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Published in: International Urogynecology Journal 8/2020

01-08-2020 | Stress Incontinence | Original Article

The safety and efficacy of CO2 laser in the treatment of stress urinary incontinence

Authors: Hanin Dabaja, Roy Lauterbach, Emad Matanes, Ilan Gruenwald, Lior Lowenstein

Published in: International Urogynecology Journal | Issue 8/2020

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Abstract

Introduction and hypothesis

Conservative treatment is recommended as first-line therapy for stress urinary incontinence (SUI). We hypothesized that CO2 laser treatment would demonstrate safety and efficacy for women with SUI.

Methods

A prospective, open-label, cohort study of 33 women (mean age 43 years) referred from a continence clinic after urologist/urogynecologist assessment, with a verified stress urinary incontinence diagnosis based on urodynamic testing. The participants completed three outpatient treatments with laser therapy and were subsequently evaluated at 1, 3 and 6 months. The independent t and chi-square tests were used to assess changes in sanitary pad usage and SUI symptoms.

Results

Sanitary pad usage decreased from a median of 12 per day at baseline to 7 at 1–3 months post-treatment (P < 0.0001) and returned to 12 at 6 months post-treatment. Scores on the Urogenital Distress Inventory and the International Consultation of Incontinence Questionnaire decreased (improved) significantly at 1–3 months post-treatment: from 45 ± 2 and 16 ± 4, respectively, to 29.3 ± 14.7 and 8.15 ± 3.1, respectively (P < 0.0001). The scores returned to levels similar to baseline at 6 months after treatment. Participants reported mild and transient side effects, with significant improvement in quality of life.

