Palacios 2017
29
VAGINAL TIGHTENING
bull Mejoria y uso en 360 grados
bull Remodelado del tejido vaginal y prevencion
INDICACIONES MAacuteS USUALES
bull ATROFIA VULVO-VAGINAL
bull INCONTINENDIA URINARIA DE STRESS
bull SINDROME DE HIPELAXITUD
bull PROLAPSO GENITAL
PROLAPSO GENITAL
bull Prolapso central no lateral Grado 1
y 2
bull Sesiones Como poco 5
)
Agenda
bull PRESENTE
bull FUTURO
bull - MEJORAR EL EFECTO
- PROTOCOLOS MAacuteS DEFINIDOS
-FUTURAS INDICACIONES
COLAGENO Y EDAD
EPHITELIUM AND LAMINA PROPIA
FUNCIONES DEL FIBROBLASTO
LAMINA PROPIA
Agenda
bull PRESENTE
bull FUTURO
bull - MEJORAR EL EFECTO
- PROTOCOLOS MAacuteS DEFINIDOS
- FUTURAS INDICACIONES
CO2RE
20-40 micras proporciona una mejora similar a la de un peeling quiacutemico pero
con un mayor control de la profundidad y menos efectos adversos
Moacutedulo Aesthetic ndash Modo Fraccionado Light
SELECCIOacuteN DE PACIENTES
bull Evaluacioacuten de los sintomas
bull Motivacioacuten y demanda del paciente
bull Abilidad y posibilidades del aparato laser
Agenda
bull PRESENTE
bull FUTURO
bull - MEJORAR EL EFECTO
- PROTOCOLOS MAacuteS DEFINIDOS
- FUTURAS INDICACIONES
NUEVAS PERSPECTIVAS
copy 2016 VIVEVE Not for publication or podium presentation 41
Dermatitis vulvares Dispareunia-vaginismo Retraccioacuten de cicatrices Recuperar la flora vaginal Problemas de las mallas Fisuras vulvares Vejiga hiperactiva Patologias conocidas ( infecciosas y tumorales)
VULVAR DERMATITIS
copy 2016 VIVEVE Not for publication or podium presentation 42
GRADOS DE DOLOR SUB-CLASIFICACIOacuteN DE
MI VISION DE FUTURO
1 Todas las mujeres despueacutes de tres meses del parto Para - Evitar laxitud vaginal
- Evitar incontinencia urinaria
- Volver a una tensioacuten vulvar y vaginal normal
2 En la menopausia y de forma anual para prevenir - Atrofia vulvo-vaginal
- Incontinencia urinaria
- Prolapso
DEFINICIOacuteN DE SIacuteNDROME DE
HIPERLAXITUD VAGINAL
Conjunto de siacutentomas que aparecen por un exceso
de laxitud vaginal debido a la alteracioacuten de la
estructura de la vagina y tejidos circundantes
Santiago Palacios 2017
29
VAGINAL TIGHTENING
bull Mejoria y uso en 360 grados
bull Remodelado del tejido vaginal y prevencion
INDICACIONES MAacuteS USUALES
bull ATROFIA VULVO-VAGINAL
bull INCONTINENDIA URINARIA DE STRESS
bull SINDROME DE HIPELAXITUD
bull PROLAPSO GENITAL
PROLAPSO GENITAL
bull Prolapso central no lateral Grado 1
y 2
bull Sesiones Como poco 5
)
Agenda
bull PRESENTE
bull FUTURO
bull - MEJORAR EL EFECTO
- PROTOCOLOS MAacuteS DEFINIDOS
-FUTURAS INDICACIONES
COLAGENO Y EDAD
EPHITELIUM AND LAMINA PROPIA
FUNCIONES DEL FIBROBLASTO
LAMINA PROPIA
Agenda
bull PRESENTE
bull FUTURO
bull - MEJORAR EL EFECTO
- PROTOCOLOS MAacuteS DEFINIDOS
- FUTURAS INDICACIONES
CO2RE
20-40 micras proporciona una mejora similar a la de un peeling quiacutemico pero
con un mayor control de la profundidad y menos efectos adversos
Moacutedulo Aesthetic ndash Modo Fraccionado Light
SELECCIOacuteN DE PACIENTES
bull Evaluacioacuten de los sintomas
bull Motivacioacuten y demanda del paciente
bull Abilidad y posibilidades del aparato laser
Agenda
