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Hsiao SM, Chang SR. Effect of tibolone versus hormone replacement therapy on lower urinary tract symptoms and sexual function. J Formos Med Assoc 2024; 123:710-715. [PMID: 38092655 DOI: 10.1016/j.jfma.2023.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 12/02/2023] [Accepted: 12/04/2023] [Indexed: 05/28/2024] Open
Abstract
BACKGROUND Few studies have compared the effects of tibolone versus hormone replacement therapy (HRT) on lower urinary tract symptoms and female sexual function. The current study aimed to compare these treatments. METHODS Women with climacteric symptoms were recruited consecutively and allocated to receive tibolone (2.5 mg) or estradiol valerate (1 mg) and medroxyprogesterone acetate (2.5 mg). Patients were followed up at 4 weeks and 12 weeks after treatment. RESULTS Overall, there were no significance of improvement in the International Prostate Symptoms Score (IPSS) scores in the HRT group. However, nocturia and the IPSS storage score improved after tibolone treatment. In addition, orgasm, satisfaction and pain improved after HRT. However, desire, lubrication, and Female Sexual Function Index (FSFI) total scores improved after tibolone treatment. There was a between-group difference in the change from baseline in the nocturia score after 4 weeks of treatment (0.1 ± 0.9 for HRT vs. -0.4 ± 1.2 for tibolone, p = 0.02). Nonetheless, there were no significant differences of the changes from baseline in the other IPSS and FSFI domains between the tibolone and HRT groups. CONCLUSION Despite the limited effect, tibolone seems to have more benefit in nocturia than HRT. In addition, tibolone seems to have benefits on overall low urinary tract storage symptoms; and both tibolone and HRT seem to have beneficial effects on female sexual function, despite there were no significant differences between tibolone and HRT.
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Affiliation(s)
- Sheng-Mou Hsiao
- Graduate School of Biotechnology and Bioengineering, Yuan Ze University, Taoyuan, Taiwan; Department of Obstetrics and Gynecology, Far Eastern Memorial Hospital, Banqiao, New Taipei, Taiwan; Department of Obstetrics and Gynecology, National Taiwan University College of Medicine, National Taiwan University Hospital, Taipei, Taiwan.
| | - Shiow-Ru Chang
- School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
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O'Reilly BA, Viereck V, Phillips C, Toozs-Hobson P, Kuhn A, Athanasiou S, Lukanović A, Palmer B, Dahly D, Daykan Y, Cardozo L. Vaginal erbium laser treatment for stress urinary incontinence: A multicenter randomized sham-controlled clinical trial. Int J Gynaecol Obstet 2024; 164:1184-1194. [PMID: 37927157 DOI: 10.1002/ijgo.15222] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 08/31/2023] [Accepted: 10/19/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVE To evaluate the efficacy and safety of non-ablative vaginal Er:YAG laser device in stress urinary incontinence (SUI) treatment. METHODS We conducted a multicenter blinded randomized sham-controlled trial in which women with urodynamic SUI were randomization to active arm using Er:YAG laser therapy, and sham arm using sham handpiece. Patients received two treatments 1 month apart. The primary outcomes measure was 1 h pad weight test measured at 6 months. Secondary outcomes were durability of treatment success at 12 months, and questionnaires for assessment of SUI severity (ICIQ-UI SF), sexual function (PISQ-12) and HRQoL (KHQ), and incidence and severity of device related adverse events and pain (VAS). RESULTS A total of 110 participants with SUI were recruited; 73 in the active arm and 37 in the sham arm. Two participants were excluded; one was assigned the wrong treatment and one withdrew their consent. Treatment success was observed in 36% of the sham arm and 59% of the active arm; in the latter, odds of achieving treatment success were more than three-fold higher (OR 3.63, 95% CI: 1.3-11.2, P = 0.02). HRQoL by KHQ showed significant improvement in the active versus the sham arm (OR 0.36, 95% CI: 0.15-0.87, P = 0.003). Similarly, subjective patient assessment of general and sexual function improvement with PISQ-12 and PGI-I showed superior effect over sham (OR 2.8, 95% CI: 1.2-7.0, P = 0.02 and OR 0.13, 95% CI: 0.05-0.36, P < 0.001, respectively). CONCLUSION Non-ablative vaginal Er:YAG laser therapy significantly improves SUI symptoms versus sham treatment. Er:YAG laser therapy should be considered as a non-surgical treatment option for SUI patients.
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Affiliation(s)
- Barry A O'Reilly
- Department of Urogynecology, Cork University Maternity Hospital, Cork, Ireland
| | - Volker Viereck
- Bladder and Pelvic Floor Center/Urogynecology, Kantonsspital Frauenfeld, Frauenfeld, Switzerland
| | - Christian Phillips
- Women's Health Unit, Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK
| | - Philip Toozs-Hobson
- Urogynecology Department, Birmingham Women's & Children's NHS Foundation Trust, Birmingham, UK
| | - Annette Kuhn
- Women's Clinic/Clinic for Gynecology, Universitätsspital Bern, Bern, Switzerland
| | - Stavros Athanasiou
- Department of Urogynecology and Pelvic Floor Surgery, Alexandra University Hospital, Athens, Greece
| | - Adolf Lukanović
- Division of Gynecology and Obstetrics, University Clinical Center Ljubljana, Ljubljana, Slovenia
| | - Brendan Palmer
- Clinical Research Facility, University College Cork, Cork, Ireland
| | - Darren Dahly
- Clinical Research Facility, University College Cork, Cork, Ireland
| | - Yair Daykan
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Linda Cardozo
- Urogynecology Department, King's College Hospital NHS Foundation Trust, London, UK
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Li PC, Ding DC. Comparison of Er:YAG and CO 2 laser therapy for women with stress urinary incontinence. Lasers Surg Med 2023; 55:653-661. [PMID: 37265011 DOI: 10.1002/lsm.23694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 05/25/2023] [Accepted: 05/25/2023] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To compare the effectiveness of Er:YAG and CO2 laser therapies for treating female stress urinary incontinence (SUI). METHODS This retrospective study included 139 women who were divided into four groups: group 1 received two therapy sessions with the Er:YAG laser, group 2 received two therapy sessions with the CO2 laser, group 3 received one therapy session with the Er:YAG laser, and group 4 received one therapy session with the CO2 laser. Patients completed three questionnaires to assess SUI symptom severity at baseline, 1 month, and 3 months after laser therapy. RESULTS Urinary incontinence symptoms significantly improved in groups 1 and 2 at both the 1- and 3-month follow-up evaluations compared to the baseline (p < 0.001). Symptoms improved after one therapy session in groups 3 and 4 at the 3-month follow-up (p < 0.001). The Er:YAG laser was more effective than the CO2 laser in improving SUI symptoms (Urogenital Distress Inventory 6 and Incontinence Impact Questionnaire 7) 3 months after treatment, regardless of the number of sessions. Both Er:YAG and CO2 laser therapies were found to be effective in reducing symptoms associated with an overactive bladder, as demonstrated by improvements in overactive bladder symptom scores. Two sessions of laser therapy were more effective than one. CONCLUSION Vaginal laser therapy could be an effective alternative treatment for mild to moderate SUI. The Er:YAG laser was more effective than CO2 laser therapy, with results lasting for at least 3 months. However, further large-scale, randomized, controlled trials are needed to confirm our findings.
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Affiliation(s)
- Pei-Chen Li
- Department of Obstetrics and Gynecology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Foundation, and Tzu Chi University, Hualien, Taiwan, ROC
| | - Dah-Ching Ding
- Department of Obstetrics and Gynecology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Foundation, and Tzu Chi University, Hualien, Taiwan, ROC
- Institute of Medical Sciences, College of Medicine, Tzu Chi University, Hualien, Taiwan, ROC
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Machado AC, Judice LMDPP, Riccetto CLZ, Toledo LGM. Applicability of vaginal energy-based devices in urogynecology: evidence and controversy. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2023; 69:e2023S129. [PMID: 37556648 PMCID: PMC10411715 DOI: 10.1590/1806-9282.2023s129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 03/21/2023] [Indexed: 08/11/2023]
Abstract
OBJECTIVE This study aimed to analyze the evidence and controversies about the use of vaginal energy-based devices (laser and radiofrequency) for treatment of genitourinary syndrome of menopause, recurrent urinary tract infection, urinary incontinence, and genital prolapse through a literature review. METHODS A search of literature databases (PubMed, Medline) was performed for publications in December 2022. Keywords included genitourinary syndrome of menopause, vaginal laxity, vaginal/vulvovaginal atrophy, urinary tract infection, urgency incontinence, frequency, urgency, stress urinary incontinence, genital prolapses AND energy-based devices, AND vaginal laser, AND vaginal radiofrequency, AND CO2 laser, AND Er:YAG laser. Publications in English from the last 7 years were reviewed and selected by the authors. RESULTS The literature regarding vaginal energy-based devices in the treatment of urogynecological conditions is primarily limited to prospective case series with small numbers and short-term follow-up. Most of these studies showed favorable results, improvement of symptoms with low risk, or no mention of serious adverse events. Consensus statement documents from major medical societies suggest caution in recommending these therapies in clinical practice until more relevant data from well-designed studies become available. CONCLUSION The potential of the vaginal laser and radiofrequency as a therapeutic arsenal for the evaluated urogynecological conditions is great, but qualified research must be done to prove their efficacy and long-term safety, define application protocols, and recommend the use of these technologies in clinical practice.
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Affiliation(s)
- Alessa Cunha Machado
- Hospital da Mulher Nise da Silveira – Maceió (AL), Brazil
- Sociedade Brasileira de Urologia, Departamento de Disfunção Miccional, Disciplina de Urologia Feminina – Rio de Janeiro (RJ), Brazil
| | - Lívia Maria da Paz Portela Judice
- Sociedade Brasileira de Urologia, Departamento de Disfunção Miccional, Disciplina de Urologia Feminina – Rio de Janeiro (RJ), Brazil
- Hospital Universitário de Brasília – Brasília (DF), Brazil
| | - Cássio Luis Zanettini Riccetto
- Sociedade Brasileira de Urologia, Departamento de Disfunção Miccional, Disciplina de Urologia Feminina – Rio de Janeiro (RJ), Brazil
- Universidade Estadual de Campinas, Faculty of Medical Sciences, Department of Urology – Campinas (SP), Brazil
| | - Luis Gustavo Morato Toledo
- Sociedade Brasileira de Urologia, Departamento de Disfunção Miccional, Disciplina de Urologia Feminina – Rio de Janeiro (RJ), Brazil
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, Department of Urology – São Paulo (SP), Brazil
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Pavčnik M, Antić A, Lukanović A, Krpan Ž, Lukanović D. Evaluation of Possible Side Effects in the Treatment of Urinary Incontinence with Magnetic Stimulation. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1286. [PMID: 37512097 PMCID: PMC10383588 DOI: 10.3390/medicina59071286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 07/06/2023] [Accepted: 07/10/2023] [Indexed: 07/30/2023]
Abstract
Background and Objectives: Magnetic stimulation is a type of conservative treatment of urinary incontinence. Our aim was to evaluate the possible side effects of this method. Materials and Methods: We conducted a systematic literature review. The key search terms were urinary incontinence, magnetic stimulation, and female. All known synonyms were used. Results: 255 titles and abstracts were retrieved, and 28 articles met our inclusion criteria. Out of 28 studies, 15 reported no side effects, five reported side effects, and eight did not report anything. There was no significant difference in the incidence of side effects between the sham and active treatment groups. Conclusions: Side effects of magnetic stimulation in comparison to other active treatments are minimal and transient. Among the conservative UI treatment methods, magnetic stimulation is one of the safest methods for the patient and as such a suitable first step in treating UI.
