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Okui N. Innovative decision making tools using discrete mathematics for stress urinary incontinence treatment. Sci Rep 2024; 14:9900. [PMID: 38688938 PMCID: PMC11061106 DOI: 10.1038/s41598-024-60407-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 04/23/2024] [Indexed: 05/02/2024] Open
Abstract
In this study, we applied graph theory to clinical decision-making for Stress Urinary Incontinence (SUI) treatment. Utilizing discrete mathematics, we developed a system to visually understand the shortest path to the desired treatment outcomes by considering various patient variables. Focusing on women aged 35-50, we examined the effectiveness of Tension-free Vaginal Tape (TVT) surgery and Vaginal Erbium Laser (VEL) treatment for over 15 years. The TVT group consisted of 102 patients who underwent surgery using either the Advantage Fit mid-urethral sling system (Boston Scientific Co., MA, USA) or the GYNECARE TVT retropubic system (Ethicon Inc., NJ, USA). The VEL group included 113 patients treated with a non-ablative Erbium: YAG laser (FotonaSmooth™ XS; Fotona d.o.o., Ljubljana, Slovenia), and there were 112 patients in the control group. We constructed a network diagram analyzing the correlations between health, demographic factors, treatment methods, and patient outcomes. By calculating the shortest path using heuristic functions, we identified significant correlations and treatment effects. This approach supports patient decision making by choosing between TVT and VEL treatments based on individual objectives. Our findings provide new insights into SUI treatment, highlighting the value of a data-driven personalized approach for clinical decision-making. This interdisciplinary study bridges the gap between mathematics and medicine, demonstrating the importance of a data-centric approach in clinical decisions.
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Affiliation(s)
- Nobuo Okui
- Kanagawa Dental University, 82 Inaka Cho, Yokosuka, Kanagawa, 238-8580, Japan.
- Yokosuka Urogynecology and Urology Clinic, 2-6 Ootaki, Yokosuka, Kanagawa, 238-0008, Japan.
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Tan Y, Zhang Y, An J, Xu X, Deng J, Chen B, Pan W. Safety and Efficacy of Erbium: Yttrium-Aluminum-Garnet Laser Treatment in Chinese Women with Mild-to-Moderate Stress Urinary Incontinence. J Womens Health (Larchmt) 2024. [PMID: 38563974 DOI: 10.1089/jwh.2023.0609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
Background: This study aims to evaluate the safety and efficacy of erbium:yttrium-aluminum-garnet (Er:YAG) laser treatment in female patients with mild-to-moderate stress urinary incontinence (SUI). Methods: From July 2018 to June 2020, 72 female patients with mild-to-moderate SUI were enrolled in this study. A baseline assessment was conducted, which included a 1-hour pad test, the validated International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI-SF), postvoid residual (PVR) testing, pelvic organ prolapse quantification (POP-Q) testing, and a cough stress test. All patients underwent four sessions of Er:YAG laser treatment using a smooth mode. A reassessment was performed 6 months after treatment to evaluate the safety and efficacy of the Er:YAG laser. Results: All patients completed four clinic visits, with a 1-month interval, and were followed up for a minimum of 6 months. No severe adverse reactions were observed during the treatment process. The 1-hour pad test revealed a significant reduction in urinary leakage from baseline (6.30 ± 1.06 g) to the 6-month follow-up (2.70 ± 0.96 g, p < 0.001), with 34 of 72 (47.22%) patients achieving negative results. The ICIQ-UI-SF score significantly decreased from baseline to 6 months (10.82 ± 1.38 to 2.96 ± 0.52, p < 0.001). PVR experimental results showed a significant decrease in residual urine volume after treatment (103.72 ± 8.61 mL to 43.86 ± 4.92 mL, p < 0.001). At the 6-month follow-up, hematoxylin and eosin staining results demonstrated that Er:YAG laser treatment significantly facilitated an increase in the thickness of squamous epithelial cells. The efficacy of Er:YAG laser treatment for SUI was 77.78% (56/72). Conclusions: Several objective and subjective assessments confirmed the safety and efficacy of vaginal smooth mode Er:YAG laser treatment for mild-to-moderate SUI during the 6-month follow-up period. Nonablative Er:YAG laser in the smooth mode is a viable treatment option for SUI patients.
