Surgical treatments for vulvar and vaginal dysplasia: a randomized controlled trial.
OBJECTIVE
To compare pain, adverse effects and recurrence of dysplasia in patients with vaginal intraepithelial neoplasia or vulvar intraepithelial neoplasia prospectively treated by carbon dioxide laser or ultrasonic surgical aspiration.


METHODS
Patients were randomly assigned to receive treatment by laser or ultrasonic surgical aspiration from 2000-2005. Preoperative biopsy was done to confirm presence of dysplasia. Patients completed a visual analog scale regarding pain and were evaluated at 2-4 weeks to assess scarring, wound healing, and adverse effects. Patients returned every 3 months for 1 year for pelvic examination and cytology to assess recurrence. Follow-up colposcopy and biopsy were used at the discretion of the treating physician. Student t test, chi2, analysis of variance and multiple logistic regression were used for analysis.


RESULTS
One hundred ten patients were randomly assigned. Ninety-six (87.3%) patients completed 1 year follow-up. Mean age of patients was 48.5 years. Mean visual analog scale score was significantly lower in patients treated by ultrasonic surgical aspiration (20.7 compared with 35.1; P=.032). For patients with vulvar lesions, there was less scarring with ultrasonic surgical aspiration (P<.01). Recurrence overall was 25% and was similar for ultrasonic surgical aspiration compared with laser (relative risk 0.96, 95% confidence interval 0.64-1.50, number needed to treat 95.6). Recurrence was associated with younger age (P<.01).


CONCLUSIONS
Patients treated with ultrasonic surgical aspiration for vulvar and vaginal dysplasia reported less postoperative pain. Vulvar scarring was more common in patients treated by the laser. There was no difference in recurrence of dysplasia during a 1-year follow-up period between the two surgical modalities.


BACKGROUND
ClinicalTrials.gov, www.clinicaltrials.gov, NCT00394758


METHODS
I.
von Gruenigen
Vivian E
VE
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University Hospital Case Medical Center, Case School of Medicine, Cleveland, Ohio, USA. vivian.vongruenigen@UHhospitals.org
Gibbons
Heidi E
HE
Gibbins
Karen
K
Jenison
Eric L
EL
Hopkins
Michael P
MP
D002278:Carcinoma in Situ / Q000473:pathology / Q000601:surgery*; D002921:Cicatrix; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053685:Laser Therapy / Q000009:adverse effects / Q000379:methods*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control*; D010147:Pain Measurement; D010149:Postoperative Pain; D016896:Treatment Outcome; D014464:Ultrasonic Therapy / Q000009:adverse effects / Q000379:methods*; D014623:Vaginal Diseases / Q000473:pathology / Q000601:surgery*; D014845:Vulvar Diseases / Q000473:pathology / Q000601:surgery*