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Affiliation(s)
- Maja Pavčnik
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Anja Antić
- Ljubljana University Medical Center, 1000 Ljubljana, Slovenia
| | - Adolf Lukanović
- Division of Gynecology and Obstetrics, Ljubljana University Medical Center, 1000 Ljubljana, Slovenia
- Department of Gynecology and Obstetrics, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Žan Krpan
- Independent Researcher, Zanzna s.p., 1000 Ljubljana, Slovenia
| | - David Lukanović
- Division of Gynecology and Obstetrics, Ljubljana University Medical Center, 1000 Ljubljana, Slovenia
- Department of Gynecology and Obstetrics, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
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Tian Z, Wang X, Fu L, Du Z, Sun Z. Impact of female stress urinary incontinence and related treatments on the sexual function of male partners: a systematic review and meta-analysis. J Sex Med 2023:7192113. [PMID: 37291077 DOI: 10.1093/jsxmed/qdad070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 04/18/2023] [Accepted: 05/01/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND No conclusions have been reached on whether female stress urinary incontinence (SUI) and related treatments affect male partners' sexual function. AIM To assess the effects of female SUI and related treatments on male partners' sexual function. METHODS A comprehensive search of the PubMed, Embase, Web of Science, Cochrane, and Scopus databases was performed up to September 6, 2022. Studies were included that investigated the effect of female SUI and related treatments on male partners' sexual function. OUTCOME Male partners' sexual function. RESULTS Of the 2294 citations identified, 18 studies with 1350 participants were included. Two studies assessed the effect of female SUI without treatment on male partners' sexual function, finding that partners had more erectile dysfunction, more sexual dissatisfaction, and less sexual frequency than partners of women without urinary incontinence. Seven studies directly assessed the effect of female SUI treatments on male partners' sexual function by surveying the male partners. Among these, 4 assessed transobturator suburethral tape (TOT) surgery; 1 assessed TOT and tension-free vaginal tape obturator surgery; and the remaining 2 assessed pulsed magnetic stimulation and laser treatment. Among the 4 TOT studies, 3 used the International Index of Erectile Function (IIEF). TOT surgery significantly improved the total IIEF score (mean difference [MD] = 9.74, P < .00001), along with erectile function (MD = 1.49, P < .00001), orgasmic function (MD = 0.35, P = .001), sexual desire (MD = 2.08, P < .00001), intercourse satisfaction (MD = 2.36, P < .00001), and overall satisfaction (MD = 3.46, P < .00001). However, the improvements in IIEF items may be of unclear clinical significance, as 4 points in the erectile function domain of the IIEF are typically defined as the minimal clinically important difference. In addition, 9 studies indirectly assessed the effect of female SUI surgery on male partners' sexual function by surveying patients with the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire. The results demonstrated no significant differences in erectile function (MD = 0.08, P = .40) or premature ejaculation (MD = 0.07, P = .54). CLINICAL IMPLICATIONS The effects of female SUI and related treatments on male partners' sexual function were summarized for the first time, providing a reference for future clinical practice and scientific research. STRENGTHS AND LIMITATIONS A limited number of studies that used various scales met the standardized eligibility criteria. CONCLUSION Female SUI may affect male partners' sexual function, and female patients' anti-incontinence surgery does not appear to have a clinically significant improvement on the sexual function of their partners.
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Affiliation(s)
- Zhao Tian
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing 100730, China
| | - Xiuqi Wang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing 100730, China
| | - Linru Fu
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing 100730, China
| | - Zhe Du
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing 100730, China
| | - Zhijing Sun
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing 100730, China
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Pavarini N, Valadares ALR, Varella GM, Brito LGO, Juliato CRT, Costa-Paiva L. Sexual function after energy-based treatments of women with urinary incontinence. A systematic review and meta-analysis. Int Urogynecol J 2023; 34:1139-1152. [PMID: 36680596 DOI: 10.1007/s00192-022-05419-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 11/17/2022] [Indexed: 01/22/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Urinary incontinence (UI) affects approximately 50% of adult women worldwide and is associated with declining sexual function (SF). Energy-based devices emerged as a minimally invasive alternative treatment. Nevertheless, their effect on sexuality is uncertain. We hypothesize that the UI energy treatment can lead to sexual function improvement. METHODS A search was performed in PubMed, Cochrane Library, Web of Science, Embase, and Scopus for randomized clinical trials (RCTs) and nonrandomized studies of intervention, which treated incontinent women using energy, with UI and sexual function (SF) as outcomes. Severe comorbidities, pelvic organ prolapse (POP)> grade 2, and use of medication to treat UI or that affects SF were excluded. Quality assessment and meta-analysis were performed. RESULTS From 322 articles, 11 RCTs were included for qualitative analysis. UI symptoms improved in all studies. Regarding SF, RCT with premenopausal women showed improvement in SF in the Er:Yag group (Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire-12 and Female Sexual Function Index). A prospective study showed improvement in SF independent of the grade of SUI. RF showed benefits for SF but was not superior to pelvic floor muscle training. One nonrandomized study of intervention with a High-Intensity Focused Electromagnetic Field showed significant improvement of SF in the Golombok Rust Inventory of Sexual Satisfaction total score, a decline in pain and dissatisfaction domains. Meta-analysis with 4 RCTs and 2 nonrandomized studies found no difference between groups (0.26 (95% CI -0.67 to 1.20, and -0.74 (95% CI -3.78 to 2.30) respectively). CONCLUSIONS This meta-analysis did not confirm that energy equipment improved the SF of women with UI.
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Affiliation(s)
- Nádia Pavarini
- School of Medical Science, University of Campinas (UNICAMP), Campinas, Brazil
| | - Ana L R Valadares
- Department of Obstetrics and Gynecology, School of Medicine, University of Campinas (UNICAMP), Rua Alexander Fleming, 101, Cidade Universitária Zeferino Vaz, Campinas, SP, 13083-881, Brazil.
| | - Glaucia M Varella
- School of Medical Science, University of Campinas (UNICAMP), Campinas, Brazil
| | - Luiz G O Brito
- Department of Obstetrics and Gynecology, School of Medicine, University of Campinas (UNICAMP), Rua Alexander Fleming, 101, Cidade Universitária Zeferino Vaz, Campinas, SP, 13083-881, Brazil
| | - Cássia R T Juliato
- Department of Obstetrics and Gynecology, School of Medicine, University of Campinas (UNICAMP), Rua Alexander Fleming, 101, Cidade Universitária Zeferino Vaz, Campinas, SP, 13083-881, Brazil
| | - Lúcia Costa-Paiva
- Department of Obstetrics and Gynecology, School of Medicine, University of Campinas (UNICAMP), Rua Alexander Fleming, 101, Cidade Universitária Zeferino Vaz, Campinas, SP, 13083-881, Brazil
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Gao L, Wang Y, Wen W, Duan Y, Li Z, Dang E, Li P, Yu L, Zhou C, Lu M, Wang G. Fractional carbon dioxide vaginal laser treatment of stress urinary incontinence: Remodeling of vaginal tissues and improving pelvic floor structures. Lasers Surg Med 2023; 55:268-277. [PMID: 36748855 DOI: 10.1002/lsm.23641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 11/22/2022] [Accepted: 01/27/2023] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To demonstrate remodeling of vaginal biomechanical and physiological properties using vaginal fractional carbon dioxide (CO2 ) laser treatment of stress urinary incontinence (SUI). MATERIALS AND METHODS The study cohort included 26 patients with SUI between October 2019 and November 2020. Patients were treated with two sessions of FemTouch vaginal fractional CO2 laser with a one-month interval. Three subjective assessments were administered to all patients: female sexual function index (FSFI), vaginal health index score (VHIS), and international consultation on incontinence questionnaire-short form (ICIQ-SF). Vaginal tissue biopsies were taken from 6 patients before treatment and one-month after the final treatment. Vaginal tactile imaging (VTI) measurements, ultrasonography, and magnetic resonance imaging (MRI) scans were performed before treatment and 10-12-months after treatment in 10, 9, and 6 patients, respectively. RESULTS The average age of the cohort was 39.5 ± 12.0 years. The overall scores for FSFI, VHIS, and ICIQ-SF significantly improved in patients after each treatment sessions as compared with baseline scores. VTI showed significantly increased pressure resistance of both the anterior and posterior vaginal walls after treatment. Ultrasonography showed significant decreases in bladder neck mobility and urethrovesical angle during the Valsalva maneuver after treatment. MRI scans showed significant decreases in the length of the vaginal anterior wall after treatment. Histological examination confirmed that the laser treatment led to a thicker stratified squamous epithelium layer as compared to the baseline. CONCLUSIONS Our results demonstrated that vaginal fractional CO₂ laser treatment can restore vaginal biomechanical and physiological properties by increasing vaginal tightening and improving pelvic floor structures.
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Affiliation(s)
- Lin Gao
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Yuanli Wang
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Wei Wen
- Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yunyan Duan
- Department of Medical Technology, Xi'an Medical University, Xi'an, China
| | - Zhaoyang Li
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Erle Dang
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Peng Li
- Department of Radiology, The Affiliated Hospital of Qingdao Binhai University, Qingdao, China
| | - Lei Yu
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Chenxi Zhou
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Meiheng Lu
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Gang Wang
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
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Effect of vaginal energy-based treatment on female stress urinary incontinence: a systematic review and meta-analysis of randomized controlled trials. World J Urol 2023; 41:405-411. [PMID: 36536169 DOI: 10.1007/s00345-022-04247-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 12/05/2022] [Indexed: 12/23/2022] Open
Abstract
PURPOSE To evaluate the efficacy and safety of vaginal energy-based therapies in treating female SUI. METHODS The PubMed, EMBASE, Web of Science, and Scopus databases were searched up to September 2022 to identify RCTs comparing energy-based therapies with placebo intervention in treating female SUI. The primary outcome was International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) score. Secondary outcomes included the 1-h pad test and cure rate. RESULTS A total of 577 patients from 6 studies were included in the meta-analysis. Energy-based therapies did not significantly improve the ICIQ-SF score at all visits (≤ 1 month: SMD, -0.39; 95% CI - 0.80 to 0.03; P = 0.07; 3 months: SMD, - 1.32; 95% CI - 4.07 to 1.43; P = 0.35; 6 months: SMD, - 0.39; 95% CI - 0.91 to 0.12; P = 0.14). The subgroup analysis showed that there was no significant improvement in ICIQ-SF score in the CO2 laser group compared to the placebo group at all visits (≤ 1 month: SMD, - 0.13; 95% CI - 0.59 to 0.34; P = 0.59; 3 months: SMD, - 1.50; 95% CI - 3.91 to 0.92; P = 0.22; 6 months: SMD, 0.13; 95% CI - 0.47 to 0.72; P = 0.67). Meta-analysis was not performed in Er: YAG laser and radiofrequency therapy due to insufficient trials. CONCLUSION Based on the limited clinical evidence, our meta-analysis showed no prior efficacy of energy-based therapy over placebo intervention. However, the results of this meta-analysis should be taken with caution due to the limited amount of available evidence and the heterogeneity among the included studies. PROSPERO REGISTRATION NUMBER CRD42022360471.