bull PRESENTE
bull FUTURO
bull - MEJORAR EL EFECTO
- PROTOCOLOS MAacuteS DEFINIDOS
- FUTURAS INDICACIONES
NUEVAS PERSPECTIVAS
copy 2016 VIVEVE Not for publication or podium presentation 41
Dermatitis vulvares Dispareunia-vaginismo Retraccioacuten de cicatrices Recuperar la flora vaginal Problemas de las mallas Fisuras vulvares Vejiga hiperactiva Patologias conocidas ( infecciosas y tumorales)
VULVAR DERMATITIS
copy 2016 VIVEVE Not for publication or podium presentation 42
GRADOS DE DOLOR SUB-CLASIFICACIOacuteN DE
MI VISION DE FUTURO
1 Todas las mujeres despueacutes de tres meses del parto Para - Evitar laxitud vaginal
- Evitar incontinencia urinaria
- Volver a una tensioacuten vulvar y vaginal normal
2 En la menopausia y de forma anual para prevenir - Atrofia vulvo-vaginal
- Incontinencia urinaria
- Prolapso
29
VAGINAL TIGHTENING
bull Mejoria y uso en 360 grados
bull Remodelado del tejido vaginal y prevencion
INDICACIONES MAacuteS USUALES
bull ATROFIA VULVO-VAGINAL
bull INCONTINENDIA URINARIA DE STRESS
bull SINDROME DE HIPELAXITUD
bull PROLAPSO GENITAL
PROLAPSO GENITAL
bull Prolapso central no lateral Grado 1
y 2
bull Sesiones Como poco 5
)
Agenda
bull PRESENTE
bull FUTURO
bull - MEJORAR EL EFECTO
- PROTOCOLOS MAacuteS DEFINIDOS
-FUTURAS INDICACIONES
COLAGENO Y EDAD
EPHITELIUM AND LAMINA PROPIA
FUNCIONES DEL FIBROBLASTO
LAMINA PROPIA
Agenda
bull PRESENTE
bull FUTURO
bull - MEJORAR EL EFECTO
- PROTOCOLOS MAacuteS DEFINIDOS
- FUTURAS INDICACIONES
CO2RE
20-40 micras proporciona una mejora similar a la de un peeling quiacutemico pero
con un mayor control de la profundidad y menos efectos adversos
Moacutedulo Aesthetic ndash Modo Fraccionado Light
SELECCIOacuteN DE PACIENTES
bull Evaluacioacuten de los sintomas
bull Motivacioacuten y demanda del paciente
bull Abilidad y posibilidades del aparato laser
Agenda
bull PRESENTE
bull FUTURO
bull - MEJORAR EL EFECTO
- PROTOCOLOS MAacuteS DEFINIDOS
- FUTURAS INDICACIONES
NUEVAS PERSPECTIVAS
copy 2016 VIVEVE Not for publication or podium presentation 41
Dermatitis vulvares Dispareunia-vaginismo Retraccioacuten de cicatrices Recuperar la flora vaginal Problemas de las mallas Fisuras vulvares Vejiga hiperactiva Patologias conocidas ( infecciosas y tumorales)
VULVAR DERMATITIS
copy 2016 VIVEVE Not for publication or podium presentation 42
GRADOS DE DOLOR SUB-CLASIFICACIOacuteN DE
MI VISION DE FUTURO
1 Todas las mujeres despueacutes de tres meses del parto Para - Evitar laxitud vaginal
- Evitar incontinencia urinaria
- Volver a una tensioacuten vulvar y vaginal normal
2 En la menopausia y de forma anual para prevenir - Atrofia vulvo-vaginal
- Incontinencia urinaria
- Prolapso
INDICACIONES MAacuteS USUALES
bull ATROFIA VULVO-VAGINAL
bull INCONTINENDIA URINARIA DE STRESS
bull SINDROME DE HIPELAXITUD
bull PROLAPSO GENITAL
PROLAPSO GENITAL
bull Prolapso central no lateral Grado 1
y 2
bull Sesiones Como poco 5
)
Agenda
bull PRESENTE
bull FUTURO
bull - MEJORAR EL EFECTO
- PROTOCOLOS MAacuteS DEFINIDOS
-FUTURAS INDICACIONES
COLAGENO Y EDAD
EPHITELIUM AND LAMINA PROPIA
FUNCIONES DEL FIBROBLASTO
LAMINA PROPIA
Agenda
bull PRESENTE
