Laser Therapy in the Treatment of Female Urinary Incontinence and Genitourinary Syndrome of Menopause: An Update

Abstract

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.

Physical methods for the treatment of genitourinary syndrome of menopause: A systematic review

“…After reviewing the full‐text articles, an additional 20 records were excluded. This process resulted in 49 articles, 1,2,4,13‐58 which were further reviewed using a hand‐searching approach. Table 2 displays all the selected studies.…”

“…Table 2 displays all the selected studies. Of these, 37 were about the CO 2 laser, 1,2,4,13,14,17‐19,22‐27,29‐31,33‐37,39,42,45‐47,49‐58 10 were about the Erbium laser, 15,16,20,32,38,40,41,43,44,48 and two were about radiofrequency 21,28 . Outcomes of the studies included in the systematic review are shown in Table 3.…”

“…Genitourinary syndrome of menopause (GSM) is a new term created to replace vulvovaginal atrophy (VVA). It is characterized by symptoms ranging from genital (dryness, burning, and irritation) and sexual changes (lack of lubrication, discomfort/pain, impaired function) to urinary symptoms (urgency, dysuria) 1,2 . During this period, there is a decrease in circulating estrogen, which provokes thinning of the vaginal epithelium and a reduction in its collagen content, hyalinization, and elastin content, thereby increasing the connective tissue density and reducing the vascularity of the vagina.…”

Gyn-Aesthetic: the ‘new normal’ after COVID-19

“…The energy-releasing systems developed for vulvovaginal use stimulate neocollagenesis and neoelastogenesis after the tissue surface temperature reaches 40-45°C [32]. Four decades of observation allows us to safely argue that there is no risk of neoplastic growth or DNA mutation.…”

Pixel CO2 Laser for the Treatment of Stress Urinary Incontinence: A Prospective Observational Multicenter Study

“…Since 2015, many clinical studies have shown the advantages of different energy‐based devices (EBD) for the treatment of SUI/genitourinary syndrome of menopause (GSM), mainly Er:YAG and carbon dioxide (CO 2 ) laser [6]. Most studies have referred to the use of nonablative Er:YAG laser for the treatment of SUI [7–9], and one study specified its use for SUI and mixed urinary incontinence (MUI) [10].…”