Abstract
Background: Non-ablative erbium laser has become one of the new proposed treatments for various female pelvic floor disorders.
Objective: To assess the effects of vaginal erbium laser treatment with the non-invasive 2940 nm Erbium:yttrium-aluminum-garnet (Er:YAG) laser using the non-ablative SMOOTH® mode (Vaginal Erbium Laser, VEL) on patients with pelvic organ prolapse and co-existing stress urinary incontinence (SUI), if present.
Methods: This was a retrospective study carried out by the analysis of data recorded during a two-year period from charts of 41 patients that completed VEL treatment for cystocele (Group A); 27 of these also had concomitant stress urinary incontinence (Group B).
Results: The average cystocele grade in Group A was 2, while in Group B it was 1.96. The patients received on average 2.7 laser sessions. The average cystocele grade in the patient population decreased by 0.95. Patients with concomitant SUI also had a clinically significant improvement in SUI symptoms. The average ICIQ-UI short form score at baseline was 11.33, which decreased to 3.56 after the completed treatment sessions. Satisfaction with the treatment results was high.
Conclusion: This retrospective study has shown that vaginal non-ablative Er:YAG laser treatment with SMOOTH® mode seems to be an effective and safe option for reducing grades of cystocele as well as symptoms of coexisting SUI.
References
Chiaffarino F, Chatenoud L, Dindelli M, et al. Reproductive factors, family history, occupation and risk of urogenital prolapse. Eur J Obstet Gynecol Reprod Biol. 1999;82:63-7.
Altman D, Forsman M, Falconer C, Lichtenstein P. Genetic influence on stress urinary incontinence and pelvic organ prolapse. Eur Urol. 2008;54:918-22.
Bugge C, Adams EJ, Gopinath D, Reid F. Pessaries (mechanical devices) for pelvic organ prolapse in women. Cochrane Database Syst Rev. 2013;2013:CD004010.
Maher C, Feiner B, Baessler K, Glazener CM. Surgical management of pelvic organ prolapse in women. Cochrane database Syst Rev. 2010;(4):CD004014.
Smith FJ, Holman CDJ, Moorin RE, Tsokos N. Lifetime risk of undergoing surgery for pelvic organ prolapse. Obstet Gynecol. 2010;116:1096-100.
Subak LL, Waetjen LE, van den Eeden S, Thom DH, Vittinghoff E, Brown JS. Cost of pelvic organ prolapse surgery in the United States. Obstet Gynecol. 2001;98:646-51.
Glazener CM, Breeman S, Elders A, et al.; PROSPECT study group. Mesh, graft, or standard repair for women having primary transvaginal anterior or posterior compartment prolapse surgery: two parallel-group, multicentre, randomised, controlled trials (PROSPECT). Lancet. 2017;389:381-92.
Ugianskiene A, Davila GW, Su TH; FIGO Urogynecology and Pelvic Floor Committee. FIGO review of statements on use of synthetic mesh for pelvic organ prolapse and stress urinary incontinence. Int J Gynecol Obstet. 2019;147:147-55.
Vizintin Z, Lukac M, Kazic M, Tettamanti M. Erbium laser in gynecology. 2015;18 Suppl 1:4-8.
Ogrinc UB, Sencar S. Non-ablative vaginal erbium YAG laser for the treatment of cystocele. Ital J Gynaecol Obstet. 2017;29:19-25.
Ogrinc UB, Sencar S, Vizintin Z (2017) #178. 3 years follow-up of pelvic organ prolapses treated with Er:YAG laser. Lasers Surg Med. 49(S28):63.
Apolikhina I, Gorbunova E, Sukhikh G. Erbium-YAG laser: our 4 years’ experience for treatment pelvic floor disfunction. Int Urogynecol J. 2017;28(Suppl 1):227.
Vizintin Z, Rivera M, Fistonić I, et al. Novel Minimally Invasive VSP Er:YAG laser treatments in gynecology. J Laser Heal Acad. 2012;2012:46-58. Available at: http://www.doja49.ro/wp-content/uploads/2015/01/Dr.-Mario-Rivera-Zdenko-Vizintin-Laser-Gynecology.pdf. Accessed July 20, 2022.
Fistonić N, Fistonić I, Guštek ŠF, et al. Minimally invasive, non-ablative Er:YAG laser treatment of stress urinary incontinence in women—a pilot study. Lasers Med Sci. 2016;31:635-43.
Gaviria JE, Korosec B, Fernandez J, Montero G. Up to 3-Year Follow-up of Patients with Vaginal Relaxation Syndrome Participating in Laser Vaginal Tightening. J Laser Heal Acad. 2016:6-11. Available at: https://www.laserandhealthacademy.com/media/objave/academy/priponke/gaviria_laha_2016_onlinefirst_0001.pdf. Accessed July 20, 2022.
Ogrinc UB, Senčar S, Lenasi H. Novel minimally invasive laser treatment of urinary incontinence in women. Lasers Surg Med. 2015;47:689-97.