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Affiliation(s)
- Yi Tan
- Department of Obstetrics and Gynecology, Dongguan Nancheng Hospital, Dongguan, China
| | - Yuchan Zhang
- Department of Obstetrics and Gynecology, Dongguan Nancheng Hospital, Dongguan, China
| | - Junli An
- Department of Obstetrics and Gynecology, Dongguan Nancheng Hospital, Dongguan, China
| | - Xueqiong Xu
- Department of Obstetrics and Gynecology, Dongguan Nancheng Hospital, Dongguan, China
| | - Jun Deng
- Department of Obstetrics and Gynecology, Dongguan Nancheng Hospital, Dongguan, China
| | - Biaowei Chen
- Department of Obstetrics and Gynecology, Dongguan Nancheng Hospital, Dongguan, China
| | - Wenwei Pan
- Department of Obstetrics and Gynecology, Dongguan Maternal and Child Health Care Hospital, Dongguan, China
- Dongguan Key Laboratory of Female Reproductive Health, Dongguan, China
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Sikora M, Gamper M, Zivanovic I, Münst J, Bischofberger H, Kociszewski J, Viereck V. Current Treatment of Stress Urinary Incontinence by Bulking Agents and Laser Therapy-An Update. J Clin Med 2024; 13:1377. [PMID: 38592248 PMCID: PMC10932143 DOI: 10.3390/jcm13051377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 02/22/2024] [Accepted: 02/26/2024] [Indexed: 04/10/2024] Open
Abstract
Stress urinary incontinence (SUI) affects around 20% of women. In addition to the established suburethral sling insertion, two less invasive approaches are of interest today: urethral bulking agents and vaginal laser therapy. This review discusses articles through December 2023 identified by a PubMed literature search using the keywords "incontinence" and "bulking" or "laser". Although the two approaches are less effective than sling insertions, there are specific conditions in which one or the other technique is more advantageous. Injecting bulking agents into the urethra only takes some minutes and works without general anesthesia. The method is particularly suited for elderly, frail, or obese patients with multiple comorbidities, but is also applicable for all patients and in combination with other therapies. Generally, the safety profile is good but differs between bulking materials. Two laser types-the Erbium:YAG laser with SMOOTH-mode and the fractional ablative CO2 laser-deliver heat into the tissue to induce tissue tightening and regeneration. Intravaginal laser therapy improves mild to moderate SUI, while studies describe how intraurethral laser therapy is also beneficial for severe SUI. Young women between childbirths, as well as postmenopausal women, may benefit from laser therapy. The method is safe, can be performed on an outpatient basis, and does not require any artificial material.
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Affiliation(s)
- Michal Sikora
- Department of Gynecology and Obstetrics, Spital Thurgau Frauenfeld, 8501 Frauenfeld, Switzerland; (M.S.); (M.G.); (I.Z.); (J.M.); (H.B.)
| | - Marianne Gamper
- Department of Gynecology and Obstetrics, Spital Thurgau Frauenfeld, 8501 Frauenfeld, Switzerland; (M.S.); (M.G.); (I.Z.); (J.M.); (H.B.)
| | - Irena Zivanovic
- Department of Gynecology and Obstetrics, Spital Thurgau Frauenfeld, 8501 Frauenfeld, Switzerland; (M.S.); (M.G.); (I.Z.); (J.M.); (H.B.)
| | - Julia Münst
- Department of Gynecology and Obstetrics, Spital Thurgau Frauenfeld, 8501 Frauenfeld, Switzerland; (M.S.); (M.G.); (I.Z.); (J.M.); (H.B.)
| | - Helena Bischofberger
- Department of Gynecology and Obstetrics, Spital Thurgau Frauenfeld, 8501 Frauenfeld, Switzerland; (M.S.); (M.G.); (I.Z.); (J.M.); (H.B.)
| | - Jacek Kociszewski
- Department of Gynecology and Obstetrics, Evangelisches Krankenhaus Hagen-Haspe, 58135 Hagen, Germany;
| | - Volker Viereck
- Department of Gynecology and Obstetrics, Spital Thurgau Frauenfeld, 8501 Frauenfeld, Switzerland; (M.S.); (M.G.); (I.Z.); (J.M.); (H.B.)
