Novel minimally invasive laser treatment of urinary incontinence in women

Abstract

Background and objective: Urinary incontinence (UI) is a common disorder that affects women of various ages and impacts all aspects of life. Our aim was to evaluate the non-invasive erbium:yttrium-aluminum-garnet (Er:YAG) laser that exploits its thermal effect and has been used in reconstructive and rejuvenation surgery as a potential treatment strategy for stress UI (SUI) and mixed UI (MUI).

Study design/materials and methods: We included 175 women (aged 49.7 ± 10 years) with newly diagnosed SUI (66% of women) and MUI (34%), respectively. Patients were clinically examined and classified by incontinence types (SUI and MUI) and grades (mild, moderate, severe, and very severe) using International Consultation on Incontinence Modular Questionnaire (ICIQ) and assessing Incontinence Severity Index (ISI). Using Er:YAG laser, we performed on average 2.5 ± 0.5 procedures in each woman separated by a 2 month period. At each session, clinical examination was performed, ICIQ and ISI assessed and treatment discomfort measured with visual analog system (VAS) pain scale, and adverse effects and patients' satisfaction were followed. Follow-ups were performed at 2, 6, and 12 months after the treatment.

Results: After the treatment, ISI decreased for 2.6 ± 1.0 points in patients diagnosed with mild UI before the treatment, for 3.6 ± 1.4 points in those with moderate UI, for 5.7 ± 1.8 points in those with severe UI and for 8.4 ± 2.6 in those with very severe UI (P < 0.001, paired samples t-test). Altogether, in 77% patients diagnosed with SUI, a significant improvement was found after treatment, while only 34% of women with MUI exhibited no UI at one year follow-up. Age did not affect the outcome. No major adverse effects were noticed in either group.

Conclusion: The results of our study, have shown that new non-invasive Er:YAG laser could be regarded as a promising additional treatment strategy for SUI with at least one year lasting positive effects. On the other hand, it does not seem appropriate for treating MUI.

Keywords: Er-Yag laser; gynecology; mixed urinary incontinence; non-invasive procedure; stress urinary incontinence.

Figure 1

Scheme of the 2,940 nm Er:YAG laser device.

Figure 2

The effect of the Er:YAG laser therapy on the improvement of incontinence severity index (ISI). The distribution of patients (in %) regarding ISI (expressed in points) before the treatment (blue line), at the first follow‐up (2 months after the first procedure, red line), at the second follow‐up (6 months after the first procedure, green line) and one year after the laser treatment (violet line) is presented. ***P < 0.001, ANOVA with Bonferroni test.

Figure 3

The effect of Er:YAG laser therapy on the improvement of the grade of urinary incontinence (UI). Plots show the distribution of patients (in %) with regard to the grade of incontinence (mild, moderate, severe, very severe; see legend) before treatment, at the first, second, and last follow up. ***P < 0.001, ANOVA with Bonferroni test.

Figure 4

The incontinence severity index (ISI) decrease following therapy with respect to (A) the grade of urinary incontinence (UI) and (B) to age. ISI decrease one year after the Er:YAG laser treatment is shown with regard to (A) the grade of UI diagnosed before the induction of therapy and (B) in different age groups. Data are presented as means and SD. **P < 0.01, ANOVA with Bonferroni test.

Figure 5

Final outcome at one year follow‐up regarding the type of incontinence as diagnosed before the therapy. The distribution of patients with regard to the final urinary incontinence (UI, expressed in %, see the legend at the right hand) one year after the treatment with Er:YAG laser, from the group of stress UI (SUI) and mixed UI (MUI) diagnosed before induction of therapy.