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Tan Y, Zhang Y, An J, Xu X, Deng J, Chen B, Pan W. Safety and Efficacy of Erbium: Yttrium-Aluminum-Garnet Laser Treatment in Chinese Women with Mild-to-Moderate Stress Urinary Incontinence. J Womens Health (Larchmt) 2024; 33:685-691. [PMID: 38563974 DOI: 10.1089/jwh.2023.0609] [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] [Indexed: 04/04/2024] Open
Abstract
Background: This study aims to evaluate the safety and efficacy of erbium:yttrium-aluminum-garnet (Er:YAG) laser treatment in female patients with mild-to-moderate stress urinary incontinence (SUI). Methods: From July 2018 to June 2020, 72 female patients with mild-to-moderate SUI were enrolled in this study. A baseline assessment was conducted, which included a 1-hour pad test, the validated International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI-SF), postvoid residual (PVR) testing, pelvic organ prolapse quantification (POP-Q) testing, and a cough stress test. All patients underwent four sessions of Er:YAG laser treatment using a smooth mode. A reassessment was performed 6 months after treatment to evaluate the safety and efficacy of the Er:YAG laser. Results: All patients completed four clinic visits, with a 1-month interval, and were followed up for a minimum of 6 months. No severe adverse reactions were observed during the treatment process. The 1-hour pad test revealed a significant reduction in urinary leakage from baseline (6.30 ± 1.06 g) to the 6-month follow-up (2.70 ± 0.96 g, p < 0.001), with 34 of 72 (47.22%) patients achieving negative results. The ICIQ-UI-SF score significantly decreased from baseline to 6 months (10.82 ± 1.38 to 2.96 ± 0.52, p < 0.001). PVR experimental results showed a significant decrease in residual urine volume after treatment (103.72 ± 8.61 mL to 43.86 ± 4.92 mL, p < 0.001). At the 6-month follow-up, hematoxylin and eosin staining results demonstrated that Er:YAG laser treatment significantly facilitated an increase in the thickness of squamous epithelial cells. The efficacy of Er:YAG laser treatment for SUI was 77.78% (56/72). Conclusions: Several objective and subjective assessments confirmed the safety and efficacy of vaginal smooth mode Er:YAG laser treatment for mild-to-moderate SUI during the 6-month follow-up period. Nonablative Er:YAG laser in the smooth mode is a viable treatment option for SUI patients.
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Affiliation(s)
- Yi Tan
- Department of Obstetrics and Gynecology, Dongguan Nancheng Hospital, Dongguan, China
| | - Yuchan Zhang
- Department of Obstetrics and Gynecology, Dongguan Nancheng Hospital, Dongguan, China
| | - Junli An
- Department of Obstetrics and Gynecology, Dongguan Nancheng Hospital, Dongguan, China
| | - Xueqiong Xu
- Department of Obstetrics and Gynecology, Dongguan Nancheng Hospital, Dongguan, China
| | - Jun Deng
- Department of Obstetrics and Gynecology, Dongguan Nancheng Hospital, Dongguan, China
| | - Biaowei Chen
- Department of Obstetrics and Gynecology, Dongguan Nancheng Hospital, Dongguan, China
| | - Wenwei Pan
- Department of Obstetrics and Gynecology, Dongguan Maternal and Child Health Care Hospital, Dongguan, China
- Dongguan Key Laboratory of Female Reproductive Health, Dongguan, China
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Harland N, Walz S, Eberli D, Schmid FA, Aicher WK, Stenzl A, Amend B. Stress Urinary Incontinence: An Unsolved Clinical Challenge. Biomedicines 2023; 11:2486. [PMID: 37760927 PMCID: PMC10525672 DOI: 10.3390/biomedicines11092486] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 08/29/2023] [Accepted: 09/05/2023] [Indexed: 09/29/2023] Open
Abstract
Stress urinary incontinence is still a frequent problem for women and men, which leads to pronounced impairment of the quality of life and withdrawal from the social environment. Modern diagnostics and therapy improved the situation for individuals affected. But there are still limits, including the correct diagnosis of incontinence and its pathophysiology, as well as the therapeutic algorithms. In most cases, patients are treated with a first-line regimen of drugs, possibly in combination with specific exercises and electrophysiological stimulation. When conservative options are exhausted, minimally invasive surgical therapies are indicated. However, standard surgeries, especially the application of implants, do not pursue any causal therapy. Non-absorbable meshes and ligaments have fallen into disrepute due to complications. In numerous countries, classic techniques such as colposuspension have been revived to avoid implants. Except for tapes in the treatment of stress urinary incontinence in women, the literature on randomized controlled studies is insufficient. This review provides an update on pharmacological and surgical treatment options for stress urinary incontinence; it highlights limitations and formulates wishes for the future from a clinical perspective.