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Ranjbar A, Mehrnoush V, Darsareh F, Kotb A, Zakaria A, Shekari M, Jahromi MS. Vaginal Laser Therapy for Stress Urinary Incontinence: A Systematic Review of Prospective Randomized Clinical Trials. J Menopausal Med 2022; 28:103-111. [PMID: 36647273 PMCID: PMC9843031 DOI: 10.6118/jmm.22017] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 10/31/2022] [Accepted: 12/07/2022] [Indexed: 01/15/2023] Open
Abstract
The most common type of urinary incontinence in women is stress urinary incontinence (SUI) which negatively impacts several aspects of life. The newly introduced vaginal laser therapy is being considered for treating SUI. This systematic review aimed to evaluate the efficacy of vaginal laser therapy for stress urinary incontinence in menopausal women. We searched the following databases: MEDLINE (via PubMed), EMBASE, Cochrane Library databases, Web of Science, clinical trial registry platforms, and Google Scholar, using the MeSH terms and keywords [Urinary Incontinence, Stress] and [(lasers) OR laser]. In our systematic review, prospective randomized clinical studies on women diagnosed with SUI as per the International Continence Society's diagnostic criteria were included. The Cochrane Risk-of-Bias assessment tool for randomized clinical trials was used to evaluate the quality of studies. A total of 256 relevant records in literature databases and registers and 25 in additional searches were found. Following a review of the titles, abstracts, and full texts, four studies involving 431 patients were included. Three studies used CO2-lasers, and one used Erbium: YAG-laser. The results of all four studies revealed the short-term improvement of SUI following both the Erbium: YAG-laser and CO2-laser therapy. SUI treatment with CO2-laser and Erbium: YAG-laser therapy is a quick, intuitive, well-tolerated procedure that successfully improves incontinence-related symptoms. The long-term impact of such interventions has not been well established as most trials focused on the short-term effects.
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Affiliation(s)
- Amene Ranjbar
- Fertility and Infertility Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Vahid Mehrnoush
- Department of Urology, Northern Ontario University School of Medicine, Thunder Bay, ON, Canada
| | - Fatemeh Darsareh
- Mother and Child Welfare Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Ahmed Kotb
- Department of Urology, Northern Ontario University School of Medicine, Thunder Bay, ON, Canada
| | - Ahmed Zakaria
- Department of Urology, Northern Ontario University School of Medicine, Thunder Bay, ON, Canada
| | - Mitra Shekari
- Mother and Child Welfare Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
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Clinical Consensus Statement: Vaginal Energy-Based Devices. UROGYNECOLOGY (HAGERSTOWN, MD.) 2022; 28:633-648. [PMID: 36256959 DOI: 10.1097/spv.0000000000001241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
ABSTRACT This clinical consensus statement on vaginal energy-based devices (EBDs) reflects an update by content experts from the American Urogynecologic Society's EBD writing group. In 2019, the American Urogynecologic Society's EBD writing group used a modified Delphi process to assess statements that were evaluated for consensus after a structured literature search. A total of 40 statements were assessed and divided into 5 categories: (1) patient criteria, (2) health care provider criteria, (3) efficacy, (4) safety, and (5) treatment considerations. Of the 40 statements that were assessed, 28 reached consensus and the remaining 12 did not. Lack of evidence was among the main reasons that vulvovaginal EBD treatment statements did not reach consensus. In March 2022, these statements were reassessed using the interim literature.
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Alexander JW, Karjalainen P, Ow LL, Kulkarni M, Lee JK, Karjalainen T, Leitch A, Ryan G, Rosamilia A. CO 2 surgical laser for treatment of stress urinary incontinence in women: a randomized controlled trial. Am J Obstet Gynecol 2022; 227:473.e1-473.e12. [PMID: 35662546 DOI: 10.1016/j.ajog.2022.05.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 05/07/2022] [Accepted: 05/22/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Stress urinary incontinence is a common condition that can be treated conservatively and/or surgically. Given the risks of surgery, developing effective nonsurgical treatment options would be beneficial. Some studies have suggested that laser therapy may improve or cure stress urinary incontinence. However, there is a lack of sham-controlled randomized controlled trials to judge treatment efficacy. OBJECTIVE This study aimed to compare the effects of CO2 vaginal laser vs sham therapy for treating stress urinary incontinence. STUDY DESIGN This was a multicenter, participant-blinded, sham-controlled, parallel group (1:1) superiority randomized controlled trial performed in outpatient clinics in 2 hospitals. We included women aged 18 to 80 years with objective and subjective stress urinary incontinence. Participants had undertaken or declined supervised pelvic floor muscle training. Intervention was performed using a CO2 fractionated vaginal laser. Participants underwent 3 treatments, 4 weeks apart, with increasing energy and density settings. Sham treatment was performed using an identical technique with a deactivated pedal. The primary outcome was the subjective stress urinary incontinence rate (proportion with leak with cough, sneeze, or laughter) at 3 months after completion of treatment. Secondary outcomes included objective stress urinary incontinence, change in the disease-specific patient-reported outcomes, health-related quality of life, and adverse effects. Categorical outcomes were compared using the chi square test and continuous outcomes using analysis of covariance, adjusting for the baseline score. RESULTS There were 52 participants who received laser and 49 who received sham treatment. One participant in each group withdrew from the study before the endpoint, and 2 participants in the laser group did not participate in the follow-up visits. Participant mean age was 53 (34-79) years. Mean body mass index was 26.1 (18.1-49.6); 90% were vaginally parous. At 3 months, there was no difference between the sham and active treatment arm in subjective stress urinary incontinence (46 [96%] vs 48 [98%]; relative risk, 0.98 [95% confidence interval, 0.91-1.05]; P=.55) or in objective stress urinary incontinence (37 [80%] vs 33 [80%]; relative risk, 0.99 [95% confidence interval, 0.81-1.23]; P=.995). Patient-reported outcomes and health-related quality of life were also comparable between the groups. Vaginal bleeding occurred in 3 participants after laser and 1 participant after sham treatment. Pain during treatment did not differ between laser and sham treatment. CONCLUSION We were unable to show an improvement in stress urinary incontinence after CO2 vaginal laser therapy compared with sham treatment.
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Affiliation(s)
- James W Alexander
- Department of Obstetrics and Gynaecology, Monash Health, University of New South Wales Sydney, Melbourne, Victoria, Australia
| | - Paivi Karjalainen
- Department of Obstetrics and Gynaecology, Monash Health, Melbourne, Victoria, Australia; Department of Obstetrics and Gynecology, Hospital Nova, Central Finland Healthcare District, Jyväskylä, Finland; Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland; Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland; Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Lin Li Ow
- Department of Obstetrics and Gynaecology, Monash Health, Melbourne, Victoria, Australia
| | - Mugdha Kulkarni
- Department of Obstetrics and Gynaecology, Monash Health, Melbourne, Victoria, Australia
| | - Joseph K Lee
- Department of Obstetrics and Gynaecology, Monash Health, Melbourne, Victoria, Australia
| | - Teemu Karjalainen
- Department of Surgery, Hospital Nova, Central Finland Healthcare District, Jyväskylä, Finland
| | - Alison Leitch
- Department of Obstetrics and Gynaecology, Monash Health, Melbourne, Victoria, Australia
| | | | - Anna Rosamilia
- Department of Obstetrics and Gynaecology, Monash Health, Melbourne, Victoria, Australia; Cabrini Hospital, Monash University, Melbourne, Victoria, Australia.
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The Clinical Effects of Pixel CO 2 Laser on Bladder Neck and Stress Urinary Incontinence. J Clin Med 2022; 11:jcm11174971. [PMID: 36078900 PMCID: PMC9457154 DOI: 10.3390/jcm11174971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 08/21/2022] [Accepted: 08/22/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Our study aims to assess Pixel CO2 laser efficacy for female stress urinary incontinence (SUI). Methods: In the study, 25 women with SUI were included and scheduled for vaginal Pixel CO2 Laser (FemiLift™, Alma Lasers, Israel) treatment. All subjects had a baseline and 6-month post-treatment assessment that included three-dimensional perineal ultrasound and validated questionnaires. Results: Data showed that monthly three-session vaginal Pixel CO2 Laser treatment significantly improved SUI symptoms, as evidenced by validated questionnaires, including UDI-6, IIQ-7, ICIQ, and vaginal laxity questionnaire (p < 0.05). The Pixel CO2 Laser efficacy in vaginal treatment was 20/25 (80%), and the perineal sonography showed that laser treatment significantly decreased bladder neck mobility and middle urethral area (during resting and straining). Permanent adverse events were not found. Conclusions: The results of our study suggested that for the treatment of mild to moderate SUI symptoms, Pixel CO2 Laser is effective and safe; however, more studies and a longer follow-up should be conducted to confirm its efficacy and durability.
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Mortensen OE, Christensen SE, Løkkegaard E. The evidence behind the use of LASER for genitourinary syndrome of menopause, vulvovaginal atrophy, urinary incontinence and lichen sclerosus: A state-of-the-art review. Acta Obstet Gynecol Scand 2022; 101:657-692. [PMID: 35484706 DOI: 10.1111/aogs.14353] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 03/08/2022] [Accepted: 03/12/2022] [Indexed: 11/30/2022]
Abstract
In recent years, LASER has been introduced as a minimally invasive treatment for a broad range of vaginal and vulvar symptoms and diseases. However, the efficacy and safety of vaginal and vulvar LASER has continuously been questioned. The aim of this study is to create an overview of the current literature and discuss the controversies within the use of LASER for genitourinary syndrome of menopause, vulvovaginal atrophy, urinary incontinence and lichen sclerosus. A search string was built in PubMed. The search was commenced on August 25, 2021 and closed on October 27, 2021. Two authors screened the studies in Covidence for inclusion according to the eligibility criteria in the protocol. The data were extracted from the studies and are reported in both text and tables. This review included 114 papers, of which 15 were randomized controlled trials (RCTs). The effect of LASER as a vaginal treatment was investigated for genitourinary syndrome of menopause in 36 studies (six RCTs), vulvovaginal atrophy in 34 studies (four RCTs) and urinary incontinence in 30 studies (two RCTs). Ten studies (three RCTs) investigated the effect of vulvar treatment for lichen sclerosus. Half of the included RCTs, irrespective of indication, did not find a significant difference in improvement in women treated with vaginal CO2 or Er:YAG LASER compared with their respective controls. However, most non-comparative studies reported significant improvement after exposure to vaginal or vulvar LASER across all indications. Included studies generally had a short follow-up period and only a single RCT followed their participants for more than 6 months post treatment. Adverse events were reported as mild and transient and 99 studies including 51 094 patients provided information of no serious adverse events. In conclusion, this review found that the effect of vaginal and vulvar LASER decreases with higher study quality where potential biases have been eliminated. We therefore stress that all patients who are treated with vaginal or vulvar LASER should be carefully monitored and that LASER for those indications as a treatment should be kept on a research level until further high-quality evidence is available.