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Prodromidou A, Zacharakis D, Athanasiou S, Kathopoulis N, Varthaliti A, Douligeris A, Michala L, Athanasiou V, Salvatore S, Grigoriadis T. CO 2 Laser versus Sham Control for the Management of Genitourinary Syndrome of Menopause: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Pers Med 2023; 13:1694. [PMID: 38138921 PMCID: PMC10744987 DOI: 10.3390/jpm13121694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 11/28/2023] [Accepted: 11/30/2023] [Indexed: 12/24/2023] Open
Abstract
In the context of the menopausal transition, genitourinary syndrome of menopause (GSM) refers to a range of genitourinary symptoms, from vaginal dryness to dysuria and urinary urgency. While hormonal treatments are standard, their associated side effects have driven the exploration of alternatives like vaginal CO2 laser. We aimed to evaluate the randomized controlled trials (RCTs) comparing vaginal CO2 laser treatment for GSM to sham controls. This systematic review sourced four electronic databases until June 2023. The analysis incorporated seven RCTs with 407 women. The CO2 laser and sham control were comparable for most parameters, including the female sexual function index (FSFI) and visual analogue scale (VAS) for dyspareunia, vaginal health index, pH, and patient satisfaction. However, the CO2 laser group showed significant improvement in the vaginal assessment scale for GSM symptoms. Sensitivity analyses revealed that parameters like FSFI showed significant differences in favor of CO2 laser group upon the exclusion of specific studies. In conclusion, vaginal CO2 laser therapy emerges as a promising alternative for GSM management, especially for most bothersome GSM symptoms; however, the need for further well-designed RCTs remains to validate its broad safety and efficacy.
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Affiliation(s)
- Anastasia Prodromidou
- 1st Department of Obstetrics and Gynaecology, Alexandra Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece; (D.Z.); (S.A.); (N.K.); (A.V.); (A.D.); (L.M.); (T.G.)
| | - Dimitrios Zacharakis
- 1st Department of Obstetrics and Gynaecology, Alexandra Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece; (D.Z.); (S.A.); (N.K.); (A.V.); (A.D.); (L.M.); (T.G.)
| | - Stavros Athanasiou
- 1st Department of Obstetrics and Gynaecology, Alexandra Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece; (D.Z.); (S.A.); (N.K.); (A.V.); (A.D.); (L.M.); (T.G.)
| | - Nikolaos Kathopoulis
- 1st Department of Obstetrics and Gynaecology, Alexandra Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece; (D.Z.); (S.A.); (N.K.); (A.V.); (A.D.); (L.M.); (T.G.)
| | - Antonia Varthaliti
- 1st Department of Obstetrics and Gynaecology, Alexandra Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece; (D.Z.); (S.A.); (N.K.); (A.V.); (A.D.); (L.M.); (T.G.)
| | - Athanasios Douligeris
- 1st Department of Obstetrics and Gynaecology, Alexandra Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece; (D.Z.); (S.A.); (N.K.); (A.V.); (A.D.); (L.M.); (T.G.)
| | - Lina Michala
- 1st Department of Obstetrics and Gynaecology, Alexandra Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece; (D.Z.); (S.A.); (N.K.); (A.V.); (A.D.); (L.M.); (T.G.)
| | | | - Stefano Salvatore
- Obstetrics and Gynaecology Department, IRRCS San Raffaele Hospital, Vita-Salute San Raffaele University, 20125 Milan, Italy;
| | - Themos Grigoriadis
- 1st Department of Obstetrics and Gynaecology, Alexandra Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece; (D.Z.); (S.A.); (N.K.); (A.V.); (A.D.); (L.M.); (T.G.)