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Affiliation(s)
- Niklas Harland
- Department of Urology, University of Tuebingen Hospital, 72076 Tuebingen, Germany; (N.H.); (S.W.); (A.S.)
| | - Simon Walz
- Department of Urology, University of Tuebingen Hospital, 72076 Tuebingen, Germany; (N.H.); (S.W.); (A.S.)
| | - Daniel Eberli
- Department of Urology, University Hospital Zurich, 8091 Zurich, Switzerland; (D.E.); (F.A.S.)
| | - Florian A. Schmid
- Department of Urology, University Hospital Zurich, 8091 Zurich, Switzerland; (D.E.); (F.A.S.)
| | - Wilhelm K. Aicher
- Centre for Medical Research, University of Tuebingen Hospital, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany;
| | - Arnulf Stenzl
- Department of Urology, University of Tuebingen Hospital, 72076 Tuebingen, Germany; (N.H.); (S.W.); (A.S.)
| | - Bastian Amend
- Department of Urology, University of Tuebingen Hospital, 72076 Tuebingen, Germany; (N.H.); (S.W.); (A.S.)
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Montera R, Ficarola F, Angioli R, Terranova C, Nardone CDC, Guzzo F, Plotti F, Luvero D. Efficacy of termoablative fractional CO 2 laser (Monnalisa Touch) in stress urinary incontinence. Neurourol Urodyn 2023; 42:393-400. [PMID: 36519661 DOI: 10.1002/nau.25112] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 10/31/2022] [Accepted: 12/05/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE Usually, in stress urinary incontinence (SUI), nonsurgical therapy such as pelvic floor muscle training (PFMT) and lifestyle changes are proposed before surgical treatment. Laser therapy has recently been recommended for the treatment of SUI, helping to reconstruct the collagen that supports the vagina and the pelvic floor. The aim of the study was to evaluate the efficacy of SUI treatment with a CO2 intravaginal laser in patients waiting for anti-incontinence surgery (TVT-O). METHODS This is a prospective, case-control study. Fifty-two patients have been included in our study and we divided them into two groups: atrophy and no atrophy. We also adopted a control group retrospectively identified from our database of patients undergoing PFMT. The subjective estimation of SUI symptoms before and after treatment was evaluated using the Visual Analog Scale before and after 1, 6, and 12 months of treatment. The objective evaluation with the urodynamic study with the stress test and a 3-day voiding diary to count the number of episodes of incontinence, before and after treatment. RESULTS The intravaginal CO2 laser improved all the parameters considered for SUI in both groups. Its results were more relevant in the atrophy group, in comparison to the no atrophy group, even if they were both statistically significant. There were no statistically significant differences for all the parameters evaluated for SUI between laser treatment and PFMT in the control group. CONCLUSION The CO2 laser is well-tolerated, minimally invasive, safe, and showing efficacy for SUI. More studies are needed to consider it as first-instance therapy, like PFMT, or at least, as a bridge therapy to surgery.
