Vaginal Dysplasia

Vaginal Dysplasia CME
News Author: Will Boggs, MDCME Author: Désirée Lie, MD, MSEd DisclosuresRelease Date: April 20, 2007; Valid for credit through April 20, 2008
Credits Available
Physicians - maximum of 0.25 AMA PRA Category 1 Credit(s)™ for physicians;Family Physicians - up to 0.25 AAFP Prescribed credit(s) for physicians
April 20, 2007 — Ultrasonic surgical aspiration offers significant advantages over laser ablation for vulvar and vaginal intraepithelial neoplasia, according to a report in the April issue of Obstetrics & Gynecology.
"I favor the USA (ultrasonic surgical aspiration) based on the pain data and the cosmetic result," Dr. Vivian E. von Gruenigen from University Hospitals Case Medical Center, Cleveland, Ohio, told Reuters Health. "If I as a woman had vulvar dysplasia, I would request the USA."
Dr. von Gruenigen and colleagues compared postoperative adverse effects, pain, and recurrence rates between laser ablation and ultrasound surgical aspiration for 96 women with vulvar intraepithelial neoplasia or vaginal intraepithelial neoplasia.
Laser surgery was performed with a carbon dioxide laser, with tissue destruction to a depth of 1 - 3 mm depending on location. With ultrasonic surgical aspiration, the authors note, "the handheld tool vibrates and contains separate irrigation and suction channels. Lesions are removed to the reticular layer of the dermis."
Women treated with ultrasound surgical aspiration experienced less pain than women treated with laser. Visual analog scale scores were 20.7 compared with 35.1 (P = 0.032), the authors report. In addition, women with vulvar dysplasia had less scarring after ultrasonic surgical aspiration than after laser ablation.
Recurrence rates during the year after surgery were similar with ultrasonic surgical aspiration (24.4%) and laser (25.5%), the report indicates, and recurrence rates were higher for vulvar procedures than for vaginal procedures, regardless of treatment.
Recurrence rates did not differ for patients treated for new disease compared with recurrent disease, the researchers note. In fact, on multiple logistic regression, age was the only factor significantly associated with recurrence.
Both treatments had similar adverse effects, according to the investigators, including minor genital complaints of infection, dysuria, burning, adhesions, and discharge.
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