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Affiliation(s)
- Olivia Engholt Mortensen
- Department of Obstetrics and Gynecology, Nordsjaellands Hospital, Institute of Clinical Medicine, University of Copenhagen, Hillerød, Denmark
| | - Sarah Emilie Christensen
- Department of Obstetrics and Gynecology, Nordsjaellands Hospital, Institute of Clinical Medicine, University of Copenhagen, Hillerød, Denmark
| | - Ellen Løkkegaard
- Department of Obstetrics and Gynecology, Nordsjaellands Hospital, Institute of Clinical Medicine, University of Copenhagen, Hillerød, Denmark
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15
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Ruffolo AF, Braga A, Torella M, Frigerio M, Cimmino C, De Rosa A, Sorice P, Castronovo F, Salvatore S, Serati M. Vaginal Laser Therapy for Female Stress Urinary Incontinence: New Solutions for a Well-Known Issue-A Concise Review. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:512. [PMID: 35454351 PMCID: PMC9028572 DOI: 10.3390/medicina58040512] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 03/25/2022] [Accepted: 04/02/2022] [Indexed: 11/21/2022]
Abstract
Background and Objectives: Insufficient connective urethra and bladder support related to childbirth and menopausal estrogen decrease leads to stress urinary incontinence (SUI). The aim of this review is to narratively report the efficacy and safety of new mini-invasive solutions for SUI treatment as laser energy devices, in particular, the microablative fractional carbon dioxide laser and the non-ablative Erbium-YAG laser. Materials and Methods: For this narrative review, a search of literature from PubMed and EMBASE was performed to evaluate the relevant studies and was limited to English language articles, published from January 2015 to February 2022. Results: A significant subjective improvement, assessed by the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-UI-SF) was reported at the 6-month follow up, with a cure rate ranged from 21% to 38%. A reduction of effect was evidenced between 6 and 24-36 months. Additionally, the 1-h pad weight test evidence a significant objective improvement at the 2-6-month follow up. Conclusions: SUI after vaginal laser therapy resulted statistically improved in almost all studies at short-term follow up, resulting a safe and feasible option in mild SUI. However, cure rates were low, longer-term data actually lacks and the high heterogeneity of methods limits the general recommendations. Larger RCTs evaluating long-term effects are required.
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Affiliation(s)
- Alessandro Ferdinando Ruffolo
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Hospital, Vita-Salute University, 20132 Milan, Italy; (A.F.R.); (S.S.)
| | - Andrea Braga
- Department of Obstetrics and Gynecology, EOC-Beata Vergine Hospital, 6850 Mendrisio, Switzerland; (A.B.); (F.C.)
| | - Marco Torella
- Department of Obstetrics and Gynecology, Second Faculty, 80100 Naples, Italy;
| | | | - Chiara Cimmino
- Department of Obstetrics and Gynecology, Del Ponte Hospital, University of Insubria, 21100 Varese, Italy; (C.C.); (A.D.R.); (P.S.)
| | - Andrea De Rosa
- Department of Obstetrics and Gynecology, Del Ponte Hospital, University of Insubria, 21100 Varese, Italy; (C.C.); (A.D.R.); (P.S.)
| | - Paola Sorice
- Department of Obstetrics and Gynecology, Del Ponte Hospital, University of Insubria, 21100 Varese, Italy; (C.C.); (A.D.R.); (P.S.)
| | - Fabiana Castronovo
- Department of Obstetrics and Gynecology, EOC-Beata Vergine Hospital, 6850 Mendrisio, Switzerland; (A.B.); (F.C.)
| | - Stefano Salvatore
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Hospital, Vita-Salute University, 20132 Milan, Italy; (A.F.R.); (S.S.)
| | - Maurizio Serati
- Department of Obstetrics and Gynecology, Del Ponte Hospital, University of Insubria, 21100 Varese, Italy; (C.C.); (A.D.R.); (P.S.)
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16
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Long CY, Wu PC, Chen HS, Lin KL, Loo Z, Liu Y, Wu CH. Changes in sexual function and vaginal topography using transperineal ultrasound after vaginal laser treatment for women with stress urinary incontinence. Sci Rep 2022; 12:3435. [PMID: 35236871 PMCID: PMC8891315 DOI: 10.1038/s41598-022-06601-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 11/26/2021] [Indexed: 11/09/2022] Open
Abstract
We aim to assess the changes in sexual function and vaginal topography using 3-D transperineal ultrasound in stress-incontinent women treated with Er:YAG vaginal laser. Two hundred and twenty women with stress urinary incontinence (SUI) treated with Er:YAG laser were recruited. Assessment before and 6 months after the treatment included vaginal topography using 3-D transperineal ultrasound and sexual function using female sexual function index questionnaire (FSFI). A total of 50 women with complete data showed that the symptomatic improvement was noted in 37 (74%) women. After Er:YAG vaginal laser treatment, significantly decreased width and cross-sectional area in proximal, middle, and distal vagina were found in women with SUI. Nearly all of the domains of FSFI improved significantly after the vaginal laser treatment, except sexual desire. In conclusion, 3-D transperineal ultrasound can be used to conduct vaginal topography. After Er:YAG vaginal laser treatment, the anatomical changes of vaginal shrinkage and the improvement of female sexual function were both noted. The favorable outcome of sexual function partly related to the tightening of vagina, as evidenced by the measurements of the 3-D transperineal ultrasound.
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Affiliation(s)
- Cheng-Yu Long
- Department of Obstetrics and Gynecology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100, Ziyou 1st Rd., Sanmin Dist., Kaohsiung City, 807, Taiwan.,Department of Obstetrics and Gynecology, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Regenerative Center, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Pei-Chi Wu
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan
| | - Hung-Sheng Chen
- Department of Obstetrics and Gynecology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100, Ziyou 1st Rd., Sanmin Dist., Kaohsiung City, 807, Taiwan
| | - Kun-Ling Lin
- Department of Obstetrics and Gynecology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100, Ziyou 1st Rd., Sanmin Dist., Kaohsiung City, 807, Taiwan.,Department of Obstetrics and Gynecology, Kaohsiung Municipal Da-Ton Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Zixi Loo
- Department of Obstetrics and Gynecology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100, Ziyou 1st Rd., Sanmin Dist., Kaohsiung City, 807, Taiwan.,Department of Obstetrics and Gynecology, Kaohsiung Municipal Da-Ton Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yiyin Liu
- Department of Obstetrics and Gynecology, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chin-Hu Wu
- Department of Obstetrics and Gynecology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100, Ziyou 1st Rd., Sanmin Dist., Kaohsiung City, 807, Taiwan.
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17
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Okui N, Miyazaki H, Takahashi W, Miyauchi T, Ito C, Okui M, Shigemori K, Miyazaki Y, Vizintin Z, Lukac M. Comparison of urethral sling surgery and non-ablative vaginal Erbium:YAG laser treatment in 327 patients with stress urinary incontinence: a case-matching analysis. Lasers Med Sci 2022; 37:655-663. [PMID: 33886071 PMCID: PMC8803680 DOI: 10.1007/s10103-021-03317-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 04/05/2021] [Indexed: 02/06/2023]
Abstract
Stress urinary incontinence (SUI) occurs when abdominal pressure, such as from coughing or sneezing, causes urine leakage. We retrospectively compared tension-free vaginal tape (TVT) and non-ablative vaginal Erbium:YAG laser treatment (VEL) by propensity score (PS) analysis in women with SUI. No PS analysis studies have investigated urethral sling surgery using polypropylene TVT and VEL for SUI. Data from patients aged 35-50 years who were treated for SUI and registered at several institutions were selected. Patients with medical records covering 1 year for the 1-h pad test, who completed the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) and the Overactive Bladder Symptom Score (OABSS), were included. We analyzed 102, 113, and 112 patients in the TVT, VEL, and control groups, respectively. Compared with the control group, the TVT and VEL groups exhibited significant improvement in the 1-h pad test and ICIQ-SF. In the PS analysis, the TVT and VEL groups similarly improved in the 1-h pad test and ICIQ-SF. As for the OABSS, the VEL group showed significantly greater improvement than the TVT group. In the odds ratio analysis for the 1-h pad test, no differences in any of the parameters were observed between TVT and VEL. VEL may be considered an alternative to TVT for SUI treatment.
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Affiliation(s)
- Nobuo Okui
- Urology, Kanagawa Dental University, Yokosuka, Kanagawa, Japan.
- Urology, Dr Okui's Urogynecology and Urology, Yokosuka, Kanagawa, Japan.
- Urology, Teikyo University, Tokyo, Tokyo, Japan.
- Urology, Koshigawa Hospital, Dokkyo University, Saitama, Saitama, Japan.
- Urology, Yokosuka City Hospital, Yokosuka, Kanagawa, Japan.
| | - Hironari Miyazaki
- Urology, Dr Okui's Urogynecology and Urology, Yokosuka, Kanagawa, Japan
- Urology, Yakuin Urogenital Clinic, Fukuoka, Fukuoka, Japan
| | - Wataru Takahashi
- Urology, Dr Okui's Urogynecology and Urology, Yokosuka, Kanagawa, Japan
- Urology, Kengun Kumamoto Urology, Kumamoto, Kumamoto, Japan
- Urology, Kumamoto University, Kumamoto, Kumamoto, Japan
| | - Toshihide Miyauchi
- Urology, Dr Okui's Urogynecology and Urology, Yokosuka, Kanagawa, Japan
- Urology, Ooita Urology Hospital, Ooita, Ooita, Japan
| | - Chikako Ito
- Urology, Dr Okui's Urogynecology and Urology, Yokosuka, Kanagawa, Japan
- Urology and Gynecology, Saint Sofia Clinic, Nagoya, Aichi, Japan
| | - Machiko Okui
- Urology, Dr Okui's Urogynecology and Urology, Yokosuka, Kanagawa, Japan
- Urology, Yokosuka City Hospital, Yokosuka, Kanagawa, Japan
| | | | | | | | - Matjaž Lukac
- Fotona d.o.o., Stegne 7, 1000, Ljubljana, EU, Slovenia
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Vaginal erbium laser for treatment of stress urinary incontinence: optimization of treatment regimen for a sustained long-term effect. Lasers Med Sci 2022; 37:2157-2164. [PMID: 35067817 DOI: 10.1007/s10103-021-03474-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 11/15/2021] [Indexed: 10/19/2022]
Abstract
Stress urinary incontinence (SUI) is a common health problem that affects roughly 35% of women in the reproductive period. A prospective uncontrolled study was conducted to assess the long-term efficacy and safety of a non-ablative Er:YAG laser treatment of SUI. Forty-three patients participated in the study. All women underwent three sessions of IncontiLase® procedure, and efficacy of laser treatment was assessed by 1-h pad test, 24-h pad test, 3-day voiding diary, and ICIQ-UI SF questionnaire at multiple follow-ups. Statistical analysis was performed using one-way repeated measures ANOVA. Patients were questioned about discomfort during treatment and any adverse events following the laser procedures. All outcome measures showed a significant change over a period of the entire clinical trial. Eighteen-month follow-up revealed a fading of the effect, which was alleviated by single-session maintenance treatments every 6 months. There were no serious adverse events reported during the study. All reported side effects were mild and transient. The application of non-ablative Er:YAG laser for SUI treatment significantly improves the SUI symptoms. High improvement rates and patient satisfaction can be maintained with single-session maintenance treatments performed every 6 months. Long-term safety profile of multiple non-ablative Er:YAG laser treatment is shown. NCT04348994, 16.04.2020, retrospectively registered.