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Barba M, Cola A, De Vicari D, Costa C, Castelli AP, Volontè S, Fruscio R, Frigerio M. Efficacy of a Diode Vaginal Laser in the Treatment of the Genitourinary Syndrome of Menopause. Bioengineering (Basel) 2023; 10:1158. [PMID: 37892888 PMCID: PMC10603982 DOI: 10.3390/bioengineering10101158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 09/16/2023] [Accepted: 09/29/2023] [Indexed: 10/29/2023] Open
Abstract
INTRODUCTION Genitourinary syndrome of menopause (GSM) and vulvovaginal atrophy (VVA) are the most frequent menopause-related clinical entities and are consistently included in the definition of pelvic floor disorders (PFDs). Nonhormonal therapies, such as lubricants and moisturizers, are indicated as first-line treatments, while the "gold standard'' is represented by topical estrogen products; however, in cancer survivors hormonal treatment is not indicated. For this reason, energy-based therapeutic approaches-for instance, through laser technologies-may be employed as alternative options in this kind of patient; however, there are no studies evaluating the efficacy of a pure diode vaginal laser in the treatment of GSM. As a consequence, with our study, we aimed to evaluate outpatient nonablative diode laser treatment in sexually active women, with contraindications, no response, or refusal of local estrogenic therapy. METHODS This prospective study included patients with GSM, aged ≥ 18 years old, with contraindications, or refusal of local estrogen therapies. Women were evaluated via the use of their Vaginal Health Index (VHI) scores, which consists of five measures: elasticity, fluid volume, pH, epithelial integrity, and moisture. Moreover, the intensity of VVA symptoms (vaginal burning, vaginal itching, vaginal dryness, dyspareunia, and dysuria) was measured using a 10 cm visual analog scale (VAS), where the left extreme of the scale (score = 0) indicated "absence of symptom" and the right indicated "symptom as bad as it could be" (score = 100). Sexual function was evaluated with the Female Sexual Function Index (FSFI-19) questionnaire. The treatment was performed using a Leonardo Dual diode laser (Biolitec Italia Srl, Milano, Italy). The laser treatment consisted of three sessions, one per month. One month after the third session, the VHI, symptom VAS, and FSFI-19 were re-evaluated. In addition, the Patient Global Impression of Improvement (PGI-I) questionnaire was collected. RESULTS Our study enrolled a total of 26 consecutive patients. All patients were either in menopause or under treatment with gonadotropin-releasing hormone (GnRH). None of the patients reported adverse effects after laser treatment. In total, 19 (73.1%) patients referred improvements of their symptoms according to PGI-I scores. All domains of the FSFI-19 questionnaire, significantly improved after the diode laser treatment. The mean VHI score increased by 3.2 points, from 12.2 to 15.4 (p < 0.001). Additionally, we documented a significant improvement in symptoms affecting the VAS score, from 69.2 to 43.5 points (p < 0.001). CONCLUSION A diode vaginal laser is an effective and easily tolerated ambulatory procedure for vaginal functional restoration in the treatment of GSM and VVA.
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Affiliation(s)
- Marta Barba
- Department of Gynecology, IRCC San Gerardo dei Tintori, University of Milano-Bicocca, 20900 Monza, Italy; (M.B.); (A.C.); (D.D.V.); (C.C.); (S.V.); (R.F.)
| | - Alice Cola
- Department of Gynecology, IRCC San Gerardo dei Tintori, University of Milano-Bicocca, 20900 Monza, Italy; (M.B.); (A.C.); (D.D.V.); (C.C.); (S.V.); (R.F.)
| | - Desirèe De Vicari
- Department of Gynecology, IRCC San Gerardo dei Tintori, University of Milano-Bicocca, 20900 Monza, Italy; (M.B.); (A.C.); (D.D.V.); (C.C.); (S.V.); (R.F.)