bull FUTURO
bull - MEJORAR EL EFECTO
- PROTOCOLOS MAacuteS DEFINIDOS
- FUTURAS INDICACIONES
CO2RE
20-40 micras proporciona una mejora similar a la de un peeling quiacutemico pero
con un mayor control de la profundidad y menos efectos adversos
Moacutedulo Aesthetic ndash Modo Fraccionado Light
SELECCIOacuteN DE PACIENTES
bull Evaluacioacuten de los sintomas
bull Motivacioacuten y demanda del paciente
bull Abilidad y posibilidades del aparato laser
Agenda
bull PRESENTE
bull FUTURO
bull - MEJORAR EL EFECTO
- PROTOCOLOS MAacuteS DEFINIDOS
- FUTURAS INDICACIONES
NUEVAS PERSPECTIVAS
copy 2016 VIVEVE Not for publication or podium presentation 41
Dermatitis vulvares Dispareunia-vaginismo Retraccioacuten de cicatrices Recuperar la flora vaginal Problemas de las mallas Fisuras vulvares Vejiga hiperactiva Patologias conocidas ( infecciosas y tumorales)
VULVAR DERMATITIS
copy 2016 VIVEVE Not for publication or podium presentation 42
GRADOS DE DOLOR SUB-CLASIFICACIOacuteN DE
MI VISION DE FUTURO
1 Todas las mujeres despueacutes de tres meses del parto Para - Evitar laxitud vaginal
- Evitar incontinencia urinaria
- Volver a una tensioacuten vulvar y vaginal normal
2 En la menopausia y de forma anual para prevenir - Atrofia vulvo-vaginal
- Incontinencia urinaria
- Prolapso
PROLAPSO GENITAL
bull Prolapso central no lateral Grado 1
y 2
bull Sesiones Como poco 5
)
Agenda
bull PRESENTE
bull FUTURO
bull - MEJORAR EL EFECTO
- PROTOCOLOS MAacuteS DEFINIDOS
-FUTURAS INDICACIONES
COLAGENO Y EDAD
EPHITELIUM AND LAMINA PROPIA
FUNCIONES DEL FIBROBLASTO
LAMINA PROPIA
Agenda
bull PRESENTE
bull FUTURO
bull - MEJORAR EL EFECTO
- PROTOCOLOS MAacuteS DEFINIDOS
- FUTURAS INDICACIONES
CO2RE
20-40 micras proporciona una mejora similar a la de un peeling quiacutemico pero
con un mayor control de la profundidad y menos efectos adversos
Moacutedulo Aesthetic ndash Modo Fraccionado Light
SELECCIOacuteN DE PACIENTES
bull Evaluacioacuten de los sintomas
bull Motivacioacuten y demanda del paciente
bull Abilidad y posibilidades del aparato laser
Agenda
bull PRESENTE
bull FUTURO
bull - MEJORAR EL EFECTO
- PROTOCOLOS MAacuteS DEFINIDOS
- FUTURAS INDICACIONES
NUEVAS PERSPECTIVAS
copy 2016 VIVEVE Not for publication or podium presentation 41
Dermatitis vulvares Dispareunia-vaginismo Retraccioacuten de cicatrices Recuperar la flora vaginal Problemas de las mallas Fisuras vulvares Vejiga hiperactiva Patologias conocidas ( infecciosas y tumorales)
VULVAR DERMATITIS
copy 2016 VIVEVE Not for publication or podium presentation 42
GRADOS DE DOLOR SUB-CLASIFICACIOacuteN DE
MI VISION DE FUTURO
1 Todas las mujeres despueacutes de tres meses del parto Para - Evitar laxitud vaginal
- Evitar incontinencia urinaria
- Volver a una tensioacuten vulvar y vaginal normal
2 En la menopausia y de forma anual para prevenir - Atrofia vulvo-vaginal
- Incontinencia urinaria
- Prolapso
Agenda
bull PRESENTE
bull FUTURO
bull - MEJORAR EL EFECTO
- PROTOCOLOS MAacuteS DEFINIDOS
-FUTURAS INDICACIONES
COLAGENO Y EDAD
EPHITELIUM AND LAMINA PROPIA
FUNCIONES DEL FIBROBLASTO
LAMINA PROPIA
Agenda
bull PRESENTE
bull FUTURO
