engleski

Erbium Laser Treatment for early stages of Stress Urinary Incontinence (SUI) in Women

Objective: Approximately 40% of women suffer from urine leakage, since only about one fourth of them address their symptoms to their medical providers. Frequent deliveries and the process of ageing distend vaginal musculature irreversibly, reducing the level of pelvic floor muscle contraction. This effect significantly deteriorates their quality of life. The same number of women report dissatisfaction concerning their ability to achieve sexual gratification due to vaginal relaxation, which interferes with the intensity of contact during sexual intercourse, thus significantly impairing one of the most important domains of quality of life. Facial ptosis, uvular and soft-palate relaxation in snoring disorder are only some of the entities where the application of laser-generated thermal impulses has been scientifically confirmed as highly successful. The hypothesis that laser therapy can be effectively used in the gynecological practice for the treatment of genitourinary disorders was researched to prove the efficacy of laser photo thermal effect in the treatment of static urinary incontinence and pelvic diaphragm distension of the 1st and 2nd grade in women. Laser-generated thermal enegy, particularly in the moist environment, not only effectively improve collagen structures, but also stimulates collagen neogenesis producing tightening and shrinking of endopelvic fascia and pelvic floor tissue which consolidates the long-term outcome enhancing sexual gratification in women with previous SUI. Methods: This open-labeled, prospective, single-center pilot study was conducted on 83 woman patients who were scheduled for laser vaginal tightening or Kegel exercises in control group after completing inclusion criteria: mild or moderate SUI ; history of vaginal delivery ; pelvic organ prolapse of the 1st or 2nd grade ; Q-tip angle, while straining, over 30 degrees ; low score of PISQ12 and positive score of ICIQ-UI questionnaires ; low perineometry values assessing pelvic floor muscle strength and endurance (maximal pressure, average pressure, duration of pressure). Procedure was performed with Er-Yag laser XS Dynamis® (Fotona, Slovenia). Follow up was scheduled for 1, 2 and 6 months, measuring all the parameters. Results: Preliminary results have showed significant improvement (p<0.05) in all the domains tested: ICIQ-UI scores decreased by more than 3 points at all follow-ups. A mean duration of muscle contraction measured with perineometry at 1 month increased by 4.7 s, at 3 months by 11.8 s and at 6 months by 22.8 s. Q-tip angle decreased by 14.7° at 1 month follow-up, by 15.9° at 3 months and by 22.5° at 6 months. PISQ-12 scores increased after 1 month by 5.4 points, after 3 months by 5.9 points and after 6 months by 6.6 points. Conclusion: Novel treatment of the early stages of SUI and vaginal distension effectively improve relevant parameters of pelvic floor muscles strength and quality of life as well. This is the first study that objectivizes the effect of exclusively erbium laser photo effect on vaginal tightening without using any kind of surgical adjuvant techniques. The results after the intervention show significant improvement in reducing SUI episodes empowering vaginal and pelvic wall strength, simultaneously enhancing better sexual response. By employing this new method based on the photo-thermal effect of laser waves, it is possible, for women with early-stage prolapse or stress incontinence, to avoid minor (sling) or major surgical interventions (vaginal hysterectomy with colporrhaphy).

laser ; stress urinary incontinence ; sexual gratification

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