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Affiliation(s)
- Roberto Montera
- Department of Obstetrics and Gynecology, Campus Bio-Medico University Hospital Foundation, Rome, Italy
| | - Fernando Ficarola
- Department of Obstetrics and Gynecology, Campus Bio-Medico University Hospital Foundation, Rome, Italy
| | - Roberto Angioli
- Department of Obstetrics and Gynecology, Campus Bio-Medico University Hospital Foundation, Rome, Italy
| | - Corrado Terranova
- Department of Obstetrics and Gynecology, Campus Bio-Medico University Hospital Foundation, Rome, Italy
| | - Carlo De Cicco Nardone
- Department of Obstetrics and Gynecology, Campus Bio-Medico University Hospital Foundation, Rome, Italy
| | - Federica Guzzo
- Department of Obstetrics and Gynecology, Campus Bio-Medico University Hospital Foundation, Rome, Italy
| | - Francesco Plotti
- Department of Obstetrics and Gynecology, Campus Bio-Medico University Hospital Foundation, Rome, Italy
| | - Daniela Luvero
- Department of Obstetrics and Gynecology, Campus Bio-Medico University Hospital Foundation, Rome, Italy
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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: 0] [Impact Index Per Article: 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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Wallace SL, St Martin B, Lee K, Sokol ER. A cost-effectiveness analysis of vaginal carbon dioxide laser therapy compared with standard medical therapies for genitourinary syndrome of menopause-associated dyspareunia. Am J Obstet Gynecol 2020; 223:890.e1-890.e12. [PMID: 32562659 DOI: 10.1016/j.ajog.2020.06.032] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 06/02/2020] [Accepted: 06/10/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Topical vaginal estrogen therapy is considered the gold standard treatment for genitourinary syndrome of menopause-associated dyspareunia, but early investigations of energy-based devices show promise for patients with contraindications or those who are refractory to vaginal estrogen cream therapy. Although evaluating safety, efficacy, and long-term outcomes for novel technologies is critically important when new technologies become available to treat unmet healthcare needs, evaluation of the costs of these new technologies compared with existing therapies is also critically important but often understudied. OBJECTIVE We sought to perform a cost-effectiveness analysis of 3 therapies for genitourinary syndrome of menopause, including vaginal estrogen therapy, oral ospemifene therapy, and vaginal CO2 laser therapy and determine if vaginal laser therapy is a cost-effective treatment strategy for dyspareunia associated with genitourinary syndrome of menopause. STUDY DESIGN An institutional review board-exempt cost-effectiveness analysis was performed by constructing a decision tree using decision analysis software (TreeAge Pro; TreeAge Software, Inc, Williamstown, MA) using integrated empirical data from the published literature. Tornado plots and 1-way and 2-way sensitivity analyses were performed to assess how changes in the model's input parameters altered the overall outcome of the cost-effectiveness analysis model. RESULTS All 3 treatment methods were found to be cost-effective below the willingness-to-pay threshold of $50,000.00 per quality-adjusted life year for moderate dyspareunia. The incremental cost-effectiveness ratio for vaginal CO2 laser therapy was $16,372.01 and the incremental cost-effectiveness ratio for ospemifene therapy was $5711.14. Although all 3 treatment strategies were on the efficient frontier, vaginal CO2 laser therapy was the optimal treatment strategy with the highest effectiveness. In a 1-way sensitivity analysis of treatment adherence, vaginal CO2 laser therapy was no longer cost-effective when the adherence fell below 38.8%. Vaginal estrogen cream and ospemifene therapies remained cost-effective treatment strategies at all ranges of adherence. When varying the adherence to 100% for all strategies, oral ospemifene therapy was "dominated" by both vaginal CO2 laser therapy and vaginal estrogen cream therapy. In a 2-way sensitivity analysis of vaginal CO2 laser therapy adherence and vaginal CO2 laser therapy cost, vaginal CO2 laser therapy still remained the optimal treatment strategy at 200% of its current cost ($5554.00) when the adherence was >55%. When the cost fell to 20% of its current cost ($555.40), it was the optimal treatment strategy at all adherence values above 29%. CONCLUSION This study showed that vaginal fractional CO2 laser therapy is a cost-effective treatment strategy for dyspareunia associated with GSM, as are both vaginal estrogen and oral ospemifene therapies. In our model, vaginal CO2 laser therapy is the optimal cost-effective treatment strategy, and insurance coverage should be considered for this treatment option if it is proven to be safe and effective in FDA trials.
