Fractional carbon dioxide vaginal laser treatment of stress urinary incontinence: Remodeling of vaginal tissues and improving pelvic floor structures

Abstract

Objective To demonstrate remodeling of vaginal biomechanical and physiological properties using vaginal fractional carbon dioxide (CO2) laser treatment of stress urinary incontinence (SUI). Materials and Methods The study cohort included 26 patients with SUI between October 2019 and November 2020. Patients were treated with two sessions of FemTouch vaginal fractional CO2 laser with a one‐month interval. Three subjective assessments were administered to all patients: female sexual function index (FSFI), vaginal health index score (VHIS), and international consultation on incontinence questionnaire‐short form (ICIQ‐SF). Vaginal tissue biopsies were taken from 6 patients before treatment and one‐month after the final treatment. Vaginal tactile imaging (VTI) measurements, ultrasonography, and magnetic resonance imaging (MRI) scans were performed before treatment and 10–12‐months after treatment in 10, 9, and 6 patients, respectively. Results The average age of the cohort was 39.5 ± 12.0 years. The overall scores for FSFI, VHIS, and ICIQ‐SF significantly improved in patients after each treatment sessions as compared with baseline scores. VTI showed significantly increased pressure resistance of both the anterior and posterior vaginal walls after treatment. Ultrasonography showed significant decreases in bladder neck mobility and urethrovesical angle during the Valsalva maneuver after treatment. MRI scans showed significant decreases in the length of the vaginal anterior wall after treatment. Histological examination confirmed that the laser treatment led to a thicker stratified squamous epithelium layer as compared to the baseline. Conclusions Our results demonstrated that vaginal fractional CO₂ laser treatment can restore vaginal biomechanical and physiological properties by increasing vaginal tightening and improving pelvic floor structures.

CO2 laser therapy for management of stress urinary incontinence in women: a systematic review and meta-analysis

“…The therapy involves the use of a high-energy CO 2 laser to stimulate collagen production in the vaginal tissues, which can help to strengthen the pelvic floor muscles and improve bladder control. [19][20][21] The procedure is minimally invasive and can be performed in a doctor's office with minimal discomfort. Advantageously, the procedure does not require a hospital stay, and patients can usually resume their normal activities within a few days.…”

“…This procedure mechanistically involves the use of a CO 2 laser to stimulate collagen production and tighten the tissues around the urethra, which can help improve bladder control and reduce leakage. [19][20][21] Numerous studies have investigated the effectiveness of CO 2 laser therapy for management of SUI-related symptoms. However, the results have been constrained by small sample sizes, varying study designs, different follow-up times, and conflicting outcomes.…”