bull - MEJORAR EL EFECTO
- PROTOCOLOS MAacuteS DEFINIDOS
- FUTURAS INDICACIONES
CO2RE
20-40 micras proporciona una mejora similar a la de un peeling quiacutemico pero
con un mayor control de la profundidad y menos efectos adversos
Moacutedulo Aesthetic ndash Modo Fraccionado Light
SELECCIOacuteN DE PACIENTES
bull Evaluacioacuten de los sintomas
bull Motivacioacuten y demanda del paciente
bull Abilidad y posibilidades del aparato laser
Agenda
bull PRESENTE
bull FUTURO
bull - MEJORAR EL EFECTO
- PROTOCOLOS MAacuteS DEFINIDOS
- FUTURAS INDICACIONES
NUEVAS PERSPECTIVAS
copy 2016 VIVEVE Not for publication or podium presentation 41
Dermatitis vulvares Dispareunia-vaginismo Retraccioacuten de cicatrices Recuperar la flora vaginal Problemas de las mallas Fisuras vulvares Vejiga hiperactiva Patologias conocidas ( infecciosas y tumorales)
VULVAR DERMATITIS
copy 2016 VIVEVE Not for publication or podium presentation 42
GRADOS DE DOLOR SUB-CLASIFICACIOacuteN DE
MI VISION DE FUTURO
1 Todas las mujeres despueacutes de tres meses del parto Para - Evitar laxitud vaginal
- Evitar incontinencia urinaria
- Volver a una tensioacuten vulvar y vaginal normal
2 En la menopausia y de forma anual para prevenir - Atrofia vulvo-vaginal
- Incontinencia urinaria
- Prolapso
COLAGENO Y EDAD
EPHITELIUM AND LAMINA PROPIA
FUNCIONES DEL FIBROBLASTO
LAMINA PROPIA
Agenda
bull PRESENTE
bull FUTURO
bull - MEJORAR EL EFECTO
- PROTOCOLOS MAacuteS DEFINIDOS
- FUTURAS INDICACIONES
CO2RE
20-40 micras proporciona una mejora similar a la de un peeling quiacutemico pero
con un mayor control de la profundidad y menos efectos adversos
Moacutedulo Aesthetic ndash Modo Fraccionado Light
SELECCIOacuteN DE PACIENTES
bull Evaluacioacuten de los sintomas
bull Motivacioacuten y demanda del paciente
bull Abilidad y posibilidades del aparato laser
Agenda
bull PRESENTE
bull FUTURO
bull - MEJORAR EL EFECTO
- PROTOCOLOS MAacuteS DEFINIDOS
- FUTURAS INDICACIONES
NUEVAS PERSPECTIVAS
copy 2016 VIVEVE Not for publication or podium presentation 41
Dermatitis vulvares Dispareunia-vaginismo Retraccioacuten de cicatrices Recuperar la flora vaginal Problemas de las mallas Fisuras vulvares Vejiga hiperactiva Patologias conocidas ( infecciosas y tumorales)
VULVAR DERMATITIS
copy 2016 VIVEVE Not for publication or podium presentation 42
GRADOS DE DOLOR SUB-CLASIFICACIOacuteN DE
MI VISION DE FUTURO
1 Todas las mujeres despueacutes de tres meses del parto Para - Evitar laxitud vaginal
- Evitar incontinencia urinaria
- Volver a una tensioacuten vulvar y vaginal normal
2 En la menopausia y de forma anual para prevenir - Atrofia vulvo-vaginal
- Incontinencia urinaria
- Prolapso
EPHITELIUM AND LAMINA PROPIA
FUNCIONES DEL FIBROBLASTO
LAMINA PROPIA
Agenda
bull PRESENTE
bull FUTURO
bull - MEJORAR EL EFECTO
- PROTOCOLOS MAacuteS DEFINIDOS
- FUTURAS INDICACIONES
CO2RE
20-40 micras proporciona una mejora similar a la de un peeling quiacutemico pero
con un mayor control de la profundidad y menos efectos adversos
Moacutedulo Aesthetic ndash Modo Fraccionado Light
SELECCIOacuteN DE PACIENTES
bull Evaluacioacuten de los sintomas
