Structural Reorganization of the Vaginal Mucosa in Stress Urinary Incontinence under Conditions of Er:YAG Laser Treatment

Лапий, Г. А.; Yakovleva, A Yu; Неймарк, А. И.

doi:10.1007/s10517-017-3650-0

Cited by 68 publications

(78 citation statements)

References 4 publications

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“…Reorganization of existing collagen fibers [22], formation of new ones (neocollagenesis) [22], and neoangiogenesis [22] have been successfully applied for the treatment of various non-surgical gynecological indications, including GSM, vaginal relaxation syndrome (VRS) and stress urinary incontinence (SUI). We hypothesized that by creating a superficial warming process we would promote an initial vasodilation effect improving the performance of the intrinsic mechanism of continence by decreasing the radius of the urethra due to the improvement in the submucosal vascular plexus and increased thickness of the epithelium [22]. Addressing the trophism of the vaginal canal as well as the urethral mucosa improves not only the symptoms of GSM but also symptoms of urinary incontinence (UI) [19], which opens an important future research area, that should focus on synergistic effect of the combined vaginal and urethral application of Erbium SMOOTH TM laser.…”

Section: Discussionmentioning

confidence: 99%

“…Parameters used during the intraurethral laser procedure are derived from the RenovaLase 1 protocol (developed by Fotona d.o.o. ), which has been shown to improve the vulvovaginal symptoms of GSM [7][8][9][10][11] and to promote neoangiogenesis [22], a highly desirable effect that improves the trophism of the mucosal tissue.…”

Section: Methodsmentioning

confidence: 99%

“…Vaginal laser therapy, such as fractional CO 2 and nonablative Erbium SMOOTH TM laser therapy have been established as promising treatment modalities for management of vulvovaginal symptoms of GSM [7][8][9][10][11], with Erbium SMOOTH TM having also show good results in treatment of stress urinary incontinence (SUI) [12][13][14][15], vaginal relaxation syndrome (VRS) [16,17] and mild prolapses [18]. The safety and efficacy of the intraurethral Erbium SMOOTH TM procedure for the treatment of type III SUI have been demonstrated in our recent study [19].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Intraurethral Erbium:YAG laser for the management of urinary symptoms of genitourinary syndrome of menopause: A pilot study

Gaspar

Maestri²,

Silva

et al. 2018

Lasers Surg Med

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ObjectivesGenitourinary syndrome of menopause (GSM) combines the conditions of vulvovaginal atrophy (VVA) and urinary tract dysfunction, which is a result of urethral atrophy. There are several treatment methods available for the management of vulvovaginal symptoms of GSM, whereas urinary tract dysfunction often remains overlooked and undertreated. The objective of this pilot study was to assess the safety and efficacy of intraurethral Er:YAG laser treatment of urinary symptoms of GSM.Patients and MethodsPatients with diagnosed GSM, having less than 5% of vaginal superficial cells in the cytology, vaginal pH higher than 5, with urinary symptoms of GSM (dysuria, frequency, urgency) and impaired continence due to urethral atrophy, received two sessions of intraurethral Er:YAG laser with a 3‐week interval in‐between the sessions. Laser energy was delivered in non‐ablative way using Erbium SMOOTH™ mode technology and a 4‐mm thick cannula. Therapeutic efficacy was determined using ICIQ‐SF, the 1‐hour pad test and VAS scores. Occurrence of adverse effects was followed at every visit. Follow ups (FU) were at 3 and 6 months.Results29 female patients fulfilling the inclusion criteria were included in this pilot study and received two sessions of the intraurethral non‐ablative Erbium SMOOTH™ laser therapy. Significant improvement was observed in all measured parameters at both FU. ICIQ‐SF improved by an average of 64% at 3 months FU and by 40% at 6 months. The 1‐hour pad test showed a reduction of the quantity of leaked urine by 59% at 3 months FU and by 42% at 6 months FU. All urinary symptoms of GSM improved. Dysuria dropped to 13% and 31% of baseline values at three and 6 months respectively, urinary urgency dropped to 23% and 47% and frequency dropped to 22% and 43% after 3 and 6 months, respectively. Adverse effects were mild and transient.ConclusionsOur findings suggest that intraurethral Er:YAG laser is an efficacious and safe modality for treatment of urinary symptoms of GSM, however, prospective, randomized, and controlled trials with larger number of patients are needed to better assess the long‐term effect of this novel procedure. Lasers Surg. Med. 50:802–807, 2018. © 2018 The Authors. Lasers in Surgery and Medicine Published by Wiley Periodicals, Inc.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Intraurethral Erbium:YAG laser for the management of urinary symptoms of genitourinary syndrome of menopause: A pilot study