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Affiliation(s)
- Shannon L Wallace
- Division of Urogynecology, Department of Obstetrics and Gynecology, Stanford University Hospital, Palo Alto, CA.
| | - Brad St Martin
- Division of Urogynecology, Department of Obstetrics and Gynecology, Stanford University Hospital, Palo Alto, CA
| | - Kyueun Lee
- Department of Health Research and Policy, Stanford University, Palo Alto, CA
| | - Eric R Sokol
- Division of Urogynecology, Department of Obstetrics and Gynecology, Stanford University Hospital, Palo Alto, CA
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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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Vaginal energy-based devices: characterization of adverse events based on the last decade of MAUDE safety reports. Menopause 2020; 28:135-141. [PMID: 33003133 DOI: 10.1097/gme.0000000000001661] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Energy-based devices have gained momentum as minimally invasive procedures to treat both medical and cosmetic pelvic floor disorders including genitourinary syndrome of menopause, vaginal laxity, stress urinary incontinence, dyspareunia, and vulvar disorders such as lichen diseases and vestibulitis. However, the FDA recently issued a statement cautioning patients and providers that the safety and efficacy of energy-based devices for the treatment of vaginal symptoms has not been well established. Additionally, the FDA sent letters to the manufactures of energy-based devices with notifications that they could be violating the marketing standards of the FDA. The existing data on side effects is insufficient and limited to observational studies. We sought to characterize the safety events of vaginal energy-based devices by analysis of surveillance data from the FDA Manufacturer and User Facility Device Experience (MAUDE) database and specifically look at those events that occurred prior to the July 30, 2018 warning. METHODS The MAUDE database was queried between September 30, 2013 and October 31, 2019 for all vaginal energy-based devices. The incidence of safety events was reported for these devices and the most common complaints were described and characterized. Event reporting was analyzed before and after July 30, 2018. RESULTS Forty-two unique and relevant medical device reports (MDRs) were retrieved. The Mona Lisa Touch had the highest number of MDRs (40.5%) followed by ThermiVa (16.7%) and Viveve (14.2%). Each medical device report was associated with a single patient experience and within the 42 medical device reports, there were 85 complaints. A majority of the MDR complaints (52.9%) were also indications for energy-based devices procedures, which include vaginal pain, dyspareunia, lichen sclerosis, and urinary frequency. Two-thirds of the complaints (68.2%) were related to pain, but serious adverse events such as third-degree burns (3.5%) were rare. Most of the reportable events occurred before July 30, 2018 (83.3%), but most were reported after July 30, 2018 (78.6%). CONCLUSIONS MAUDE-reported data suggests that the majority of patient complaints after vaginal energy-based device treatment include vaginal pain, bladder pain, and urinary symptoms. This study suggests that the majority of complaints are not severe, and some may be related to progression of the disease. The few severe adverse events reported in the MAUDE database may have contributed to the FDA warning regarding energy-based devices. Recall bias after the FDA warning, as well as the potential for litigation, may have prompted an increase in adverse event reporting after July 30, 2018.
