BACKGROUND Overactive bladder syndrome (OABS) is a common disorder that encompasses urgency, frequency, and nocturia. Various methods of therapies have been utilized worldwide. Despite progresses, it remains a formidable challenge. Laser treatment has emerged to reliably treat the symptoms complex. This study was intended to evaluate the effect of fractional CO2 laser on the main symptoms of OABS. MATERIALS AND METHODS A prospective pre-and post-intervention pilot study was conducted on 31 female subjects recruited from a general hospital in Tehran, Iran. They were treated with 3 laser applications at one-month interval using the intravaginal fractional micro-ablative CO2 laser. The study measures were urgency, frequency, nocturia, leakage, International Consultation on Incontinence Overactive Bladder (ICIQ-OAB), Urogenital Distress Inventory Short Form (UDI-6), and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12), which were examined at baseline and every month thereafter up to the end of the laser treatment sessions. RESULTS The findings indicated that statistically significant differences occurred in the ICIQ-OAB score and urgency during treatment sessions as compared to the baseline (p<0.05). Laser therapy led to marked improvements in the UDI-6 score only at month 3 (p=0.001). Nocturia, frequency, leakage, and PISQ-12 score did not ameliorate upon laser administration (p>0.05). CONCLUSION In this pilot study, it was found that fractional CO2 laser could be effective in the amelioration of some OABS symptoms in menopausal women. Further investigations with a larger sample size and long-term follow-ups are required to substantiate these preliminary findings.
There are several techniques for repairing prolapse in the posterior vaginal compartment, yet there is no general agreement on the best surgical procedure. This study was performed to investigate the outcomes of the common vaginal route technique for posterior vaginal wall prolapse repair in the first Iranian fellowship teaching center for female pelvic floor disorders. This prospective cohort study was performed on women with posterior vaginal wall prolapse with or without prolapse of other vaginal compartments who underwent surgery between 2014 and 2018 in a referral center for female pelvic floor disorders. A follow-up period of 12 months was considered. Patients subjected to the transvaginal technique by attachment of the rectovaginal fascia to the pericervical ring using vaginal native tissue were included. Among the 107 patients, the Pelvic Floor Distress Inventory-20 (PFDI-20) scores were 141.87 ± 34.48 and 100.87 ± 26.48 before and after surgery, respectively, showing the significant improvement of patient’s symptoms after surgery in the 12-month follow-up. Comparing Pelvic Organ Prolapse Quantification (POP-Q) results before and after surgery, a significant improvement in patients’ conditions was seen at the 12-month follow-up. Based on the results of the present study, the surgical procedure of the rectovaginal fascia attachment to the pericervical ring in posterior vaginal wall prolapse repair seems an effective surgical intervention without significant morbidity in the short-term follow-up.
Division of Female Pelvic Medicine and Surgery, Department of Obstetrics and Gynecology, Emam Khomeini Hospital, Tehran University of medical sciences proposed a clinically relevant algorithm to guide appropriate decision making based on underlying risk stratification and resource utilization in order to resume elective surgeries, following COVID-19 pandemic crisis. The consequence of standardized decision-making factors and transparency of the principles will provide more assurance, consistency, and reliability on both sides, care providers and the patient. It also will decrease ethical dilemmas and moral criticism for surgeons. Eventually, this approach is applicable in any other disaster preparedness as a logical stratification of surgical indications for the female pelvic floor surgical procedures.
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