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19
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Abdelaziz A, Dell J, Karram M. Transvaginal radiofrequency energy for the treatment of urinary stress incontinence: A comparison of monopolar and bipolar technologies in both pre- and post-menopausal patients. Neurourol Urodyn 2021; 40:1804-1810. [PMID: 34288106 DOI: 10.1002/nau.24748] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 07/02/2021] [Accepted: 07/02/2021] [Indexed: 11/10/2022]
Abstract
AIM A study to compare the effect of two different radio frequency energy models (mono polar and bipolar) for the treatment of urinary stress incontinence. METHODS Retrospective chart review, which was conducted at 2 sites, 69 patients received treatment with a bipolar radiofrequency device. Out of those 69 patients, 13 patients received bipolar in conjugation with CO2 laser treatment, while 32 patients received monopolar frequency. The study protocol normally consists of three sessions of treatment. Each session was four weeks apart with a whole 6-month duration follow-up. Results were evaluated by urogenital distress inventory (UDI)-6 questionnaire before and after treatment. RESULTS The bipolar group improved UDI-6 scores across time more so than did the monopolar group with some evidence suggesting that the bipolar radiofrequency treatment was more effective compared to the monopolar radiofrequency. Three months after treatment, the bipolar group UDI-6 values were lower than those of the monopolar group. Six months after treatment, the UDI-6 scores increased in both groups, suggesting decrease efficacy with time however, the bipolar group's UDI-6 scores were consistently lower than the monopolar group's scores. CONCLUSION This study shows benefit of both monopolar and bipolar radiofrequency device in patients with stress urinary incontinence and mixed UI, with bipolar RF more efficacious than monopolar RF. More randomized prospective studies are needed to confirm these findings.
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Affiliation(s)
- Ahmed Abdelaziz
- Division of Urogynecology, OBGYN Department, The Christ Hospital, University of Cincinnati, Cincinnati, Ohio, USA
| | - Jeffrey Dell
- OBGYN Department, Institute for Female Pelvic Medicine, Knoxville, Tennessee, USA
| | - Mickey Karram
- Division of Urogynecology, OBGYN Department, The Christ Hospital, University of Cincinnati, Cincinnati, Ohio, USA
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20
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Cruff J, Khandwala S. A Double-Blind Randomized Sham-Controlled Trial to Evaluate the Efficacy of Fractional Carbon Dioxide Laser Therapy on Genitourinary Syndrome of Menopause. J Sex Med 2021; 18:761-769. [PMID: 33757774 DOI: 10.1016/j.jsxm.2021.01.188] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 01/12/2021] [Accepted: 01/29/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Despite some prospective case series showing effectiveness of vaginal laser to treat genitourinary syndrome of menopause (GSM), there is a paucity of placebo-controlled level one evidence. AIM To assess the effect of fractional carbon dioxide (CO2) laser therapy to treat GSM against a sham comparator. METHODS We conducted a parallel, randomized, double-blind, sham-controlled trial to compare menopausal women treated with fractional CO2 laser against sham treatment for improvement in GSM-related dyspareunia. Three treatments were given 6 weeks apart, and participants attended a 6-month visit from study start for primary (proportion improved) and secondary (vaginal health index, VHI; visual analogue scale, VAS; modified global assessment, PGI-I; Female Sexual Function Index, FSFI; Day-to-Day Impact of Vaginal Aging, DIVA; Urinary Distress Inventory short-form, UDI-6) assessments. OUTCOMES The primary endpoint was a 2-stage improvement in GSM-related dyspareunia from baseline to 6 months determined by a severity scale, and the proportion of subjects who achieved this were compared between groups. RESULTS Thirty participants were randomized to laser (n = 14) or sham (n = 16). In the treatment arm, 13 attended all treatments, and 1 attended at least 2 while in the sham arm, 14 attended all treatments, and 2 attended at least 2 treatments. Twelve (86%) in the treatment arm and 16 (100%) in the sham arm attended the 6-month visit. There were no differences in the proportion improved between treatments and controls (64% vs. 67%, respectively, P = 1.000). Both arms showed significant within-group improvements based on VHI and VAS, but not between groups. Similar findings were observed on sexual impact questionnaires with improvements within both groups from baseline to 6 months but not by median differences between the groups at 6 months. There were no adverse events in either of the arms. CLINICAL IMPLICATIONS Further well-powered research is needed to determine efficacy of fractional CO2 laser for the treatment of GSM, especially in light of a potential placebo effect. STRENGTHS & LIMITATIONS We present a sham-controlled double-blinded randomized trial using validated tools; the main limitation included an underpowered proportion of sexually active participants for the primary outcome. CONCLUSION This study was underpowered to draw conclusions regarding the efficacy of fractional CO2 laser therapy in the treatment of GSM. We did observe improvements in the sham-arm to suggest a possible placebo contribution. Further well-powered level one research is needed to demonstrate the therapeutic effect of this novel modality. Cruff J, Khandwala S, A Double-Blind Randomized Sham-Controlled Trial to Evaluate the Efficacy of Fractional Carbon Dioxide Laser Therapy on Genitourinary Syndrome of Menopause. J Sex Med 2021;18:761-769.
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Affiliation(s)
- Jason Cruff
- Department of Obstetrics/Gynecology-Female Pelvic Medicine & Reconstructive Surgery, Marshfield Clinic Health System, Marshfield, WI, USA.
| | - Salil Khandwala
- Advanced Urogynecology of Michigan, P.C., Dearborn, MI, USA; Department of Female Pelvic Medicine & Reconstructive Surgery, Beaumont Health, Wayne, MI, USA
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21
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Alsulihem A, Corcos J. The use of vaginal lasers in the treatment of urinary incontinence and overactive bladder, systematic review. Int Urogynecol J 2021; 32:553-572. [PMID: 33175226 DOI: 10.1007/s00192-020-04548-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 09/24/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To evaluate the available literature to assess the safety, efficacy, and outcomes of lasers in the treatment of female stress urinary incontinence (SUI) and overactive bladder (OAB). METHODS Pubmed search was conducted up to May 2020, including observational and investigational human studies that documented the effects on laser treatment in SUI and OAB. RESULTS A total of 27 studies, recording subjective or objective measures in SUI or OAB were included. Lasers used included Er:YAG and Fractional CO2 lasers. The overall quality of studies was poor, and 23/27 studies were case series (LOE:4). Er:YAG laser showed a modest reduction in mild SUI cases, with benefits lasting a maximum of 13-16 months. Er:YAG laser for OAB showed conflicting results, with a trend to improve OAB symptoms for up to 12 months. Fractional CO2 laser showed an improvement of mild SUI in few studies; however, no long-term data are available. For OAB symptoms, studies showed minimal improvement that was evaluated in short term studies. When reported, adverse events were insignificant, however, they were not reported systematically. Several limitations have been noticed in the current literature of vaginal lasers, including large variation in laser settings and protocols, short term follow up, lack of urodynamic evaluation, and appropriate objective measures. CONCLUSION Based on the available literature, lasers cannot be recommended as a treatment option at this time. Future better-quality studies are needed to document the exact mechanism of action, longevity, safety and its eventual place into the current treatment algorithms of SUI and OAB.
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Affiliation(s)
- Ali Alsulihem
- Department of Urology, Jewish General Hospital, McGill University, 3755 Chemin de la Côte-Sainte-Catherine, Montréal, QC, H3T 1E2, Canada
- Department of Urology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Jacques Corcos
- Department of Urology, Jewish General Hospital, McGill University, 3755 Chemin de la Côte-Sainte-Catherine, Montréal, QC, H3T 1E2, Canada.
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Klap J, Campagne-Loiseau S, Berrogain N, Bosset PO, Cardot V, Charles T, Deffieux X, Donon L, Girard F, Peyrat L, Roulette P, Thuillier C, Tibi B, Vidart A, Wagner L, Hermieu JF, Cornu JN. [Vaginal LASER therapy for genito-urinary disorders: A systematic review and statement from the Committee for Female Urology and Pelviperineology of the French Association of Urology]. Prog Urol 2021; 31:634-650. [PMID: 33516611 DOI: 10.1016/j.purol.2020.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 11/08/2020] [Accepted: 11/09/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Vaginal LASER therapy is increasingly used in the field of urogynecology, but several points remain unclear. Our goal was to produce a systematic review of available evidence and provide a critical appraisal of available data. METHODS A systematic review until march 2020 was conducted using PubMed/MEDLINE, Cochrane and Embase databases. All studies about vaginal LASER use in the field of urogynecology were included. RESULTS Forty studies have been included (8 for genitourinary syndrome of menopause, 19 for stress urinary incontinence, 3 for overactive bladder, 7 for urogenital prolapse, 3 for other indications). Data were heterogeneous, and level of evidence was weak or very weak. Few studies were comparative, and only 3 were randomized). Mild improvement of symptoms and quality of life and limited satisfaction were seen for genitourinary syndrome, stress urinary incontinence, overactive bladder and prolapse. Few adverse events were reported. However, major methodological biases were noted regarding efficacy and safety evaluation. No long-term results were available. CONCLUSIONS While Vaginal LASER therapy seem to provide encouraging results, the level of evidence supporting its use was weak, especially regarding long-term outcomes. Studies of better quality are warranted before any recommendation can be made. Current use should be limited to clinical research.