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Mounir DM, Hernandez N, Gonzalez RR. Update: The Clinical Role of Vaginal Lasers for the Treatment of the Genitourinary Syndrome of Menopause. Urology 2020; 151:2-7. [PMID: 32966821 DOI: 10.1016/j.urology.2020.09.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 08/26/2020] [Accepted: 09/13/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To educate providers on the emergence of vaginal lasers for the treatment of the genitourinary syndrome of menopause (GSM) and discuss the peer-reviewed literature regarding their use. MATERIALS AND METHODS A search of literature databases (PubMed and Medline) was performed for publications in February 2020. Keywords included genitourinary syndrome of menopause, urinary incontinence, overactive bladder, urgency, urinary tract infections, atrophy, laser, and vaginal. We reviewed the available published literature, identifying articles, guidance, and society statements on the use vaginal laser therapies. RESULTS The literature regarding vaginal laser therapy in the treatment of the GSM is primarily limited to prospective case series with small numbers and short-term follow-up. Nevertheless, these studies have demonstrated reductions in genitourinary syndrome of menopause symptoms. High quality data describing the safety, benefits, and appropriate use of vaginal laser therapy is lacking. CONCLUSION Vaginal laser treatment for the GSM is of interest as it provides patients with a nonhormonal treatment option. Further research to better outline the indications, efficacy, safety, and applications of this technology is needed before supporting its universal use for the management of the GSM.
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Affiliation(s)
- Danny M Mounir
- Houston Methodist Hospital, Department of Urology, Houston, TX
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Lane GI, Barboglio-Romo P, Crescenze I, Raza D, Clemens JQ, Dahm P, Gupta P. Vaginal lasers for treating stress urinary incontinence in women. Hippokratia 2020. [DOI: 10.1002/14651858.cd013643] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
| | | | - Irene Crescenze
- Department of Urology; Ohio State University; Columbus Ohio USA
| | - Daniel Raza
- Tulane University; New Orleans Louisiana USA
| | | | - Philipp Dahm
- Urology Section; Minneapolis VA Health Care System; Minneapolis Minnesota USA
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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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Aguiar LB, Politano CA, Costa-Paiva L, Juliato CRT. Efficacy of Fractional CO 2 Laser, Promestriene, and Vaginal Lubricant in the Treatment of Urinary Symptoms in Postmenopausal Women: A Randomized Clinical Trial. Lasers Surg Med 2020; 52:713-720. [PMID: 31990089 DOI: 10.1002/lsm.23220] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND OBJECTIVES Evaluating the efficacy of the fractional CO2 laser, promestriene, and vaginal lubricant to treat urinary symptoms in women with genitourinary syndrome of menopause. STUDY DESIGN/MATERIALS AND METHODS We conducted a randomized clinical trial with 72 postmenopausal women aged 50 years or older. The participants were randomized to one intervention each in three treatment groups fractional CO2 laser, promestriene, and vaginal lubricant. Urinary symptoms were assessed prior to treatment and 2 weeks after treatment completion using validated questionnaires, the International Consultation on Incontinence Questionnaire (ICIQ-UI SF), and the International Consultation on Incontinence Questionnaire Overactive Bladder (ICIQ-OAB). RESULTS There was a significant reduction in the total ICIQ-UI SF score in the intragroup comparison (baseline vs. week 14) of the CO2 laser group (P = 0.004). This group also showed a statistically significant reduction in nocturia (1.33 ± 0.87 vs. 1.00 ± 0.76, respectively; P = 0.031). In the intergroup comparison after treatment, nocturia in the lubricant group had worsened compared with that of the other two groups (P = 0.002). Regarding the total ICIQ-OAB score, the results of the CO2 laser group were superior to those of the lubricant group in the intergroup comparison (7.76 ± 3.36, P = 0.020; analysis of variance P = 0.038). CONCLUSION The results were significantly different between the intravaginal fractional CO2 laser and topical estrogen groups for treating urinary symptoms related to the genitourinary syndrome of menopause. Further controlled and randomized studies are needed. Lasers Surg. Med. © 2020 Wiley Periodicals, Inc.
