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Is there enough evidence to justify the use of laser and other thermal therapies in female lower urinary tract dysfunction? Report from the ICIa??RS 2019
摘要： Aims: There is increasing evidence to suggest that thermomodulation may have a role in the management of women with lower urinary tract dysfunction (LUTD) and there has been widespread adoption of laser and radiofrequency (RF) therapies within clinical practice. However, in many areas of LUTD, the data are still limited and there remains a need for further evaluation of the safety and efficacy of thermal therapy. The aim of this study proposal is to report the findings of the International Consultation on Incontinence Research Society to clarify our current knowledge regarding the evidence for thermal therapy in LUTD and to set research priorities for the future. Methods: Literature review based on the search terms: "laser," "radiofrequency," "genitourinary syndrome of the menopause" or "urogenital atrophy," "stress urinary incontinence (SUI)," "pelvic organ prolapse," "OAB" or "overactive bladder," and "urinary tract infection." Results: The current available evidence, though of low or very low quality, appears promising for the use of laser therapy in the management of genitourinary syndrome of the menopause, there are some data to suggest a possible role in SUI although very little evidence for urogenital prolapse. At present, the evidence supporting the use of laser in OAB and recurrent urinary tract infection is limited or lacking, while the available evidence for RF in the management of all forms of LUTD is much less robust. Conclusions: Laser and RF are being introduced clinically as a minimally invasive, low‐risk interventions for women with LUTD although at present, the evidence supporting usage is limited. Consequently, there is an urgent need to demonstrate the safety and efficacy with prospective long‐term studies including sham studies and comparative studies with current standard therapy.
关键词： lower urinary tract dysfunction,laser,radiofrequency,female,atrophy,stress urinary incontinence
更新于2025-09-19 17:13:59
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Re: Erbium:YAG Laser Treatment of Female Stress Urinary Incontinence: Midterm Data
摘要： The role of intravaginal laser therapy for the treatment of women with a clinical and urodynamic diagnosis of stress urinary incontinence (SUI) or mixed urinary incontinence was the focus of the recent study by Kuszka and colleagues. To evaluate subjective and objective outcomes of Er:YAG therapy with SMOOTH mode technology, the authors enrolled 59 women, of whom 32 had grade I (54%), 16 had grade II (27%), and 11 had grade III SUI (19%). Using validated questionnaires (ICIQ-UI SF, PISQ 12) and 1-h pad weight at baseline, after two, four, and five laser sessions, and at 6-mo and 2-yr follow-up, the authors found that intravaginal laser therapy led to cure/improvement for grades I and II but not for severe SUI. At least three laser sessions at intervals of 1 mo are required to obtain better results from laser therapy. Outcomes at the 6-mo and 2-yr follow-up visits were similar, indicating that laser treatment is suitable and does not need to be repeated within 2 yr.
关键词： Female Stress,Urinary Incontinence,Midterm Data,Treatment,Erbium:YAG Laser
更新于2025-09-19 17:13:59
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Quality and Reliability of Publicly Accessible Information on Laser Treatments for Urinary Incontinence: What Is Available to Our Patients?
摘要： 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. Journal of Minimally Invasive Gynecology (2020) 00, 1?7. ? 2020 AAGL. All rights reserved.
关键词： Website review,Stress urinary incontinence,Laser vaginal treatment
更新于2025-09-19 17:13:59
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Efficacy of the Use of Fractional CO2RE Intima Laser Treatment in Stress and Mixed Urinary Incontinence
摘要： Objective: The objective of this clinical study was to evaluate the efficacy of a vaginal CO2 laser treatment (CO2RE Intima) in patients with moderate, severe and very severe stress urinary incontinence (SUI) or mixed urinary incontinence (MUI), as well as its impact in sexual relations. Design: This was a single-center, prospective, interventional study that included 25 women aged 35-68 years who presented with moderate, severe and very severe symptoms of SUI or MUI, based on Sandvik index and ICIQ-UI scores. A series of three fractional micro-ablative CO2 laser treatment sessions was performed, each spaced 4 to 6 weeks apart. Improvements were measured and evaluated using scores from validated questionnaires including the International Consultation on Incontinence Questionnaire (ICIQ-IU), the Sandvik severity index, and the Female Sexual Function Index (FSFI). Adverse events were recorded throughout the study and assessed using the Common Side Effect Questionnaire that evaluates pain, hemorrhage, burn, bruising and edema. Results: CO2RE intima laser treatment resulted in a significant improvement (P<0.001) in the scores of both the ICIQ-UI questionnaire and the Sandvik index, after the 2nd session; and this significance persisted after the 3rd treatment session. Improvements in UI severity was also achieved; after the 1st laser treatment, a significant improvement in severity was seen (p< 0.01), the significance of which showed to increase after the 2nd and 3rd treatment sessions (p<0.001). Improvement related to the type of UI measured with the ICIQ questionnaire was significant in both cases with SUI (p=0.035) and MUI (p<0.001) after the second treatment. This difference persisted after the 3rd treatment in cases of MUI and the trend, though not the statistical significance, persisted in SUI cases, (p=0.197). Improvement in severity was significant in both SUI and MUI types, from the first treatment to the end of the study. Sexual function of patients as reflected in the FSFI questionnaire scores also showed to improve; the difference was significant after the second session (p=0.013) and persisted at the end of the study (p= 0.047). Conclusion: Fractional, micro-ablative CO2RE Intima laser treatment is a minimally invasive procedure that can significantly improve moderate and severe SUI and MUI. It also improves sexual function in women with these types of incontinence. Though our positive results are promising, this preliminary data must be confirmed with other studies.