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Affiliation(s)
- J Klap
- Service d'urologie, hôpital privé Claude-Galien, 91480 Quincy-sous-Senart, France
| | - S Campagne-Loiseau
- Service de gynécologie-obstétrique, CHU d'Estaing, Clermont-Ferrand, France
| | - N Berrogain
- Clinique Ambroise-Paré, 31100 Toulouse, France
| | - P O Bosset
- Service d'urologie, hôpital Foch, 40, rue Worth, 92150 Suresnes, France
| | - V Cardot
- Clinique de Meudon-Clamart, 3, avenue de Villacoublay, 92360 Meudon, France
| | - T Charles
- Service d'urologie, CHU de La-Miletrie, 86000 Poitiers, France
| | - X Deffieux
- Service de gynécologie-obstétrique, hôpital Antoine-Béclère, AP-HP, 92140 Clamart, France
| | - L Donon
- Clinique de la Côte Basque, 64100 Bayonne, France
| | - F Girard
- Service d'urologie, clinique Oudinot fondation Cognac-Jay, 2, rue Rousselet, 75007 Paris, France
| | - L Peyrat
- Service d'urologie, clinique Turin, 75008 Paris, France
| | - P Roulette
- Service d'urologie, centre hospitalier de Cahors, 335, rue Wilson, 46005 Cahors cedex, France
| | - C Thuillier
- Service d'urologie, CHU de Grenoble-Alpes, 38000 Grenoble, France
| | - B Tibi
- Service d'urologie, hôpital Pasteur 2, CHU de Nice, 30, voie Romaine - CS 51069, 06001 Nice cedex 1, France
| | - A Vidart
- Service d'urologie, hôpital Foch, 40, rue Worth, 92150 Suresnes, France
| | - L Wagner
- Service d'urologie, CHU de Nîmes, place du Pr-Robert-Debré, 30029 Nîmes cedex 9, France
| | - J-F Hermieu
- Service d'urologie, hôpital Bichat, AP-HP, Paris, France
| | - J-N Cornu
- Service d'urologie, hôpital Charles-Nicolle, université de Rouen, 76000 Rouen, France.
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A Systematic Review of Nonsurgical Vulvovaginal Restoration Devices: An Evidence-Based Examination of Safety and Efficacy. Plast Reconstr Surg 2020; 146:552e-564e. [PMID: 33141529 DOI: 10.1097/prs.0000000000007236] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The efficacy and safety of vulvovaginal restoration devices were called into question in a U.S. Food and Drug Administration statement on July 30, 2018, claiming that women are being harmed by laser and other energy-based devices. The goal of this systematic literature review was to assess existing data, determine gaps in evidence, and propose opportunities for continued investigation pertaining to laser and energy-based vaginal restoration techniques. METHODS A review of literature using PubMed, Cochrane Library databases, Embase, MEDLINE, and the Cumulative Index to Nursing and Allied Health Literature was conducted on January 9, 2019, and articles up to this point were considered. For inclusion, studies had to be available or translated in English and relate to clinical medicine, direct patient care, and nonsurgical energy-based vulvovaginal procedures. RESULTS The authors found five level I studies, 19 level II studies, four level III studies, and 46 level IV studies that used 15 different devices. Various degrees of improvement of symptoms were reported in all studies. Adverse events/side effects were noted in two of the 13 radiofrequency device studies, 15 of the 23 erbium:yttrium-aluminum-garnet device studies, and 17 of the 37 carbon dioxide device studies. The majority of adverse events were considered mild. CONCLUSIONS The majority of studies resulted in mild to no adverse side effects. However, there is a large gap in level I evidence. As a result, the authors emphasize the necessity of supplemental data surrounding this subject and suggest that additional randomized sham-controlled studies be conducted to further investigate vulvovaginal restoration devices in an effort to address women's health issues.
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Elia D, Gambiacciani M, Ayoubi JM, Berreni N, Bohbot JM, Descamps P, Druckmann R, Geoffrion H, Haab F, Heiss N, Rygaloff N, Russo E. Female urine incontinence: vaginal erbium laser (VEL) effectiveness and safety. Horm Mol Biol Clin Investig 2020; 41:/j/hmbci.ahead-of-print/hmbci-2020-0012/hmbci-2020-0012.xml. [PMID: 33119542 DOI: 10.1515/hmbci-2020-0012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 05/06/2020] [Indexed: 11/15/2022]
Abstract
Urinary incontinence is a common health problem that impacts the quality of life of women at different ages. Its physiopathology is not unequivocal, and it is necessary to consider the stress urinary incontinence (SUI), the overactive bladder syndrome and the mixed incontinence (MUI). According to the type of incontinence, its impact on the quality of life and age of the patients, therapeutic strategies are currently summarized in physiotherapy, surgery and drug treatments. We already know the benefit/risk ratio of each of these strategies. Our objective is to evaluate the potential effectiveness and safety of the VEL, an innovative vaginal laser technique (VEL - Vaginal Erbium Laser, erbium yttrium-aluminum-garnet -Er: YAG) a non-invasive laser proposed as a treatment for SUI, overactive bladder syndrome and MUI. The mechanisms of action of lasers are discussed in general and those of VEL in particular with the description of the Smooth® mode. To do this, we have collected the 21 published studies including the first randomized vs. placebo and two pilot studies of intra-urethral VEL. In conclusion: VEL procedures already have their place between the rehabilitation of the perineal floor and surgery. Further properly sized, randomized studies are needed to evaluate the laser treatments in comparison with other therapies, as well as to assess the duration of the therapeutic effects and the safety of repeated applications.
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Affiliation(s)
- David Elia
- Vaginal Erbium Laser Academy France, Paris, France
| | | | | | | | | | | | | | | | | | - Niko Heiss
- Vaginal Erbium Laser Academy France, Paris, France
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25
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Cañadas Molina A, Sanz Baro R. The first major complication due to laser treatment for stress urinary incontinence: a short report. Climacteric 2020; 24:206-209. [PMID: 32990051 DOI: 10.1080/13697137.2020.1816958] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AIM Stress urinary incontinence (SUI) is a common benign disease causing a markedly negative impact on quality of life. Vaginal laser is a minimally invasive treatment and no major complications of this technique have been published to date. The purpose of the article is to present the first major adverse event related to this treatment. MATERIALS AND METHODS We present the case of a 48-year-old woman with an important complication after vaginal laser for SUI. RESULTS The patient presented a transverse vaginal septum and shortening of vaginal length after two sessions of vaginal erbium:yttrium aluminum garnet laser treatment. She required two surgical interventions, local injections, and pelvic floor physiotherapy, although currently the patient has not experienced complete resolution of symptoms. DISCUSSION AND CONCLUSIONS Vaginal laser use can lead to serious adverse events. Selection of patients and treatment must be carried out with caution.
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Affiliation(s)
- A Cañadas Molina
- Department of Gynecology and Obstetrics, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - R Sanz Baro
- Department of Gynecology and Obstetrics, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
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Alcalay M, Ben Ami M, Greenshpun A, Hagay Z, Schiff E. Fractional-Pixel CO 2 Laser Treatment in Patients With Urodynamic Stress Urinary Incontinence: 1-Year Follow-Up. Lasers Surg Med 2020; 53:960-967. [PMID: 32965724 DOI: 10.1002/lsm.23329] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 09/07/2020] [Accepted: 09/13/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND AND OBJECTIVES Vaginal pixelated low power and long pulses (LPLP) CO2 laser has been suggested as an optional treatment for stress urinary incontinence (SUI) with many studies reporting short-term improvements. The objective of this study was to assess the 1-year subjective and objective efficacy of vaginal CO2 laser in women with urodynamic SUI. STUDY DESIGN/MATERIALS AND METHODS This was a prospective multicenter study. Patients with confirmed urodynamic SUI graded as mild or moderate were included. We used three sessions of fractional pixelated CO2 laser for vaginal application and followed up the patients at 6 and 12 months. We used the following measures at follow-up: 1-hour pad test (ICS protocol), questionnaires including Pelvic Floor Distress Inventory 20 (PFDI-20), Pelvic Floor Impact Questionnaire (PFIQ), Patient Global Impression of Improvement (PGI-I), and a 3-day urinary diary. The urodynamic assessment was repeated at 6 months. RESULTS Fifty-two patients with SUI had three laser treatments, of whom 48 completed a 6-month follow-up and 42 patients completed 12-month follow-up. No serious adverse events were recorded during the study period. A significant reduction on the 1-hour pad test was found from baseline (6.3 ± 1.6 g) to the 12-month follow-up (3.7 ± 1.4 g, P < 0.05) was found. PGI-I showed 75.0%, 61.9%, and 64.3% improvements at 3, 6, and 12 months, respectively. PFDI improved significantly and consistently from baseline until 12 months (37.2 ± 3.89 to 16.1 ± 3.7, P < 0.05). Similarly, PFIQ showed significant improvements from the first treatment up to 12 months. Urodynamic assessment at 6 months showed that 41.4% of patients had no stress incontinence. CONCLUSION The vaginal CO2 laser was found to be effective for mild-to-moderate SUI over a follow-up period of 1 year, according to a variety of objective and subjective parameters. The wide range of parameters enables optimal patient consultation and subsequent treatment. Lasers Surg. Med. © 2020 Wiley Periodicals LLC.
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Affiliation(s)
- Menachem Alcalay
- Department of Obstetrics and Gynecology, Urogynecology Unit, Pade Poria Medical Center, Tiberias, Israel, 1520800.,Azrieli School of Medicine, Bar Ilan University, Ramat Gan, Israel, 5290002.,Department of Obstetrics and Gynecology, Urogynecology Unit, Sheba Medical Center, Ramat Gan, Israel, 5262000
| | - Moshe Ben Ami
- Department of Obstetrics and Gynecology, Urogynecology Unit, Pade Poria Medical Center, Tiberias, Israel, 1520800.,Azrieli School of Medicine, Bar Ilan University, Ramat Gan, Israel, 5290002
| | - Anatoly Greenshpun
- Department of Obstetrics and Gynecology, Urogynecology Unit, Pade Poria Medical Center, Tiberias, Israel, 1520800.,Azrieli School of Medicine, Bar Ilan University, Ramat Gan, Israel, 5290002
| | - Zion Hagay
- Department of Obstetrics and Gynecology, Kaplan Medical Center, Rehovot, Israel, 761044
| | - Eyal Schiff
- Department of Obstetrics and Gynecology, Urogynecology Unit, Sheba Medical Center, Ramat Gan, Israel, 5262000.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel, 6901125
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Erel CT, Fernandez LDC, Inan D, Makul M. Er:YAG laser treatment of urinary incontinence after failed TOT/TVT procedures. Eur J Obstet Gynecol Reprod Biol 2020; 252:399-403. [PMID: 32711294 DOI: 10.1016/j.ejogrb.2020.07.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 06/26/2020] [Accepted: 07/02/2020] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To determine if the Er:YAG laser can improve the symptoms of SUI patients after previously failed TOT/TVT procedures. STUDY DESIGN This retrospective study includes the data of patients who were recruited from two different out-patient clinics of Obstetrics and Gynecology Department. 25 women with persistent SUI after failed TOT/TVT operations and 25 women who previously did not receive either any type of surgical treatment procedure or non-invasive treatment modalities for SUI. Er:YAG laser with 2940 nm was used in the treatment procedure for SUI setting. The patients were evaluated on the basis of ICIQ-SF before and after the procedure. The severity of SUI symptoms was graded. According to the differences in the ICIQ-SF between before and after the procedure, the percentage of improvement was graded as good responders (≥50 %) or poor responders (<50 %).The duration of the treatment effect was evaluated in follow-ups with relation to maximum improvement time (MIT) and total improvement time (TIT). RESULTS The SUI patients who previously had failed TOT/TVT operations, had significantly higher initial ICIQ-SF score (p = 0.013). Non-ablative Er:YAG laser treatment significantly and similarly improved the severity of SUI symptoms in both groups (p = 0.000 for failed TOT/TVT group and p = 0.001 for non-TOT/TVT group, respectively). The women who were good responders, were younger (p = 0.012) and had less number of years in menopause (p = 0.011). The effect of Er:YAG laser treatment lasted longer among the SUI women in the good responders group (p = 0.000 for MIT and p = 0.000 for TIT, respectively). CONCLUSIONS Non-ablative Er:YAG smooth mode laser is an alternative choice of treatment for the SUI patients who previously had failed TOT/TVT procedures. Its effect lasts longer especially in younger and early postmenopausal women.