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Affiliation(s)
- Luiza Borges Aguiar
- Department of Obstetrics and Gynecology, State University of Campinas, Campinas, São Paulo, Brazil
| | - Carlos Alberto Politano
- Department of Obstetrics and Gynecology, State University of Campinas, Campinas, São Paulo, Brazil
| | - Lúcia Costa-Paiva
- Department of Gynecology and Obstetrics, State University of Campinas, Rua Alexandre Fleming, 101, Campinas, São Paulo, CEP 13083-881, Brazil
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Perruzza D, Jolliffe C, Butti A, McCaffrey C, Kung R, Gagnon L, Lee P. Quality and Reliability of Publicly Accessible Information on Laser Treatments for Urinary Incontinence: What Is Available to Our Patients? J Minim Invasive Gynecol 2020; 27:1524-1530. [PMID: 31927043 DOI: 10.1016/j.jmig.2020.01.001] [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: 10/11/2019] [Revised: 12/30/2019] [Accepted: 01/06/2020] [Indexed: 10/25/2022]
Abstract
STUDY OBJECTIVE To determine the quality and reliability of the top 20 internet search results for laser treatment of stress urinary incontinence (SUI). DESIGN Review of 20 websites. SETTING N/A. PATIENTS None. INTERVENTIONS An internet search with the most popular search engine, Google, was undertaken to identify the top 20 websites for laser treatment of SUI. The DISCERN instrument, Journal of the American Medical Association (JAMA) benchmarks, and Health on the Net Foundation Code of Conduct certification, which are standardized, validated tools for the analysis of website quality, credibility, and transparency, were used independently by 7 healthcare workers. The readability of the information was assessed by a single reviewer using the Flesch-Kincaid Grade Level and Automated Readability Index. The intraclass correlation coefficient was calculated to document the reliability among website assessors. MEASUREMENTS AND MAIN RESULTS Of the 20 websites reviewed, 15 were created by private clinics, 2 by online newspaper or newsletter sites, and 3 by laser medical device manufacturers. None of the websites met all of the JAMA criteria: 1 had attained authorship, 1 had clear attribution, none had adequate disclosure, and 2 achieved currency. None of the websites took part in the Health on the Net Foundation Code of Conduct certification program. The mean DISCERN score (to determine the quality of websites) was 40 (out of 80), with the lowest average scores within the DISCERN tool primarily associated with clarity around sources of information, website bias, posting dates, risks of treatment, and shared treatment decision-making. The intraclass correlation coefficient was calculated for the DISCERN tool (0.72; 95% confidence interval, 0.48-0.87) and JAMA benchmarks (0.85; 95% confidence interval, 0.73-0.93). The mean Flesch-Kincaid Grade Level was 13.2 (±3.1) and the Automated Readability Index scores ranged from 7.6 to 22.8 (mean 13.5 ± 3.5). CONCLUSION There is a lack of good quality, reliable, and unbiased information available to patients on laser treatment of SUI on the most commonly searched websites. Information is presented at a reading level that is above that of the average reader, which may indicate that patients will have trouble comprehending the information.