Blaganje M, Šćepanović D, Žgur L, Verdenik I, Pajk F, Lukanović A. Non-ablative Er:YAG laser therapy effect on stress urinary incontinence related to quality of life and sexual function: a randomized controlled trial. Eur J Obstet Gynecol Reprod Biol. 2018;224:153-8.
Kuszka A, Gamper M, Walser C, Kociszewski J, Viereck V. Erbium:YAG laser treatment of female stress urinary incontinence: midterm data. Int Urogynecol J. 2020;31:1859-66.
Mitsuyuki M, Štok U, Hreljac I, Yoda K, Vižintin Z. Treating vaginal laxity using nonablative Er: YAG laser: a retrospective case series of patients from 2.5 years of clinical practice. Sex Med. 2020;8:265-73.
Bai SW, Jeon MJ, Kim JY, Chung KA, Kim SK, Park KH. Relationship between stress urinary incontinence and pelvic organ prolapse. Int Urogynecol J. 2002;13:256-60; discussion 260.
Schiøtz HA, Karlsen JH, Tanbo TG. Ten-year follow-up after conservative treatment of stress urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19:911-5.
Baden WF, Walker TA. Genesis of the vaginal profile: a correlated classification of vaginal relaxation. Clin Obstet Gynecol. 1972;15:1048-54.
Avery K, Donovan J, Peters TJ, Shaw C, Gotoh M, Abrams P. ICIQ: a brief and robust measure for evaluating the symptoms and impact of urinary incontinence. Neurourol Urodyn. 2004;23:322-30.
Lukač M, Gaspar A, Bajd F. Dual tissue regeneration: non-ablative resurfacing of soft tissues with FotonaSmooth® mode Er:YAG laser. J Laser Heal Acad. 2018;2018:1-15. Available at: https://www.laserandhealthacademy.com/media/uploads/laha/docs/2018/articles/01_15_lukac_dual_tissue_laha.pdf. Accessed July 20, 2022.
Lukač M, Lozar A, Perhavec T, Bajd F. Variable heat shock response model for medical laser procedures. Lasers Med Sci. 2019;34:1147-58.
Lapii GA, Yakovleva AY, Neimark AI, Lushnikova EL. Study of proliferative activity of vaginal epithelium in women with stress urinary incontinence treated by Er:YAG laser. Bull Exp Biol Med. 2017;163:280-3.
Gaspar A, Brandi H, Gomez V, Luque D. Efficacy of Erbium:YAG laser treatment compared to topical estriol treatment for symptoms of genitourinary syndrome of menopause. Lasers Surg Med. 2017;49:160-8.
Bezmenko AA, Shmidt AA, Koval AA, Sibirev SA, Karpishchenko ZM, Gayvoronskikh DI. Morphological substantiation of applying the Er: YAG-laser for the treatment of stress urinary incontinence in women. J Obstet Women’s Dis. 2014;63:21-5.
Petros PE, Ulmsten UI. An integral theory of female urinary incontinence. Experimental and clinical considerations. Acta Obstet Gynecol Scand Suppl. 1990;153:7-31.
Okui N. Comparison between erbium-doped yttrium aluminum garnet laser therapy and sling procedures in the treatment of stress and mixed urinary incontinence. World J Urol. 2019;37:885-9.
Pardo JI, Solà VR, Morales AA. Treatment of female stress urinary incontinence with Erbium-YAG laser in non-ablative mode. Eur J Obstet Gynecol Reprod Biol. 2016;204:1-4.
Okui N, Miyazaki H, Takahashi W, et al. Comparison of urethral sling surgery and non-ablative vaginal Erbium:YAG laser treatment in 327 patients with stress urinary incontinence: a case-matching analysis. Lasers Med Sci. 2022;37:655-63.
Erel CT, Fernandez LDC, Inan D, Makul M. Er:YAG laser treatment of urinary incontinence after failed TOT/TVT procedures. Eur J Obstet Gynecol Reprod Biol. 2020;252:399-403.
Erel CT, Fistonić I, Gambacciani M, Oner Y, Fistonić N. Er:YAG laser in hysterectomized women with stress urinary incontinence: a VELA retrospective cohort, non-inferiority study. Climacteric. 2020;23:S18-S23.
Athanasiou S, Pitsouni E, Cardozo L, et al. Can pelvic organ prolapse in postmenopausal women be treated with laser therapy? Climacteric. 2021;24:101-6.
Lim R, Liong ML, Lim KK, Leong WS, Yuen KH. The minimum clinically important difference of the International Consultation on Incontinence Questionnaires (ICIQ-UI SF and ICIQ-LUTSqol). Urology. 2019;133:91-5.
Nyström E, Sjöström M, Stenlund H, Samuelsson E. ICIQ symptom and quality of life instruments measure clinically relevant improvements in women with stress urinary incontinence. Neurourol Urodyn. 2014;34:747-51.
Ali I, Swift S, Digesu GA. Surgical management of pelvic organ prolapse and stress urinary incontinence: where are we now? Int Urogynecol J. 2018;29:1-2.
Gambacciani M, Cervigni M, Gaspar A, et al. Safety of vaginal erbium laser: a review of 113,000 patients treated in the past 8 years. Climacteric. 2020;23:S28-32.
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