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Affiliation(s)
- C Tamer Erel
- Istanbul University, Cerrahpaşa School of Medicine, Department of Obstetrics and Gynecology, Istanbul, Turkey.
| | | | - Deniz Inan
- Marmara University, Department of Statistics, Istanbul, Turkey
| | - Melike Makul
- Istanbul University, Cerrahpaşa School of Medicine, Department of Obstetrics and Gynecology, Istanbul, Turkey
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Phillips C, Hillard T, Salvatore S, Toozs-Hobson P, Cardozo L. Lasers in gynaecology. Eur J Obstet Gynecol Reprod Biol 2020; 251:146-155. [PMID: 32505055 DOI: 10.1016/j.ejogrb.2020.03.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 03/12/2020] [Accepted: 03/16/2020] [Indexed: 11/28/2022]
Abstract
The use of lasers to treat gynaecological and urogynaecological conditions including genitourinary syndrome of the menopause, stress urinary incontinence, vaginal prolapse and other conditions, has become increasingly popular over recent years. Following widespread concerns over the use of mesh for treating stress urinary incontinence and pelvic organ prolapse and potential adverse outcomes from the use of mesh, there has been heightened awareness and debate over the introduction and adoption of new technologies and interventions within the speciality. On July 30th 2018 the United States Food and Drug Administration (FDA) issued a warning against the use of energy based devices (EBDS) including laser to perform "vaginal rejuvenation" or vaginal cosmetic procedures. Numerous review articles and editorials have urged for greater evidence on the efficacy and safety of vaginal lasers This review outlines the evidence to date for the use of lasers in the treatment of gynaecological conditions.
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Affiliation(s)
- Christian Phillips
- Consultant Gynaecologist and Urogynaecologist, Hampshire Hospitals, Hampshire, UK; Visiting Professor, University of Winchester, Hampshire, UK.
| | - Tim Hillard
- Consultant Obstetrician and Gynaecologist, Poole Hospital NHS Foundation Trust, UK
| | - Stefano Salvatore
- Consultant Gynaecologist and Urogynaecologist, San Raffaele Hospital, Milan, Italy
| | - Phil Toozs-Hobson
- Consultant Gynaecologist and Urogynaecologist, Birmingham Women's Hospital, UK
| | - Linda Cardozo
- Consultant Gynaecologist and Urogynaecologist, Kings College Hospital, UK
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Mackova K, Van daele L, Page A, Geraerts I, Krofta L, Deprest J. Laser therapy for urinary incontinence and pelvic organ prolapse: a systematic review. BJOG 2020; 127:1338-1346. [DOI: 10.1111/1471-0528.16273] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2020] [Indexed: 01/09/2023]
Affiliation(s)
- K Mackova
- Cluster Urogenital and Abdominal Surgery Department of Development and Regeneration KU Leuven Leuven Belgium
- Third Faculty of Medicine Institute for the Care of Mother and Child Charles University Prague Czech Republic
| | - L Van daele
- Faculty of Medicine KU Leuven Leuven Belgium
| | - A‐S Page
- Department Obstetrics and Gynaecology University Hospitals KU Leuven Leuven Belgium
| | - I Geraerts
- Department of Physical Medicine and Rehabilitation University Hospitals, KU Leuven Leuven Belgium
- Department Rehabilitation Sciences Group Biomedical Sciences KU Leuven Leuven Belgium
| | - L Krofta
- Third Faculty of Medicine Institute for the Care of Mother and Child Charles University Prague Czech Republic
| | - J Deprest
- Cluster Urogenital and Abdominal Surgery Department of Development and Regeneration KU Leuven Leuven Belgium
- Department Obstetrics and Gynaecology University Hospitals KU Leuven Leuven Belgium
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Allan BB, Bell S, Husarek K. A 12-month feasibility study to investigate the effectiveness of cryogen-cooled monopolar radiofrequency treatment for female stress urinary incontinence. Can Urol Assoc J 2020; 14:E313-E318. [PMID: 32017688 DOI: 10.5489/cuaj.6145] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The purpose of this early feasibility study was to evaluate the safety and efficacy of a non-ablative, cryogen-cooled, monopolar radiofrequency (CMRF) treatment for female stress urinary incontinence (SUI). METHODS Subjects meeting all the inclusion and exclusion criteria were enrolled and randomized into two groups. Subjects in group 1 received one CMRF treatment and subjects in group 2 received two CMRF treatments six weeks apart. Followup visits were performed at one, four, six, and 12 months post-treatment. At each study visit, subjects performed an objective, standardized one-hour pad weight test and completed several patient-reported outcome measures, a seven-day bladder voiding diary, and safety assessments. RESULTS Data indicate an improvement in SUI symptoms and quality of life for subjects, as determined by validated SUI-related patient-reported outcomes and the objective one-hour pad weight test, with a >50% reduction in pad weight from baseline for 52% of the subjects at 12 months. In addition to efficacy, the CMRF treatment was well-tolerated and safe. CONCLUSIONS The outcome measures evaluated indicate an improvement in SUI symptoms and quality of life. The sustained benefit of the CMRF vaginal treatment at 12 months suggests potential use as an office-based, non-surgical approach to treat mild to moderate SUI.
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Erel CT, Inan D, Mut A. Predictive factors for the efficacy of Er:YAG laser treatment of urinary incontinence. Maturitas 2020; 132:1-6. [DOI: 10.1016/j.maturitas.2019.11.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 09/24/2019] [Accepted: 11/08/2019] [Indexed: 12/11/2022]
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The safety and efficacy of CO2 laser in the treatment of stress urinary incontinence. Int Urogynecol J 2019; 31:1691-1696. [DOI: 10.1007/s00192-019-04204-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 11/27/2019] [Indexed: 12/28/2022]
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Erbium:YAG laser treatment of female stress urinary incontinence: midterm data. Int Urogynecol J 2019; 31:1859-1866. [DOI: 10.1007/s00192-019-04148-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 10/01/2019] [Indexed: 11/25/2022]
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Reisenauer C, Hartlieb S, Schoenfisch B, Brucker SY, Neis F. Vaginal therapy of mild and moderate stress urinary incontinence using Er:YAG laser: a real treatment option. Arch Gynecol Obstet 2019; 300:1645-1650. [DOI: 10.1007/s00404-019-05334-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 10/10/2019] [Indexed: 11/29/2022]
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Deffieux X. [Vaginal laser in pelviperineology: Fears and facts]. ACTA ACUST UNITED AC 2019; 47:694-695. [PMID: 31376507 DOI: 10.1016/j.gofs.2019.07.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Indexed: 10/26/2022]
Affiliation(s)
- X Deffieux
- Service de gynécologie-obstétrique, AP-HP, GHU Paris Sud, hôpital Antoine-Béclère, 92141 Clamart, France; Faculté de médecine, université Paris-Sud (Paris Saclay), 91405 Orsay, France.
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Samuels JB, Pezzella A, Berenholz J, Alinsod R. Safety and Efficacy of a Non-Invasive High-Intensity Focused Electromagnetic Field (HIFEM) Device for Treatment of Urinary Incontinence and Enhancement of Quality of Life. Lasers Surg Med 2019; 51:760-766. [PMID: 31172580 PMCID: PMC6851770 DOI: 10.1002/lsm.23106] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2019] [Indexed: 12/26/2022]
Abstract
Background and Objectives Urinary incontinence is a common and distressing condition which interferes with everyday life. Patients frequently experience discomfort related to urine leakage and the subsequent need to use absorbent pads. Since the continence mechanism is primarily maintained by a proper function of pelvic floor muscles (PFM), many treatment methods focused on strengthening of the PFM have been introduced in the past. The aim of this study was to evaluate the safety and efficacy of a high‐intensity focused electromagnetic technology (HIFEM) for treatment of urinary incontinence with emphasis on effects on prospective patients’ quality of life. Study Design/Materials and Methods The study followed an institutional review board approved protocol. A total of 75 women (55.45 ± 12.80 years, 1.85 ± 1.28 deliveries) who showed symptoms of stress, urge, or mixed urinary incontinence were enrolled. They received six HIFEM treatments (2 per week) in duration of 28 minutes. Outcomes were evaluated after the sixth treatment and at the 3‐month follow‐up. The primary outcome was to assess changes in urinary incontinence by the International Consultation on Incontinence Questionnaire‐Short Form (ICIQ‐SF) and changes in the number of absorbent pads used per day. The secondary outcome was subjective evaluation of the therapy and self‐reported changes in quality of life. The statistical analysis was conducted by paired T‐test and Pearson correlation coefficient (
α = 0.05). Results After the sixth session, 61 out of 75 patients (81.33%) reported significant reduction of their symptoms. The average improvement of 49.93% in ICIQ‐SF score was observed after the sixth treatment, which further increased to 64.42% at the follow‐up (both P < 0.001). Individually, the highest level of improvement was reached in patients suffering from mixed urinary incontinence (69.90%). The reduction of absorbent pads averaged 43.80% after the sixth treatment and 53.68% at 3 months (both P < 0.001), while almost 70% of patients (30 out of 43) reported decreased number of used pads. At the follow‐up, a highly significant medium correlation (r = 0.53, P < 0.001) was found between the ICIQ‐SF score improvement and the reduction in pad usage. A substantial decrease in the frequency of urine leakage triggers was documented. Patients reported no pain, downtime or adverse events, and also reported additional beneficial effects of the therapy such as increased sexual desire and better urination control. Conclusions This study demonstrated that HIFEM technology is able to safely and effectively treat a wide range of patients suffering from urinary incontinence. After six treatments, an improvement in ICIQ‐SF score and reduction in absorbent pads usage was observed. Based on subjective evaluation, these changes positively influenced quality of life. © 2019 The Authors. Lasers in Surgery and Medicine Published by Wiley Periodicals, Inc.