bull Motivacioacuten y demanda del paciente
bull Abilidad y posibilidades del aparato laser
Agenda
bull PRESENTE
bull FUTURO
bull - MEJORAR EL EFECTO
- PROTOCOLOS MAacuteS DEFINIDOS
- FUTURAS INDICACIONES
NUEVAS PERSPECTIVAS
copy 2016 VIVEVE Not for publication or podium presentation 41
Dermatitis vulvares Dispareunia-vaginismo Retraccioacuten de cicatrices Recuperar la flora vaginal Problemas de las mallas Fisuras vulvares Vejiga hiperactiva Patologias conocidas ( infecciosas y tumorales)
VULVAR DERMATITIS
copy 2016 VIVEVE Not for publication or podium presentation 42
GRADOS DE DOLOR SUB-CLASIFICACIOacuteN DE
MI VISION DE FUTURO
1 Todas las mujeres despueacutes de tres meses del parto Para - Evitar laxitud vaginal
- Evitar incontinencia urinaria
- Volver a una tensioacuten vulvar y vaginal normal
2 En la menopausia y de forma anual para prevenir - Atrofia vulvo-vaginal
- Incontinencia urinaria
- Prolapso
FUNCIONES DEL FIBROBLASTO
LAMINA PROPIA
Agenda
bull PRESENTE
bull FUTURO
bull - MEJORAR EL EFECTO
- PROTOCOLOS MAacuteS DEFINIDOS
- FUTURAS INDICACIONES
CO2RE
20-40 micras proporciona una mejora similar a la de un peeling quiacutemico pero
con un mayor control de la profundidad y menos efectos adversos
Moacutedulo Aesthetic ndash Modo Fraccionado Light
SELECCIOacuteN DE PACIENTES
bull Evaluacioacuten de los sintomas
bull Motivacioacuten y demanda del paciente
bull Abilidad y posibilidades del aparato laser
Agenda
bull PRESENTE
bull FUTURO
bull - MEJORAR EL EFECTO
- PROTOCOLOS MAacuteS DEFINIDOS
- FUTURAS INDICACIONES
NUEVAS PERSPECTIVAS
copy 2016 VIVEVE Not for publication or podium presentation 41
Dermatitis vulvares Dispareunia-vaginismo Retraccioacuten de cicatrices Recuperar la flora vaginal Problemas de las mallas Fisuras vulvares Vejiga hiperactiva Patologias conocidas ( infecciosas y tumorales)
VULVAR DERMATITIS
copy 2016 VIVEVE Not for publication or podium presentation 42
GRADOS DE DOLOR SUB-CLASIFICACIOacuteN DE
MI VISION DE FUTURO
1 Todas las mujeres despueacutes de tres meses del parto Para - Evitar laxitud vaginal
- Evitar incontinencia urinaria
- Volver a una tensioacuten vulvar y vaginal normal
2 En la menopausia y de forma anual para prevenir - Atrofia vulvo-vaginal
- Incontinencia urinaria
- Prolapso
LAMINA PROPIA
Agenda
bull PRESENTE
bull FUTURO
bull - MEJORAR EL EFECTO
- PROTOCOLOS MAacuteS DEFINIDOS
- FUTURAS INDICACIONES
CO2RE
20-40 micras proporciona una mejora similar a la de un peeling quiacutemico pero
con un mayor control de la profundidad y menos efectos adversos
Moacutedulo Aesthetic ndash Modo Fraccionado Light
SELECCIOacuteN DE PACIENTES
bull Evaluacioacuten de los sintomas
bull Motivacioacuten y demanda del paciente
bull Abilidad y posibilidades del aparato laser
Agenda
bull PRESENTE
bull FUTURO
bull - MEJORAR EL EFECTO
- PROTOCOLOS MAacuteS DEFINIDOS
- FUTURAS INDICACIONES
NUEVAS PERSPECTIVAS
copy 2016 VIVEVE Not for publication or podium presentation 41
Dermatitis vulvares Dispareunia-vaginismo Retraccioacuten de cicatrices Recuperar la flora vaginal Problemas de las mallas Fisuras vulvares Vejiga hiperactiva Patologias conocidas ( infecciosas y tumorales)
