Effectiveness of fractional CO₂ laser in women with stress urinary incontinence

Abstract

BACKGROUND: Stress urinary incontinence (SUI) is a relatively common disorder that significantly affects the quality of life. Many conservative and surgical treatment methods have been recommended for SUI, but they have major limitations.

AIMS: To assess the use of the CO₂ fractional laser in the treatment of SUI.

METHODS: This clinical trial included 55 patients with confirmed SUI. Patients underwent fractional CO₂ laser treatment 3 times at 30-day intervals. Data on age, smoking history, sexual activity, menopause, and history of hormone replacement therapy (HRT) were collected. Response to treatment was assessed by SUI severity and the level of sexual satisfaction was assessed using the visual analog scale (VAS). Patients were evaluated at 3 different time points: before treatment, and 45 days and 6 months after the last laser treatment.

RESULTS: The mean patient age was 44.4±11.4 years (range: 28 to 68 years). Smoking history was positive in 6 patients (9.1%); 19 (54.3%) were menopausal on HRT. The SUI severity score at baseline (before treatment) was 8.56±0.62 and decreased to 2.28 6 months after treatment (p<0.0001). The sexual satisfaction score was 3±0.94 at baseline and increased to 7.87±0.93 6 months after treatment (day 180) (p<0.0001, slope= + 2.2)

CONCLUSION: Our findings are in line with a previous study that showed the value of transvaginal CO₂ fractional laser treatment for alleviation of SUI symptoms and its potential as an alternative treatment. We also observed improved sexual satisfaction in SUI patients.

Key words： stress urinary incontinence; CO₂ fractional laser; sexual function

Acknowledgments

We wish to thank all our colleagues in Golestan Hospital, Ahvaz, Iran

Compliance with ethics guidelines

The authors declare that they have no conflict of interest. This paper does not involve any studies with human or animal subjects performed by any of the authors.

References

1 Fistonić N, Fistonić I, Guštek Š F, Turina I S, Marton I, Vižintin Z, Kažič M, Hreljac I, Perhavec T, Lukač M (2016). Minimally invasive, non-ablative Er:YAG laser treatment of stress urinary incontinence in women--a pilot study. Lasers Med Sci, 31(4): 635–643; Epub ahead of print

PMID

2 Isaza P G, Jaguszewska K, Cardona J L, Lukaszuk M (2017). Long-term effect of thermoablative fractional CO₂ laser treatment as a novel approach to urinary incontinence management in women with genitourinary syndrome of menopause. Int Urogynecol J Pelvic Floor Dysfunct, 29 (2) :1–5

3 Kavanagh A, Sanaee M, Carlson K V, Bailly G G (2017). Management of patients with stress urinary incontinence after failed midurethral sling. Can Urol Assoc J, 11(6Suppl2): S143–S146

PMID

4 Kociszewski J, Fabian G, Grothey S, Kuszka A, Zwierzchowska A, Majkusiak W, Barcz E (2017). Are complications of stress urinary incontinence surgery procedures associated with the position of the sling? Int J Urol, 24(2): 145–150

PMID

5 Luber K M (2004). The definition, prevalence, and risk factors for stress urinary incontinence. Rev Urol, 6(Suppl 3): S3–S9

PMID

6 Menachem A, Alexander B, Martinec K A, Gutman G (2016). The effect of vaginal CO₂ laser treatment on stress urinary incontinence symptoms. Alma Surgical.

7 Nygaard I E, Heit M (2004). Stress urinary incontinence. Obstet Gynecol, 104(3): 607–620

PMID

8 Pardo J I, Solà V R, Morales A A (2016). Treatment of female stress urinary incontinence with Erbium-YAG laser in non-ablative mode. Eur J Obstet Gynecol Reprod Biol, 204: 1–4

PMID

9 Park S H, Kang C B (2014). Effect of kegel exercises on the management of female stress urinary incontinence: A systematic review of randomized controlled trials. Advan Nur, 2014 (4) :1–10

10 Pitsouni E, Grigoriadis T, Falagas M E, Salvatore S, Athanasiou S (2017). Laser therapy for the genitourinary syndrome of menopause. A systematic review and meta-analysis. Maturitas, 103: 78–88

PMID

11 Pitsouni E, Grigoriadis T, Tsiveleka A, Zacharakis D, Salvatore S, Athanasiou S (2016). Microablative fractional CO₂-laser therapy and the genitourinary syndrome of menopause: An observational study. Maturitas, 94: 131–136

PMID

12 Salvatore S, Nappi R E, Parma M, Chionna R, Lagona F, Zerbinati N, Ferrero S, Origoni M, Candiani M, Leone Roberti Maggiore U (2015). Sexual function after fractional microablative CO₂ laser in women with vulvovaginal atrophy. Climacteric, 18(2): 219–225

PMID

13 Ulmsten U, Falconer C (1999). Connective tissue in female urinary incontinence. Curr Opin Obstet Gynecol, 11(5): 509–515

PMID

14 van Kerrebroeck P, ter Meulen F, Farrelly E, Larsson G, Edwall L, Fianu-Jonasson A (2003). Treatment of stress urinary incontinence: recent developments in the role of urethral injection. Urol Res, 30(6): 356–362

PMID

15 Zhou S, Zhang K, Atala A, Khoury O, Murphy SV, Zhao W, Fu Q (2016). Stem cell therapy for treatment of stress urinary incontinence: the current status and challenges. Stem Cell Intern, 2016 (3) :7060975