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Affiliation(s)
- Julene B Samuels
- FACS, Louisville, MD9419 Norton Commons Blvd Suite 101, River Bluff, KY, 40059
| | - Andrea Pezzella
- Southern Urogynecology: Center for Female Pelvic Medicine and Reconstructive Surgery, 115 Midlands Ct, West Columbia, SC, 29169
| | - Joseph Berenholz
- The Laser Vaginal Rejuvenation Institute of Michigan, 30445 Northwestern Hwy Suite 100, Farmington Hills, MI, 48334
| | - Red Alinsod
- South Coast Urogynecology, 31852 Coast Hwy #203, Laguna Beach, CA, 92651
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Laser Therapy in the Treatment of Female Urinary Incontinence and Genitourinary Syndrome of Menopause: An Update. BIOMED RESEARCH INTERNATIONAL 2019; 2019:1576359. [PMID: 31275962 PMCID: PMC6582847 DOI: 10.1155/2019/1576359] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Revised: 04/05/2019] [Accepted: 05/10/2019] [Indexed: 11/18/2022]
Abstract
Vaginal birth trauma is the leading cause of stress urinary incontinence (SUI) in women. Also, the process of ageing and hormonal deprivation in postmenopause alters the metabolism of connective tissues and decreases collagen production leading to pelvic floor dysfunction. Noninvasive treatment is recommended as first-line management of urinary incontinence (UI) in women. Surgical procedures are more likely to be implemented to cure UI but are associated with more adverse events. Sex hormone deficiency affects changes also in the lower urinary tract where estrogens are the main regulators of physiological functions of the vagina. In the last decade, laser treatment of SUI and of the genitourinary syndrome of menopause (GSM) has been shown a promising treatment method in peer-reviewed literature. This review's aim is to present the evidence-based medical data and laser treatment of SUI and GSM in an outpatient setting to be a good treatment option, regarding short-term as well as long-term follow-ups. Long-term follow-up studies are needed to confirm that laser treatment is a good, painless outpatient procedure with no side effects in postmenopausal women.
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Lukanović A. Commentary on “The use of laser in urogynaecology”. Int Urogynecol J 2019; 30:849. [PMID: 30710158 PMCID: PMC6491407 DOI: 10.1007/s00192-019-03885-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 01/16/2019] [Indexed: 12/01/2022]
Affiliation(s)
- Adolf Lukanović
- Department of Gynecology, University Medical Centre Ljubljana, Šlajmerjeva 3, SI-1000, Ljubljana, Slovenia.
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Singh P, Chong CYL, Han HC. Effects of Vulvovaginal Laser Therapy on Postmenopausal Vaginal Atrophy: A Prospective Study. J Gynecol Surg 2019. [DOI: 10.1089/gyn.2018.0048] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- Priyanka Singh
- Department of Urogynaecology, KK Women's and Children's Hospital, Singapore, Singapore
| | | | - How Chuan Han
- Department of Urogynaecology, KK Women's and Children's Hospital, Singapore, Singapore
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Ratz C. [Vaginal laser therapy for urinary incontinence and genitourinary syndrome of menopause : A review]. Urologe A 2019; 58:284-290. [PMID: 30721329 DOI: 10.1007/s00120-019-0861-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Use of vaginal laser therapy in the treatment of grade I stress urinary incontinence and genitourinary syndrome of menopause is gaining in importance across the globe. MATERIALS AND METHODS On the basis of the research that is currently available, an analysis is carried out regarding whether laser therapy is already suitable for use in the field of urology. RESULTS The research available is still limited: randomized controlled studies in particular are lacking. All the data published to date demonstrate a response to laser therapy with minimal side effects, high patient compliance and satisfaction, and a long-term response for a minimum of 12 months. CONCLUSIONS Vaginal laser therapy has shown potential and demonstrated its safety for use in urology as either a complementary or alternative treatment to existing treatment options, such as topical hormonal therapies, pelvic floor exercises or surgical procedures. It is necessary to define it as separate from aesthetic procedures.
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Affiliation(s)
- C Ratz
- Urologie Groß-Gerau, Am Sandböhl 2, 64521, Groß-Gerau, Deutschland.
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Effect of Er:YAG Laser for Women with Stress Urinary Incontinence. BIOMED RESEARCH INTERNATIONAL 2019; 2019:7915813. [PMID: 30766886 PMCID: PMC6350556 DOI: 10.1155/2019/7915813] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 12/25/2018] [Accepted: 01/01/2019] [Indexed: 01/24/2023]
Abstract
Purpose The aim of our study is to assess efficacy of noninvasive erbium-doped yttrium aluminium garnet laser (Er:YAG laser) for female stress urinary incontinence (SUI). Materials and Methods Forty-one women with SUI were included in the study and scheduled for vaginal Er:YAG laser treatment. The procedure was performed with a 2940 nm, Er:YAG laser (Fotona Smooth ™ XS, Fotona, Ljubljana, Slovenia), designed to heat up the vaginal mucosa to around 60°C. All subjects had a baseline and 6 months' posttreatment assessment that included perineal sonography and lower urinary tract symptoms. Results Significant improvements in both urinary frequency and incontinence were found 6 months after Er:YAG laser treatment when compared to the baseline results (p<0.001). The battery of questionnaires administered to patients, including the UDI-6, IIQ-7, OABSS, and POPDI-6, all showed significant improvement posttreatment (P < 0.001). The treatment efficacy for the vaginal Er:YAG laser for SUI at 6 months posttreatment was 75.5% (31/41). Bladder neck mobility by perineal ultrasonography decreased significantly (16.1 ± 6.4 mm to 10.5 ± 4.6 mm) after treatment (p=0.039). No permanent adverse events were found. Conclusions The Er:YAG vaginal laser seems to be a safe and efficacious treatment for women with mild to moderate SUI, this being partly related to the decrease of bladder neck mobility following laser treatment.
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Lukač M, Lozar A, Perhavec T, Bajd F. Variable heat shock response model for medical laser procedures. Lasers Med Sci 2019; 34:1147-1158. [DOI: 10.1007/s10103-018-02704-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 12/06/2018] [Indexed: 10/27/2022]
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Shobeiri SA, Kerkhof MH, Minassian VA, Bazi T. IUGA committee opinion: laser-based vaginal devices for treatment of stress urinary incontinence, genitourinary syndrome of menopause, and vaginal laxity. Int Urogynecol J 2018; 30:371-376. [PMID: 30523374 DOI: 10.1007/s00192-018-3830-0] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 11/14/2018] [Indexed: 11/26/2022]
Abstract
This committee opinion reviews the laser-based vaginal devices for treatment of genitourinary syndrome of menopause, vaginal laxity, and stress urinary incontinence. The United States Food and Drug Administration has issued a warning for unsubstantiated advertising and use of energy-based devices. Well-designed case-control studies are required to further investigate the potential benefits, harm, and efficacy of laser therapy in the treatment of genitourinary syndrome of menopause, vaginal laxity, and stress urinary incontinence. The therapeutic advantages of nonsurgical laser-based devices in urogynecology can only be recommended after robust clinical trials have demonstrated their long-term complication profile, safety, and efficacy.
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Affiliation(s)
- S Abbas Shobeiri
- Department of Obstetrics and Gynecology, INOVA Women's Hospital, Falls Church, VA, USA.
- Department of Biomedical Engineering, George Mason University, Fairfax, VA, USA.
| | - M H Kerkhof
- Curilion Female Health Clinic, Haralem, Netherlands
| | - Vatche A Minassian
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA, USA
| | - Tony Bazi
- Department of Obstetrics and Gynecology, The American University of Beirut, Beirut, Lebanon
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Impact of the mid-urethral sling for stress urinary incontinence on female sexual function and their partners’ sexual activity. Taiwan J Obstet Gynecol 2018; 57:853-857. [DOI: 10.1016/j.tjog.2018.10.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2018] [Indexed: 11/23/2022] Open
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Lin HY, Tsai HW, Tsui KH, An YF, Lo CC, Lin ZH, Liou WS, Wang PH. The short-term outcome of laser in the management of female pelvic floor disorders: Focus on stress urine incontinence and sexual dysfunction. Taiwan J Obstet Gynecol 2018; 57:825-829. [DOI: 10.1016/j.tjog.2018.10.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2018] [Indexed: 12/11/2022] Open
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Hsiao SM, Lin HH. Medical treatment of female overactive bladder syndrome and treatment-related effects. J Formos Med Assoc 2018; 117:871-878. [DOI: 10.1016/j.jfma.2018.01.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Revised: 01/12/2018] [Accepted: 01/16/2018] [Indexed: 10/18/2022] Open
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[CO 2 LASER for the treatment of vaginal symptoms of genitourinary syndrome of menopause]. ACTA ACUST UNITED AC 2018; 46:729-734. [PMID: 30241737 DOI: 10.1016/j.gofs.2018.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Indexed: 11/23/2022]
Abstract
Genitourinary syndrome of menopause (GSM) brings together a collection of signs including vaginal dryness, burning sensation and itching discomfort as well as deterioration of sexual health, dysuria, urgenturia and repeated urinary infections and may be responsible for a significant impairment of quality of life in symptomatic postmenopausal women. The management of GSM therefore represents a public health issue. Systemic or local hormonal treatments are frequently offered, as well as non-hormonal treatments. The existence of contraindications to hormonal treatments and the constraints of using local treatments lead us to propose other therapeutic options. CO2 LASER is now part of the therapeutic arsenal for the treatment of vaginal dryness in the context of GSM. There is a growing interest in this technique, especially for women who have a contraindication to hormonal therapy, as it is a globally effective, long-acting alternative with very little adverse effect. Current evidence suggests that this tool could provide a quality of life benefit to many patients with minimal side effect exposure, if used in the respect of its indications and implementation protocols. However, clinical data based on high-level therapeutic trials remain absolutely essential for this treatment to be validated and recommended by health professionals.
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Okui N. Comparison between erbium-doped yttrium aluminum garnet laser therapy and sling procedures in the treatment of stress and mixed urinary incontinence. World J Urol 2018; 37:885-889. [PMID: 30116962 PMCID: PMC6505485 DOI: 10.1007/s00345-018-2445-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 08/10/2018] [Indexed: 11/21/2022] Open
Abstract
Purpose Stress urinary incontinence (SUI) and mixed urinary incontinence (MUI) lead to poor quality of life. In Japan, urinary incontinence is treated with tension-free vaginal tape (TVT) or transobturator tape (TOT) sling procedures, which involves inserting a synthetic material; however, problems arise with artificial mesh in some instances, requiring new treatment methods. Hence, laser therapy, whereby an erbium-doped yttrium aluminum garnet laser is directed into the vagina and urethra, may be useful. The study aimed to compare the effects of these three treatments. Methods Subjects included patients who received TVT, TOT, or laser therapy (n = 50 each). The 1-h pad test, International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF), and overactive bladder symptom score were used to assess the patients before and 12 months after treatment. For laser therapy, a probe was inserted into the vagina after applying a local anesthetic to the vaginal wall, and irradiation was performed for 20 min at a wavelength of 2940 nm. This treatment was performed three times every alternate month. Results As per the 1-h pad test and ICIQ-SF, the TVT, TOT, and laser therapy groups showed comparable improvements in SUI. For patients with MUI, some in the TVT and TOT groups showed exacerbation; however, all patients in the laser therapy group tended to improve. Conclusions The efficacy of laser therapy for urinary incontinence was confirmed. This is the first study to report on the effect of laser therapy on urinary incontinence in Japanese women.
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Affiliation(s)
- Nobuo Okui
- Uro-Gyn.Net Health Care Cooperation, Dr. Okui's Urogynecology and Urology Clinic, Kanagawa, Japan.
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50
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Brandão P, Henriques J, Almeida A, Ramôa P. Female urinary incontinence: is laser treatment effective? a systematic review. ACTA ACUST UNITED AC 2018. [DOI: 10.15406/ogij.2018.09.00337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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