Conclusions

Laser therapy can be an optional conservative treatment for women who seek minimally invasive non-surgical treatment for the management of SUI. No serious adverse effects were reported though the sample size was not large, a possible limitation of the study. Further large randomized control trials are needed to appraise the efficacy and safety of laser therapy for stress urinary incontinence and to demonstrate the ultimate utility of this modality.
Literature
1.
go back to reference Castro RA, Arruda RM, Bortolini MA. Female urinary incontinence: effective treatment strategies. Climacteric: the journal of the International Menopause Society. 2015;18:135–41.CrossRef Castro RA, Arruda RM, Bortolini MA. Female urinary incontinence: effective treatment strategies. Climacteric: the journal of the International Menopause Society. 2015;18:135–41.CrossRef
2.
go back to reference MacLennan AH, Taylor AW, Wilson DH, Wilson D. The prevalence of pelvic floor disorders and their relationship to gender, age, parity and mode of delivery. BJOG: an international journal of obstetrics and gynaecology. 2000;107:1460–70.CrossRef MacLennan AH, Taylor AW, Wilson DH, Wilson D. The prevalence of pelvic floor disorders and their relationship to gender, age, parity and mode of delivery. BJOG: an international journal of obstetrics and gynaecology. 2000;107:1460–70.CrossRef
3.
go back to reference Norton P, Brubaker L. Urinary incontinence in women. Lancet. 2006;367:57–67.CrossRef Norton P, Brubaker L. Urinary incontinence in women. Lancet. 2006;367:57–67.CrossRef
4.
go back to reference Nystrom E, Sjostrom M, Stenlund H, Samuelsson E. ICIQ symptom and quality of life instruments measure clinically relevant improvements in women with stress urinary incontinence. Neurourol Urodyn. 2015;34:747–51.CrossRef Nystrom E, Sjostrom M, Stenlund H, Samuelsson E. ICIQ symptom and quality of life instruments measure clinically relevant improvements in women with stress urinary incontinence. Neurourol Urodyn. 2015;34:747–51.CrossRef
5.
go back to reference Gil KM, Somerville AM, Cichowski S, Savitski JL. Distress and quality of life characteristics associated with seeking surgical treatment for stress urinary incontinence. Health Qual Life Outcomes. 2009;7:8.CrossRef Gil KM, Somerville AM, Cichowski S, Savitski JL. Distress and quality of life characteristics associated with seeking surgical treatment for stress urinary incontinence. Health Qual Life Outcomes. 2009;7:8.CrossRef
6.
go back to reference Urinary incontinence and pelvic organ prolapse in women: management National Institute for Health and Care Excellence (NICE) guideline [NG123]. Urinary incontinence and pelvic organ prolapse in women: management National Institute for Health and Care Excellence (NICE) guideline [NG123].
7.
go back to reference Bump RC, Norton PA, Zinner NR, Yalcin I. Mixed urinary incontinence symptoms: urodynamic findings, incontinence severity, and treatment response. Obstet Gynecol. 2003;102:76–83.PubMed Bump RC, Norton PA, Zinner NR, Yalcin I. Mixed urinary incontinence symptoms: urodynamic findings, incontinence severity, and treatment response. Obstet Gynecol. 2003;102:76–83.PubMed
8.
go back to reference Schimpf MO, Rahn DD, Wheeler TL, et al. Sling surgery for stress urinary incontinence in women: a systematic review and metaanalysis. Am J Obstet Gynecol. 2014;211:71 e1–71 e27.CrossRef Schimpf MO, Rahn DD, Wheeler TL, et al. Sling surgery for stress urinary incontinence in women: a systematic review and metaanalysis. Am J Obstet Gynecol. 2014;211:71 e1–71 e27.CrossRef
9.
go back to reference Barski D, Gerullis H, Georgas E, et al. Coating of mesh grafts for prolapse and urinary incontinence repair with autologous plasma: exploration stage of a surgical innovation. Biomed Res Int. 2014;2014:296498.CrossRef Barski D, Gerullis H, Georgas E, et al. Coating of mesh grafts for prolapse and urinary incontinence repair with autologous plasma: exploration stage of a surgical innovation. Biomed Res Int. 2014;2014:296498.CrossRef
10.
go back to reference Maher C, Feiner B, Baessler K, Christmann-Schmid C, Haya N, Brown J. Surgery for women with anterior compartment prolapse. Cochrane Database Syst Rev. 2017;11:Cd004014. Maher C, Feiner B, Baessler K, Christmann-Schmid C, Haya N, Brown J. Surgery for women with anterior compartment prolapse. Cochrane Database Syst Rev. 2017;11:Cd004014.