| | - Clarissa Costa
- Department of Gynecology, IRCC San Gerardo dei Tintori, University of Milano-Bicocca, 20900 Monza, Italy; (M.B.); (A.C.); (D.D.V.); (C.C.); (S.V.); (R.F.)
| | | | - Silvia Volontè
- Department of Gynecology, IRCC San Gerardo dei Tintori, University of Milano-Bicocca, 20900 Monza, Italy; (M.B.); (A.C.); (D.D.V.); (C.C.); (S.V.); (R.F.)
| | - Robert Fruscio
- Department of Gynecology, IRCC San Gerardo dei Tintori, University of Milano-Bicocca, 20900 Monza, Italy; (M.B.); (A.C.); (D.D.V.); (C.C.); (S.V.); (R.F.)
| | - Matteo Frigerio
- Department of Gynecology, IRCC San Gerardo dei Tintori, University of Milano-Bicocca, 20900 Monza, Italy; (M.B.); (A.C.); (D.D.V.); (C.C.); (S.V.); (R.F.)
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Barba M, Cola A, Melocchi T, Braga A, Castronovo F, Manodoro S, Pennacchio M, Munno GM, Ruffolo AF, Degliuomini RS, Salvatore S, Torella M, Frigerio M. Italian validation of the Pelvic Floor Distress Inventory (PFDI-20) questionnaire. Int Urogynecol J 2023; 34:2459-2465. [PMID: 37195425 DOI: 10.1007/s00192-023-05572-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 04/27/2023] [Indexed: 05/18/2023]
Abstract
INTRODUCTION AND HYPOTHESIS The use of validated Quality of Life (QoL) questionnaires is useful in the standardization and interpretation process of pelvic floor patient symptoms, due to their functional nature and high prevalence. The Pelvic Floor Distress Inventory QoL questionnaire (PFDI-20) serves both as a symptom inventory and a measure of the degree of bother and distress caused by pelvic floor symptoms. It includes items related to pelvic organ prolapse and lower gastrointestinal and bladder dysfunction. METHODS After consensus translation and a comprehension test, the Italian version of the questionnaire was submitted to patients reporting bowel, bladder, or pelvic disorders (cases) and to asymptomatic women (controls). Cases received the questionnaire once again 2 weeks later by email. RESULTS A total of 254 patients answered the questionnaire. Construct validity was demonstrated by discriminating between cases and controls. Convergent validity was demonstrated for each domain (F < 0.001). In-ernal consistency reliability showed a satisfactory range (0.816-0.860). CONCLUSIONS The PFDI-20 allows a comprehensive assessment of the effect of pelvic floor disorders on the quality of life of women. Moreover, the PFDI-20 represents a very solid QoL tool, since it has been extensively used in literature, and its use is highly recommended by the International Consultation on Incontinence. The present study demonstrated good features for the Italian version of the PFDI-20 questionnaire.
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Affiliation(s)
| | - Alice Cola
- Gynecology Unit, Fondazione IRCCS San Gerardo Dei Tintori, Monza, Italy
| | | | - Andrea Braga
- EOC Beata Vergine, Mendrisio, Switzerland
- Italian Urogynecology - Pelvic Floor Work Group (GLUP), Monza, Italy
| | | | - Stefano Manodoro
- Italian Urogynecology - Pelvic Floor Work Group (GLUP), Monza, Italy.
- ASST Santi Paolo E Carlo, San Paolo University Hospital, University of Milano, Via Antonio Di Rudinì 8, 20142, Milan, Italy.