VULVAR DERMATITIS
copy 2016 VIVEVE Not for publication or podium presentation 42
GRADOS DE DOLOR SUB-CLASIFICACIOacuteN DE
MI VISION DE FUTURO
1 Todas las mujeres despueacutes de tres meses del parto Para - Evitar laxitud vaginal
- Evitar incontinencia urinaria
- Volver a una tensioacuten vulvar y vaginal normal
2 En la menopausia y de forma anual para prevenir - Atrofia vulvo-vaginal
- Incontinencia urinaria
- Prolapso
Agenda
bull PRESENTE
bull FUTURO
bull - MEJORAR EL EFECTO
- PROTOCOLOS MAacuteS DEFINIDOS
- FUTURAS INDICACIONES
CO2RE
20-40 micras proporciona una mejora similar a la de un peeling quiacutemico pero
con un mayor control de la profundidad y menos efectos adversos
Moacutedulo Aesthetic ndash Modo Fraccionado Light
SELECCIOacuteN DE PACIENTES
bull Evaluacioacuten de los sintomas
bull Motivacioacuten y demanda del paciente
bull Abilidad y posibilidades del aparato laser
Agenda
bull PRESENTE
bull FUTURO
bull - MEJORAR EL EFECTO
- PROTOCOLOS MAacuteS DEFINIDOS
- FUTURAS INDICACIONES
NUEVAS PERSPECTIVAS
copy 2016 VIVEVE Not for publication or podium presentation 41
Dermatitis vulvares Dispareunia-vaginismo Retraccioacuten de cicatrices Recuperar la flora vaginal Problemas de las mallas Fisuras vulvares Vejiga hiperactiva Patologias conocidas ( infecciosas y tumorales)
VULVAR DERMATITIS
copy 2016 VIVEVE Not for publication or podium presentation 42
GRADOS DE DOLOR SUB-CLASIFICACIOacuteN DE
MI VISION DE FUTURO
1 Todas las mujeres despueacutes de tres meses del parto Para - Evitar laxitud vaginal
- Evitar incontinencia urinaria
- Volver a una tensioacuten vulvar y vaginal normal
2 En la menopausia y de forma anual para prevenir - Atrofia vulvo-vaginal
- Incontinencia urinaria
- Prolapso
CO2RE
20-40 micras proporciona una mejora similar a la de un peeling quiacutemico pero
con un mayor control de la profundidad y menos efectos adversos
Moacutedulo Aesthetic ndash Modo Fraccionado Light
SELECCIOacuteN DE PACIENTES
bull Evaluacioacuten de los sintomas
bull Motivacioacuten y demanda del paciente
bull Abilidad y posibilidades del aparato laser
Agenda
bull PRESENTE
bull FUTURO
bull - MEJORAR EL EFECTO
- PROTOCOLOS MAacuteS DEFINIDOS
- FUTURAS INDICACIONES
NUEVAS PERSPECTIVAS
copy 2016 VIVEVE Not for publication or podium presentation 41
Dermatitis vulvares Dispareunia-vaginismo Retraccioacuten de cicatrices Recuperar la flora vaginal Problemas de las mallas Fisuras vulvares Vejiga hiperactiva Patologias conocidas ( infecciosas y tumorales)
VULVAR DERMATITIS
copy 2016 VIVEVE Not for publication or podium presentation 42
GRADOS DE DOLOR SUB-CLASIFICACIOacuteN DE
MI VISION DE FUTURO
1 Todas las mujeres despueacutes de tres meses del parto Para - Evitar laxitud vaginal
- Evitar incontinencia urinaria
- Volver a una tensioacuten vulvar y vaginal normal
2 En la menopausia y de forma anual para prevenir - Atrofia vulvo-vaginal
- Incontinencia urinaria
- Prolapso
SELECCIOacuteN DE PACIENTES
bull Evaluacioacuten de los sintomas
bull Motivacioacuten y demanda del paciente
bull Abilidad y posibilidades del aparato laser