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Affiliation(s)
- Darian Perruzza
- Faculty of Medicine, University of Toronto (Ms. Perruzza and Mr. Butti); Department of Obstetrics and Gynecology, Division of Urogynecology, Sunnybrook Health Sciences Centre (Drs. Jolliffe, McCaffrey, Kung, Gagnon, and Lee), University of Toronto, Toronto, Ontario
| | - Courtney Jolliffe
- Faculty of Medicine, University of Toronto (Ms. Perruzza and Mr. Butti); Department of Obstetrics and Gynecology, Division of Urogynecology, Sunnybrook Health Sciences Centre (Drs. Jolliffe, McCaffrey, Kung, Gagnon, and Lee), University of Toronto, Toronto, Ontario
| | - Andrew Butti
- Faculty of Medicine, University of Toronto (Ms. Perruzza and Mr. Butti); Department of Obstetrics and Gynecology, Division of Urogynecology, Sunnybrook Health Sciences Centre (Drs. Jolliffe, McCaffrey, Kung, Gagnon, and Lee), University of Toronto, Toronto, Ontario
| | - Carmen McCaffrey
- Faculty of Medicine, University of Toronto (Ms. Perruzza and Mr. Butti); Department of Obstetrics and Gynecology, Division of Urogynecology, Sunnybrook Health Sciences Centre (Drs. Jolliffe, McCaffrey, Kung, Gagnon, and Lee), University of Toronto, Toronto, Ontario
| | - Rose Kung
- Faculty of Medicine, University of Toronto (Ms. Perruzza and Mr. Butti); Department of Obstetrics and Gynecology, Division of Urogynecology, Sunnybrook Health Sciences Centre (Drs. Jolliffe, McCaffrey, Kung, Gagnon, and Lee), University of Toronto, Toronto, Ontario
| | - Louise Gagnon
- Faculty of Medicine, University of Toronto (Ms. Perruzza and Mr. Butti); Department of Obstetrics and Gynecology, Division of Urogynecology, Sunnybrook Health Sciences Centre (Drs. Jolliffe, McCaffrey, Kung, Gagnon, and Lee), University of Toronto, Toronto, Ontario
| | - Patricia Lee
- Faculty of Medicine, University of Toronto (Ms. Perruzza and Mr. Butti); Department of Obstetrics and Gynecology, Division of Urogynecology, Sunnybrook Health Sciences Centre (Drs. Jolliffe, McCaffrey, Kung, Gagnon, and Lee), University of Toronto, Toronto, Ontario..
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13
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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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14
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Affiliation(s)
- Swati Jha
- Consultant Gynaecologist Subspecialist in Urogynaecology Sheffield Teaching Hospitals NHS Foundation Trust Level 4, Jessop Wing, Tree Root Walk Sheffield S10 2SF UK
| | - Tim Hillard
- Consultant Gynaecologist and Urogynaecologist Department of Obstetrics and Gynaecology Poole Hospital NHS Foundation Trust Longfleet Road Poole Dorset BH15 2JB UK
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15
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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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16
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Itkonen Freitas AM, Rahkola-Soisalo P, Mikkola TS, Mentula M. Current treatments for female primary stress urinary incontinence. Climacteric 2019; 22:263-269. [DOI: 10.1080/13697137.2019.1568404] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- A.-M. Itkonen Freitas
- Department of Obstetrics and Gynaecology, Helsinki University Hospital, Helsinki University, Helsinki, Finland
| | - P. Rahkola-Soisalo
- Department of Obstetrics and Gynaecology, Helsinki University Hospital, Helsinki University, Helsinki, Finland
| | - T. S. Mikkola
- Department of Obstetrics and Gynaecology, Helsinki University Hospital, Helsinki University, Helsinki, Finland
| | - M. Mentula
- Department of Obstetrics and Gynaecology, Helsinki University Hospital, Helsinki University, Helsinki, Finland
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17
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Female Cosmetic Genital Reconstruction: a Review of Current Trends, Treatments, and Techniques. CURRENT SEXUAL HEALTH REPORTS 2019. [DOI: 10.1007/s11930-019-00191-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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18
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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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19
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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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20
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Digesu GA, Swift S. Laser treatment in urogynaecology and the myth of the scientific evidence. Int Urogynecol J 2017; 28:1443-1444. [PMID: 28842718 DOI: 10.1007/s00192-017-3458-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Accepted: 08/10/2017] [Indexed: 11/28/2022]
Affiliation(s)
- G Alessandro Digesu
- Department of Urogynaecology, St Mary's Hospital, London, UK. .,Academic Department of Obstetrics and Gynaecology, Department of Urogynaecology, St Mary's Hospital, Mint Wing, South Wharf, London, W2 1NY, UK.
| | - Steven Swift
- Department of Obstetrics and Gynaecology, Medical University of South Carolina, Charleston, SC, USA
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