| | - Marika Pennacchio
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Gaetano Maria Munno
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Alessandro Ferdinando Ruffolo
- Vita-Salute San Raffaele University, Milan, Italy
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Rebecca Susanna Degliuomini
- Vita-Salute San Raffaele University, Milan, Italy
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Stefano Salvatore
- Vita-Salute San Raffaele University, Milan, Italy
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marco Torella
- Italian Urogynecology - Pelvic Floor Work Group (GLUP), Monza, Italy
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Matteo Frigerio
- Gynecology Unit, Fondazione IRCCS San Gerardo Dei Tintori, Monza, Italy
- Italian Urogynecology - Pelvic Floor Work Group (GLUP), Monza, Italy
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Li PC, Ding DC. Comparison of Er:YAG and CO 2 laser therapy for women with stress urinary incontinence. Lasers Surg Med 2023; 55:653-661. [PMID: 37265011 DOI: 10.1002/lsm.23694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 05/25/2023] [Accepted: 05/25/2023] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To compare the effectiveness of Er:YAG and CO2 laser therapies for treating female stress urinary incontinence (SUI). METHODS This retrospective study included 139 women who were divided into four groups: group 1 received two therapy sessions with the Er:YAG laser, group 2 received two therapy sessions with the CO2 laser, group 3 received one therapy session with the Er:YAG laser, and group 4 received one therapy session with the CO2 laser. Patients completed three questionnaires to assess SUI symptom severity at baseline, 1 month, and 3 months after laser therapy. RESULTS Urinary incontinence symptoms significantly improved in groups 1 and 2 at both the 1- and 3-month follow-up evaluations compared to the baseline (p < 0.001). Symptoms improved after one therapy session in groups 3 and 4 at the 3-month follow-up (p < 0.001). The Er:YAG laser was more effective than the CO2 laser in improving SUI symptoms (Urogenital Distress Inventory 6 and Incontinence Impact Questionnaire 7) 3 months after treatment, regardless of the number of sessions. Both Er:YAG and CO2 laser therapies were found to be effective in reducing symptoms associated with an overactive bladder, as demonstrated by improvements in overactive bladder symptom scores. Two sessions of laser therapy were more effective than one. CONCLUSION Vaginal laser therapy could be an effective alternative treatment for mild to moderate SUI. The Er:YAG laser was more effective than CO2 laser therapy, with results lasting for at least 3 months. However, further large-scale, randomized, controlled trials are needed to confirm our findings.
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Affiliation(s)
- Pei-Chen Li
- Department of Obstetrics and Gynecology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Foundation, and Tzu Chi University, Hualien, Taiwan, ROC
| | - Dah-Ching Ding
- Department of Obstetrics and Gynecology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Foundation, and Tzu Chi University, Hualien, Taiwan, ROC
- Institute of Medical Sciences, College of Medicine, Tzu Chi University, Hualien, Taiwan, ROC
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Viereck V, Gamper M, Regauer S, Walser C, Zivanovic I. Nd:YAG/Er:YAG dual laser vs. topical steroid to treat vulvar lichen sclerosus: study protocol of a randomized controlled trial. Arch Gynecol Obstet 2023; 308:643-649. [PMID: 37145134 PMCID: PMC10293446 DOI: 10.1007/s00404-023-07055-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 04/24/2023] [Indexed: 05/06/2023]
Abstract
PURPOSE Vulvar lichen sclerosus (LS) is a chronic debilitating inflammatory skin disease. Today, the gold standard is a life-long topical steroid treatment. Alternative options are highly desired. We present a study protocol of a prospective, randomized, active-controlled, investigator-initiated clinical trial comparing a novel non-invasive dual Nd:YAG/Er:YAG laser therapy with the gold standard for the management of LS. METHODS We recruited 66 patients, 44 in the laser arm and 22 in the steroid arm. Patients with a physician-administered clinical LS score ≥ 4 were included. Participants received either four laser treatments 1-2 months apart, or 6 months of topical steroid application. Follow-ups were planned at 6, 12, and 24 months. The primary outcome looks at the efficacy of the laser treatment at the 6-month follow-up. Secondary outcomes look at comparisons between baseline and follow-ups within the laser or the steroid arm, and comparisons between laser vs. steroid arm. Objective (LS score, histopathology, photo documentation) and subjective (Vulvovaginal Symptoms Questionnaire, symptom VAS score, patient satisfaction) measurements, tolerability, and adverse events are evaluated. CONCLUSION The findings of this trial have the potential to offer a novel treatment option for LS. The standardized Nd:YAG/Er:YAG laser settings and the treatment regime are presented in this paper. CLINICAL TRIAL IDENTIFICATION NUMBER NCT03926299.