12.
go back to reference Arunkalaivanan A, Kaur H, Onuma O. Laser therapy as a treatment modality for genitourinary syndrome of menopause: a critical appraisal of evidence. Int Urogynecol J. 2017;28:681–5.CrossRef Arunkalaivanan A, Kaur H, Onuma O. Laser therapy as a treatment modality for genitourinary syndrome of menopause: a critical appraisal of evidence. Int Urogynecol J. 2017;28:681–5.CrossRef
13.
go back to reference Gambacciani M, Levancini M. Short-term effect of vaginal erbium laser on the genitourinary syndrome of menopause. Minerva Ginecol. 2015;67:97–102.PubMed Gambacciani M, Levancini M. Short-term effect of vaginal erbium laser on the genitourinary syndrome of menopause. Minerva Ginecol. 2015;67:97–102.PubMed
14.
go back to reference Salvatore S, Nappi RE, Zerbinati N, et al. A 12-week treatment with fractional CO2 laser for vulvovaginal atrophy: a pilot study. Climacteric: the journal of the International Menopause Society. 2014;17:363–9.CrossRef Salvatore S, Nappi RE, Zerbinati N, et al. A 12-week treatment with fractional CO2 laser for vulvovaginal atrophy: a pilot study. Climacteric: the journal of the International Menopause Society. 2014;17:363–9.CrossRef
15.
go back to reference Salvatore S, Leone Roberti Maggiore U, Athanasiou S, et al. Histological study on the effects of microablative fractional CO2 laser on atrophic vaginal tissue: an ex vivo study. Menopause. 2015;22:845–9.CrossRef Salvatore S, Leone Roberti Maggiore U, Athanasiou S, et al. Histological study on the effects of microablative fractional CO2 laser on atrophic vaginal tissue: an ex vivo study. Menopause. 2015;22:845–9.CrossRef
16.
go back to reference Hutchinson-Colas J, Segal S. Genitourinary syndrome of menopause and the use of laser therapy. Maturitas. 2015;82:342–5.CrossRef Hutchinson-Colas J, Segal S. Genitourinary syndrome of menopause and the use of laser therapy. Maturitas. 2015;82:342–5.CrossRef
17.
go back to reference Pieralli A, Fallani MG, Becorpi A, et al. Fractional CO2 laser for vulvovaginal atrophy (VVA) dyspareunia relief in breast cancer survivors. Arch Gynecol Obstet. 2016;294:841–6.CrossRef Pieralli A, Fallani MG, Becorpi A, et al. Fractional CO2 laser for vulvovaginal atrophy (VVA) dyspareunia relief in breast cancer survivors. Arch Gynecol Obstet. 2016;294:841–6.CrossRef
18.
go back to reference Arroyo C. Fractional CO2 laser treatment for vulvovaginal atrophy symptoms and vaginal rejuvenation in perimenopausal women. Int J Women’s Health. 2017;9:591–5.CrossRef Arroyo C. Fractional CO2 laser treatment for vulvovaginal atrophy symptoms and vaginal rejuvenation in perimenopausal women. Int J Women’s Health. 2017;9:591–5.CrossRef
19.
go back to reference Pagano T, De Rosa P, Vallone R, et al. Fractional microablative CO2 laser for vulvovaginal atrophy in women treated with chemotherapy and/or hormonal therapy for breast cancer: a retrospective study. Menopause. 2016;23:1108–13.CrossRef Pagano T, De Rosa P, Vallone R, et al. Fractional microablative CO2 laser for vulvovaginal atrophy in women treated with chemotherapy and/or hormonal therapy for breast cancer: a retrospective study. Menopause. 2016;23:1108–13.CrossRef
20.
go back to reference Gambacciani M, Levancini M. Vaginal erbium laser as second-generation thermotherapy for the genitourinary syndrome of menopause: a pilot study in breast cancer survivors. Menopause. 2017;24:316–9.CrossRef Gambacciani M, Levancini M. Vaginal erbium laser as second-generation thermotherapy for the genitourinary syndrome of menopause: a pilot study in breast cancer survivors. Menopause. 2017;24:316–9.CrossRef
21.
go back to reference Sokol ER, Karram MM. An assessment of the safety and efficacy of a fractional CO2 laser system for the treatment of vulvovaginal atrophy. Menopause. 2016;23:1102–7.CrossRef Sokol ER, Karram MM. An assessment of the safety and efficacy of a fractional CO2 laser system for the treatment of vulvovaginal atrophy. Menopause. 2016;23:1102–7.CrossRef
22.
go back to reference Salvatore S, Nappi RE, Parma M, et al. Sexual function after fractional microablative CO(2) laser in women with vulvovaginal atrophy. Climacteric: the journal of the International Menopause Society. 2015;18:219–25.CrossRef Salvatore S, Nappi RE, Parma M, et al. Sexual function after fractional microablative CO(2) laser in women with vulvovaginal atrophy. Climacteric: the journal of the International Menopause Society. 2015;18:219–25.CrossRef
