This study of Er:YAG laser therapy in women has demonstrated a clinically relevant, short-term improvement of stress urinary incontinence, with minimal adverse events of a transient nature.

Vaginal birth trauma is the leading cause of stress urinary incontinence (SUI) in women. Also, the process of ageing and hormonal deprivation in postmenopause alters the metabolism of connective tissues and decreases collagen production leading to pelvic floor dysfunction. Noninvasive treatment is recommended as first-line management of urinary incontinence (UI) in women. Surgical procedures are more likely to be implemented to cure UI but are associated with more adverse events. Sex hormone deficiency affects changes also in the lower urinary tract where estrogens are the main regulators of physiological functions of the vagina. In the last decade, laser treatment of SUI and of the genitourinary syndrome of menopause (GSM) has been shown a promising treatment method in peer-reviewed literature. This review’s aim is to present the evidence-based medical data and laser treatment of SUI and GSM in an outpatient setting to be a good treatment option, regarding short-term as well as long-term follow-ups. Long-term follow-up studies are needed to confirm that laser treatment is a good, painless outpatient procedure with no side effects in postmenopausal women.

Background and Objectives Energy‐based treatments have been found to be a promising treatment modality for improving stress urinary incontinence (SUI) symptoms. This prospective two‐center study was designed to evaluate the efficacy of fractional‐pixel CO2 laser for the treatment of SUI. Study Design/Materials and Methods Eighty‐five women with SUI symptoms as per the cough stress test and validated International Consultation on Incontinence Questionnaire—Urinary Incontinence Short Form (ICIQ‐UI‐SF), were treated intravaginally with Pixel‐CO2 laser. Two treatment sessions were performed with a 1‐month interval. Safety and treatment tolerance were assessed by the visual analog scale (VAS) immediately and at 1 week after each laser treatment. Associations of age and body mass index (BMI) with the ICIQ‐UI‐SF score were statistically assessed by the Jonckheere–Terpstra test. Results The ICIQ‐UI‐SF score was 12.0 at baseline, 7.0, after the first treatment, and 3.5 after the second treatment (P = 0.001). For women with BMI (25.0–29.9), the ICIQ‐UI‐SF score was 9.0 at the baseline, 6.0 after 1 month, and 5.0 at the 6 months follow‐up visit (P = 0.04). For women with BMI ≥ 30.0, the ICIQ‐UI‐SF score was reduced from 14.0 to 8.0 1 month after the baseline and 5.0 at the 6‐month follow‐up visit (P = 0.001). SUI severity evaluation at baseline showed that 27.1% of women had mild, 24.7% had moderate, 45.9% had severe, and 2.4% had very severe SUI symptoms. SUI severity scores were significantly reduced, with 45.8% of women with no SUI symptoms, 18.8% with mild, 20.8% with moderate, and 14.6% with severe SUI symptoms at the 6‐month follow‐up. The patient's evaluation of VAS after the first treatment was 1.0–1.5 (0–10) and 0.0 1 week after the second treatment. Conclusion Fractional‐pixel CO2 laser is safe and effective for treating SUI. No adverse event or significant pain was reported during or after the procedure. Its safety and efficacy are clearly demonstrated. Lasers Surg. Med. © 2020 Wiley Periodicals LLC

The use of platelet-rich plasma (PRP) for the treatment of lichen sclerosus (LS) in a 38-year-old premenopausal woman is reported. The diagnosis was confirmed histologically and the symptoms documented using the ICIQ Vaginal Symptoms Questionnaire (ICIQ-VS) and the Female Sexual Function Index (FSFI) questionnaire. PRP was prepared from autologous blood using the Regen Cellular Matrix Kit. PRP was administered twice over two months. Histology at follow-up one month after the second administration showed the epidermis was nearly normal and upper dermal cellularity had been restored. The patient was symptom-free and both her ICIQ-VS and her FSFI scores had improved significantly. PRP is a potential new treatment option for LS which needs further assessment in randomized controlled trials.