Gaspar

Maestri²,

Silva

et al. 2018

Lasers Surg Med

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“…Seventeen studies counting more than 892 female patients with UI were included in the review. 4,8,10,[14][15][16][17][18][19][20][21][22][23][24][25][26][27] The search of MEDLINE and SCOPUS provided a total of 878 records. After removing duplicates, 526 studies were excluded because they did not meet the criteria.…”

Section: Resultsmentioning

confidence: 99%

Female urinary incontinence: is laser treatment effective? a systematic review

Br¹,

Ao²

2018

OGIJ

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Background: Towards the recent promising results of microablative fractional CO 2 -laser and non-ablative photothermal Erbium: YAG-laser (Er:YAG-laser) as therapy performed in Gynaecology; this systematic review aims to summarize the effectiveness and safety of both laser technologies on female Urinary Incontinence (UI). Methods:Using "laser" and "urinary incontinence" as query, studies were searched from MEDLINE and SCOPUS up to February 2018. Information from seventeen studies, counting more than 892 female patients with UI, was systematically registered. 652 and more than 240 patients were treated with Er:YAG-laser and CO 2 -laser, respectively. Results:Results addressing patient reported outcomes through different validated questionnaires showed statistically significant improvement in UI after Laser therapy. Pad weight tests, perineometry, Q-tip test, urodynamics and epithelial biopsies as assessment to objective quantification of UI and pelvic structures remodeling also showed improvement but these results were not so consistent. In general, laser therapy was well tolerated and no major side effects were reported. Conclusion:Laser therapy seems to be a promising alternative approach to UI in women. However, there are no randomized controlled trials in this field and so the level of evidence is still low. More research is required to further apply these technologies in women safely and effectively.

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“…It is also thought to cause mechanical pull of deeper tissue layers following the shrinkage, and activation of neo-collagenogenesis pathway, which further promotes the elasticity, thickness, and strength of the vaginal wall. 12,13 Given that laser treatment of SUI is an innovative strategy, a few published exploratory pilot studies with small numbers of patients and very short followup have demonstrated some improvement in SUI. The best level of evidence is from a recent prospective study by Ogrinc et al, in which 175 patients, newly diagnosed with SUI (66%) and mixed urinary incontinence (MUI [34%]) underwent an average of 2.5 (Er:YAG) distinct laser procedures over 12 months.…”

Section: Non-ablative Laser Treatmentmentioning

confidence: 99%

Stress urinary incontinence in women: Current and emerging therapeutic options

Shamout

Campeau

2017

CUAJ

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Surgical management of stress urinary incontinence (SUI) is most commonly achieved by midurethral synthetic sling (MUS) insertion as a first-line surgical option. A great deal of research continues to evolve new management strategies to reach an optimal balance of high efficacy and minimal adverse events. This expert opinion review provides a brief and comprehensive discussion of recent advances and ongoing research in the management of SUI, with an emphasis on single-incision mini-slings, vaginal laser treatment, and cell-based therapy. It is based on data obtained from numerous published meta-analyses and original studies identified through literature search. Single-incision mini-slings appear equally effective initially compared with standard MUS (retropubic or transobturator) for the treatment of female SUI; however, this efficacy lacks durability evidence beyond one-year followup. There is a lack of sufficient clinical evidence to currently confirm long-term safety and effectiveness of cell-therapy and non-ablative vaginal laser therapy, besides suggestion of apparent initial safety. There are still significant challenges to overcome before widespread clinical practice of the latter two modalities. Future research should be aimed at identifying groups of patients who might benefit from these minimally invasive therapeutic options.

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Structural Reorganization of the Vaginal Mucosa in Stress Urinary Incontinence under Conditions of Er:YAG Laser Treatment

Cited by 68 publications

References 4 publications

Intraurethral Erbium:YAG laser for the management of urinary symptoms of genitourinary syndrome of menopause: A pilot study

Intraurethral Erbium:YAG laser for the management of urinary symptoms of genitourinary syndrome of menopause: A pilot study

Female urinary incontinence: is laser treatment effective? a systematic review

Stress urinary incontinence in women: Current and emerging therapeutic options

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