23.
go back to reference Fistonic N, Fistonic I, Gustek SF, et al. Minimally invasive, non-ablative Er:YAG laser treatment of stress urinary incontinence in women--a pilot study. Lasers Med Sci. 2016;31:635–43.CrossRef Fistonic N, Fistonic I, Gustek SF, et al. Minimally invasive, non-ablative Er:YAG laser treatment of stress urinary incontinence in women--a pilot study. Lasers Med Sci. 2016;31:635–43.CrossRef
24.
go back to reference Ogrinc UB, Sencar S, Lenasi H. Novel minimally invasive laser treatment of urinary incontinence in women. Lasers Surg Med. 2015;47:689–97.CrossRef Ogrinc UB, Sencar S, Lenasi H. Novel minimally invasive laser treatment of urinary incontinence in women. Lasers Surg Med. 2015;47:689–97.CrossRef
25.
go back to reference Filippini M, Del Duca E, Negosanti F, et al. Fractional CO2 laser: from skin rejuvenation to Vulvo-vaginal reshaping. Photomed Laser Surg. 2017;35:171–5.CrossRef Filippini M, Del Duca E, Negosanti F, et al. Fractional CO2 laser: from skin rejuvenation to Vulvo-vaginal reshaping. Photomed Laser Surg. 2017;35:171–5.CrossRef
26.
go back to reference Lee MS. Treatment of vaginal relaxation syndrome with an erbium:YAG laser using 90 degrees and 360 degrees scanning scopes: a pilot Study & Short-term Results. Laser therapy. 2014;23:129–38.CrossRef Lee MS. Treatment of vaginal relaxation syndrome with an erbium:YAG laser using 90 degrees and 360 degrees scanning scopes: a pilot Study & Short-term Results. Laser therapy. 2014;23:129–38.CrossRef
27.
go back to reference Lev-Sagie A, Kopitman A, Brzezinski A. Low-level laser therapy for the treatment of provoked Vestibulodynia-a randomized, placebo-controlled pilot trial. J Sex Med. 2017;14:1403–11.CrossRef Lev-Sagie A, Kopitman A, Brzezinski A. Low-level laser therapy for the treatment of provoked Vestibulodynia-a randomized, placebo-controlled pilot trial. J Sex Med. 2017;14:1403–11.CrossRef
28.
go back to reference Murina F, Karram M, Salvatore S, Felice R. Fractional CO2 laser treatment of the vestibule for patients with Vestibulodynia and genitourinary syndrome of menopause: a pilot study. J Sex Med. 2016;13:1915–7.CrossRef Murina F, Karram M, Salvatore S, Felice R. Fractional CO2 laser treatment of the vestibule for patients with Vestibulodynia and genitourinary syndrome of menopause: a pilot study. J Sex Med. 2016;13:1915–7.CrossRef
29.
go back to reference Drnovsek-Olup B, Beltram M, Pizem J. Repetitive Er:YAG laser irradiation of human skin: a histological evaluation. Lasers Surg Med. 2004;35:146–51.CrossRef Drnovsek-Olup B, Beltram M, Pizem J. Repetitive Er:YAG laser irradiation of human skin: a histological evaluation. Lasers Surg Med. 2004;35:146–51.CrossRef
30.
go back to reference Zerbinati N, Serati M, Origoni M, et al. Microscopic and ultrastructural modifications of postmenopausal atrophic vaginal mucosa after fractional carbon dioxide laser treatment. Lasers Med Sci. 2015;30:429–36.CrossRef Zerbinati N, Serati M, Origoni M, et al. Microscopic and ultrastructural modifications of postmenopausal atrophic vaginal mucosa after fractional carbon dioxide laser treatment. Lasers Med Sci. 2015;30:429–36.CrossRef
31.
go back to reference Poon VK, Huang L, Burd A. Biostimulation of dermal fibroblast by sublethal Q-switched Nd:YAG 532 nm laser: collagen remodeling and pigmentation. J Photochem Photobiol B. 2005;81:1–8.CrossRef Poon VK, Huang L, Burd A. Biostimulation of dermal fibroblast by sublethal Q-switched Nd:YAG 532 nm laser: collagen remodeling and pigmentation. J Photochem Photobiol B. 2005;81:1–8.CrossRef
32.
go back to reference Jiang X, Ge H, Zhou C, Chai X, Ren QS. The role of vascular endothelial growth factor in fractional laser resurfacing with the carbon dioxide laser. Lasers Med Sci. 2012;27:599–606.CrossRef Jiang X, Ge H, Zhou C, Chai X, Ren QS. The role of vascular endothelial growth factor in fractional laser resurfacing with the carbon dioxide laser. Lasers Med Sci. 2012;27:599–606.CrossRef
33.
go back to reference Chan SS, Cheung RY, Lai BP, Lee LL, Choy KW, Chung TK. Responsiveness of the pelvic floor distress inventory and pelvic floor impact questionnaire in women undergoing treatment for pelvic floor disorders. Int Urogynecol J. 2013 Feb;24(2):213–21.CrossRef Chan SS, Cheung RY, Lai BP, Lee LL, Choy KW, Chung TK. Responsiveness of the pelvic floor distress inventory and pelvic floor impact questionnaire in women undergoing treatment for pelvic floor disorders. Int Urogynecol J. 2013 Feb;24(2):213–21.CrossRef