关键词： CO2RE Intima laser,moderate and severe stress urinary incontinence,mixed urinary incontinence
更新于2025-09-16 10:30:52
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Preliminary outcome of non-ablative vaginal Erbium laser treatment for female stress and mixed urinary incontinence
摘要： Objective: This prospective study presents a preliminary result to compare the clinical ef?cacy of patients with stress urinary incontinence and mixed urinary incontinence using minimal invasive Er:YAG vaginal laser. Materials and methods: A total of 20 patients were included, in which were 10 patients with SUI and 10 patients with MUI (stress and urge incontinence), and underwent a 2940 nm Er:YAG laser with a special SMOOTH mode in an outpatient of?ce without anesthesia or postoperative medications. All patients completed two sessions of treatment with an interval time of 28 days. At three months after treatment, all patients were asked to a clinical visit for evaluate the clinical outcome by pre-treatment and post-treatment ICIQ-SF questionnaire. At pretreatment and 3 months after the completion of two therapy sessions, patients were asked to answer the ICIQ-SF questionnaire. The questionnaire consists of three scales for assessment of the treatment outcome of urinary incontinence as: no change (no change score), improvement (decrease score 1e5), and strong improvement (decrease score >5) for two groups of patients with SUI and MUI. All the results were compared by Student's t test with two way analysis of variance between the two groups. Results: A total of 20 patients presented with SUI symptom relief and improvement with treatment satisfaction. All 10 patients with SUI reported improvement after vaginal laser treatment, 70% with marked improvement and 30% with improvement. All 10 patients with MUI also had improvement, 40% with marked improvement and 60% with improvement. There was no statistically signi?cant difference in the treatment outcome between the two groups. Conclusions: Vaginal Erbium laser produce provides vaginal collagen remodeling and synthesis that may repair and restore the pelvic ?oor function. Despite of sample limitation and short follow up, this treating procedure presented a good and a safe clinical outcome in patients with SUI and with MUI by assessment of ICIQ-SF questionnaire.
关键词： Stress urinary incontinence,Er:YAG vaginal laser,Urge incontinence,Mixed urinary incontinence
更新于2025-09-12 10:27:22
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Erbium:YAG laser treatment of female stress urinary incontinence: midterm data
摘要： Introduction and hypothesis Stress urinary incontinence (SUI) is treated using intravaginal laser therapy. We wanted to find out how incontinence severity at baseline and the number of laser interventions affect success rate, and whether the effect of laser therapy was obvious 6 months and 2 years after the last laser intervention. Methods Fifty-nine women, 32 with SUI I, 16 with SUI II, and 11 with SUI III were treated using an erbium-doped yttrium aluminium garnet (Er:YAG) laser following the IncontiLase? protocol. Therapy included five laser sessions with a 1-month interval between sessions. Objective (1-h pad test) and subjective data (International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form [ICIQ-UI SF], Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire [PISQ-12]) were assessed at baseline, after two and four laser sessions and 6 months and 2 years after the fifth laser session. Results Objective cure/improve rates for mild SUI I were 69%, 78%, 91%, and 78% after two, four, and five laser sessions at the 6-month and 2-year follow-ups. Subjective cure rates (ICIQ-UI SF) were 53%, 69%, 72%, and 66%, and sexual function (PISQ-12) also improved. For SUI II, objective cure/improve rates were 31%, 63%, 69%, and 50%. Subjective cure rate was 13% at the 2-year follow-up. For SUI III, only one patient had an objective improvement after two and four laser sessions. Conclusions Intravaginal laser therapy led to cure/improvement for SUI I and SUI II, but not for severe SUI III. Outcome was better after four to five laser sessions than after two laser sessions. Follow-up data 6 months and 2 years after laser intervention showed sustainability of the treatment.
关键词： ICIQ-UI SF,1-h pad test,Stress urinary incontinence,Intravaginal laser therapy,Erbium:YAG laser,Non-ablative SMOOTH mode
更新于2025-09-12 10:27:22
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Predictive Factors for the Efficacy of Er:YAG Laser Treatment of Urinary Incontinence
摘要： Predictive Factors for the Efficacy of Er:YAG Laser Treatment of Urinary Incontinence. Methods: Eighty-two patients with UI were treated by Er:YAG laser in this cohort study. The patients were evaluated by ICIQ-SF and KHQ-UI before and after the procedure. Improvement was categorized as: none (0-25%), mild (26-50%), moderate (51-75%), or high (76-100%). The duration of the treatment effect was evaluated at follow-up in relation to maximum improvement time (MIT) and total improvement time (TIT). Objectives: To determine the efficacy and predictive factors for the success of Er:YAG laser treatment in patients with urinary incontinence (UI). Results: Forty-two patients were determined to have SUI and 40 patients MUI. The mean ISIQ-SF and KHQ-UI scores significantly improved after the procedure (p<0.0001). The SUI patients responded to the laser treatment significantly better (p<0.008). Younger women had significantly better results (p<0.008), while premenopausal women (p<0.032) and women in the early postmenopausal years (p<0.032) also saw a positive response to the Er:YAG laser treatment. Women with a lower BMI had greater improvement (p<0.011). The total laser energy expenditure during the sessions may also be a predictive parameter for the success of Er:YAG laser treatment of UI (p=0.059). MIT and TIT were significantly longer among the patients in the high-improvement group. Conclusion: Er:YAG laser treatment of the symptoms of UI, especially SUI, is more efficacious and of longer duration for younger, premenopausal or early postmenopausal women with normal BMI.
关键词： BMI,Er:YAG Laser,Stress Urinary Incontinence,Age,Menopause
更新于2025-09-11 14:15:04