Agenda
bull PRESENTE
bull FUTURO
bull - MEJORAR EL EFECTO
- PROTOCOLOS MAacuteS DEFINIDOS
- FUTURAS INDICACIONES
NUEVAS PERSPECTIVAS
copy 2016 VIVEVE Not for publication or podium presentation 41
Dermatitis vulvares Dispareunia-vaginismo Retraccioacuten de cicatrices Recuperar la flora vaginal Problemas de las mallas Fisuras vulvares Vejiga hiperactiva Patologias conocidas ( infecciosas y tumorales)
VULVAR DERMATITIS
copy 2016 VIVEVE Not for publication or podium presentation 42
GRADOS DE DOLOR SUB-CLASIFICACIOacuteN DE
MI VISION DE FUTURO
1 Todas las mujeres despueacutes de tres meses del parto Para - Evitar laxitud vaginal
- Evitar incontinencia urinaria
- Volver a una tensioacuten vulvar y vaginal normal
2 En la menopausia y de forma anual para prevenir - Atrofia vulvo-vaginal
- Incontinencia urinaria
- Prolapso
Agenda
bull PRESENTE
bull FUTURO
bull - MEJORAR EL EFECTO
- PROTOCOLOS MAacuteS DEFINIDOS
- FUTURAS INDICACIONES
NUEVAS PERSPECTIVAS
copy 2016 VIVEVE Not for publication or podium presentation 41
Dermatitis vulvares Dispareunia-vaginismo Retraccioacuten de cicatrices Recuperar la flora vaginal Problemas de las mallas Fisuras vulvares Vejiga hiperactiva Patologias conocidas ( infecciosas y tumorales)
VULVAR DERMATITIS
copy 2016 VIVEVE Not for publication or podium presentation 42
GRADOS DE DOLOR SUB-CLASIFICACIOacuteN DE
MI VISION DE FUTURO
1 Todas las mujeres despueacutes de tres meses del parto Para - Evitar laxitud vaginal
- Evitar incontinencia urinaria
- Volver a una tensioacuten vulvar y vaginal normal
2 En la menopausia y de forma anual para prevenir - Atrofia vulvo-vaginal
- Incontinencia urinaria
- Prolapso
NUEVAS PERSPECTIVAS
copy 2016 VIVEVE Not for publication or podium presentation 41
Dermatitis vulvares Dispareunia-vaginismo Retraccioacuten de cicatrices Recuperar la flora vaginal Problemas de las mallas Fisuras vulvares Vejiga hiperactiva Patologias conocidas ( infecciosas y tumorales)
VULVAR DERMATITIS
copy 2016 VIVEVE Not for publication or podium presentation 42
GRADOS DE DOLOR SUB-CLASIFICACIOacuteN DE
MI VISION DE FUTURO
1 Todas las mujeres despueacutes de tres meses del parto Para - Evitar laxitud vaginal
- Evitar incontinencia urinaria
- Volver a una tensioacuten vulvar y vaginal normal
2 En la menopausia y de forma anual para prevenir - Atrofia vulvo-vaginal
- Incontinencia urinaria
- Prolapso
VULVAR DERMATITIS
copy 2016 VIVEVE Not for publication or podium presentation 42
GRADOS DE DOLOR SUB-CLASIFICACIOacuteN DE
MI VISION DE FUTURO
1 Todas las mujeres despueacutes de tres meses del parto Para - Evitar laxitud vaginal
- Evitar incontinencia urinaria
- Volver a una tensioacuten vulvar y vaginal normal
2 En la menopausia y de forma anual para prevenir - Atrofia vulvo-vaginal
- Incontinencia urinaria
- Prolapso
MI VISION DE FUTURO
1 Todas las mujeres despueacutes de tres meses del parto Para - Evitar laxitud vaginal
- Evitar incontinencia urinaria
- Volver a una tensioacuten vulvar y vaginal normal
2 En la menopausia y de forma anual para prevenir - Atrofia vulvo-vaginal
- Incontinencia urinaria
- Prolapso