34.
go back to reference Lin HY, Tsai HW, Tsui KH, et al. The short-term outcome of laser in the management of female pelvic floor disorders: focus on stress urine incontinence and sexual dysfunction. Taiwanese journal of obstetrics & gynecology. 2018;57:825–9.CrossRef Lin HY, Tsai HW, Tsui KH, et al. The short-term outcome of laser in the management of female pelvic floor disorders: focus on stress urine incontinence and sexual dysfunction. Taiwanese journal of obstetrics & gynecology. 2018;57:825–9.CrossRef
35.
go back to reference Lin KL, Chou SH, Long CY. Effect of Er:YAG laser for women with stress urinary incontinence. Biomed Res Int. 2019;2019:7915813.PubMedPubMedCentral Lin KL, Chou SH, Long CY. Effect of Er:YAG laser for women with stress urinary incontinence. Biomed Res Int. 2019;2019:7915813.PubMedPubMedCentral
36.
go back to reference Blaganje M, Scepanovic D, Zgur L, Verdenik I, Pajk F, Lukanovic A. Non-ablative Er:YAG laser therapy effect on stress urinary incontinence related to quality of life and sexual function: a randomized controlled trial. Eur J Obstet Gynecol Reprod Biol. 2018;224:153–8.CrossRef Blaganje M, Scepanovic D, Zgur L, Verdenik I, Pajk F, Lukanovic A. Non-ablative Er:YAG laser therapy effect on stress urinary incontinence related to quality of life and sexual function: a randomized controlled trial. Eur J Obstet Gynecol Reprod Biol. 2018;224:153–8.CrossRef
37.
go back to reference Lin YH, Hsieh WC, Huang L, Liang CC. Effect of non-ablative laser treatment on overactive bladder symptoms, urinary incontinence and sexual function in women with urodynamic stress incontinence. Taiwanese journal of obstetrics & gynecology. 2017;56:815–20.CrossRef Lin YH, Hsieh WC, Huang L, Liang CC. Effect of non-ablative laser treatment on overactive bladder symptoms, urinary incontinence and sexual function in women with urodynamic stress incontinence. Taiwanese journal of obstetrics & gynecology. 2017;56:815–20.CrossRef
38.
go back to reference Gonzalez Isaza P, Jaguszewska K, Cardona JL, Lukaszuk M. 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. 2018;29:211–5.CrossRef Gonzalez Isaza P, Jaguszewska K, Cardona JL, Lukaszuk M. 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. 2018;29:211–5.CrossRef
39.
go back to reference Gaspar A, Brandi H. Non-ablative erbium YAG laser for the treatment of type III stress urinary incontinence (intrinsic sphincter deficiency). Lasers Med Sci. 2017;32:685–91.CrossRef Gaspar A, Brandi H. Non-ablative erbium YAG laser for the treatment of type III stress urinary incontinence (intrinsic sphincter deficiency). Lasers Med Sci. 2017;32:685–91.CrossRef
40.
go back to reference Neimark AI, Yakovleva AY, Lapii GA. Outcomes of ER:YAG LASER treatment of stress urinary incontinence in women. Urologiia. 2018:20–5. Neimark AI, Yakovleva AY, Lapii GA. Outcomes of ER:YAG LASER treatment of stress urinary incontinence in women. Urologiia. 2018:20–5.
41.
go back to reference Tien YW, Hsiao SM, Lee CN, Lin HH. Effects of laser procedure for female urodynamic stress incontinence on pad weight, urodynamics, and sexual function. Int Urogynecol J. 2017;28:469–76.CrossRef Tien YW, Hsiao SM, Lee CN, Lin HH. Effects of laser procedure for female urodynamic stress incontinence on pad weight, urodynamics, and sexual function. Int Urogynecol J. 2017;28:469–76.CrossRef
42.
go back to reference US Food and Drug Administration. FDA Warns Against Use of Energy-Based Devices to Perform Vaginal “Rejuvenation” or Vaginal Cosmetic Procedures [Internet]. FDA Safety Communications. US Food and Drug Administration. FDA Warns Against Use of Energy-Based Devices to Perform Vaginal “Rejuvenation” or Vaginal Cosmetic Procedures [Internet]. FDA Safety Communications.
Metadata
Title
The safety and efficacy of CO2 laser in the treatment of stress urinary incontinence
Authors
Hanin Dabaja
Roy Lauterbach
Emad Matanes
Ilan Gruenwald
Lior Lowenstein
Publication date
01-08-2020
Publisher
Springer International Publishing
Published in
International Urogynecology Journal / Issue 8/2020
Print ISSN: 0937-3462
Electronic ISSN: 1433-3023
DOI
https://doi.org/10.1007/s00192-019-04204-4

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