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Affiliation(s)
- Volker Viereck
- Department of Gynecology and Obstetrics, Cantonal Hospital Frauenfeld Postfach, 8501, Frauenfeld, Switzerland.
| | - Marianne Gamper
- Department of Gynecology and Obstetrics, Cantonal Hospital Frauenfeld Postfach, 8501, Frauenfeld, Switzerland
| | - Sigrid Regauer
- Institute of Pathology, Medical University Graz, Graz, Austria
| | - Claudia Walser
- Department of Gynecology and Obstetrics, Cantonal Hospital Frauenfeld Postfach, 8501, Frauenfeld, Switzerland
| | - Irena Zivanovic
- Department of Gynecology and Obstetrics, Cantonal Hospital Frauenfeld Postfach, 8501, Frauenfeld, Switzerland
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Barba M, Cola A, Costa C, Liberatore A, Frigerio M. Efficacy and Adverse Effects After Single-Incision Slings for Women with Stress Urinary Incontinence: A 12-Year Follow-Up. Int J Womens Health 2023; 15:1077-1082. [PMID: 37483887 PMCID: PMC10362859 DOI: 10.2147/ijwh.s410539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 07/11/2023] [Indexed: 07/25/2023] Open
Abstract
Objective Single-incision slings (SISs) are not considered the first surgical choice for stress urinary incontinence due to few data about long-term results. Our aim was to evaluate the outcomes of SISs 12 years after implantation and to search for consequences such as deterioration after a certain amount of time. Methods We included women with stress urinary incontinence both clinically and urodynamically proven who underwent SISs procedure. Objective and subjective cure rates were compared to short-term outcomes to detect possible deterioration over time. Results A total of 85 patients were analysed with a median follow-up of 12.0 (IQR 10.4-12.8) years. Objective and subjective cure rates were 81.0% and 82.1%, respectively. Median (IQR) PGI-I scores and ICIQ-SF, respectively, were 1 (1-2) and 0 (0-6.8). No significant deterioration of outcomes over time was shown after comparison between short-term and long-term follow-ups (objective cure rate 84.5% vs 81.0%, p=0.684; subjective cure rates 92.9% vs 82.1%, p=0.060). Also, voiding symptoms and overactive bladder did not differ over time (20.2% vs 21.4%, p=1.000; 20.2% vs 33.3%, p=0.080, respectively). Conclusion SISs were shown to be a procedure with a great efficacy and safety profile at very long-term follow-up.
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Affiliation(s)
- Marta Barba
- Obstetric and Gynecology Department - University of Milano-Bicocca, Monza, Italy
| | - Alice Cola
- Gynecology Department, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Clarissa Costa
- Obstetric and Gynecology Department - University of Milano-Bicocca, Monza, Italy
| | | | - Matteo Frigerio
- Gynecology Department, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
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Barba M, Cola A, Rezzan G, Costa C, Melocchi T, De Vicari D, Terzoni S, Frigerio M, Maruccia S. Flat Magnetic Stimulation for Stress Urinary Incontinence: A 3-Month Follow-Up Study. Healthcare (Basel) 2023; 11:1730. [PMID: 37372848 DOI: 10.3390/healthcare11121730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 06/05/2023] [Accepted: 06/11/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND flat magnetic stimulation is based on a stimulation produced by electromagnetic fields with a homogenous profile. Patients with stress urinary incontinence (SUI) can take advantage of this treatment. We aimed to evaluate medium-term subjective, objective, and quality-of-life outcomes in patients with stress urinary incontinence to evaluate possible maintenance schedules. METHODS a prospective evaluation through the administration of the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), the Incontinence Impact Questionnaire (IIQ7), and the Female Sexual Function Index (FSFI) was performed at three different time points: at the baseline (T0), at the end of treatment (T1), and at 3-month follow-up (T2). The stress test and the Patient Global Impression of Improvement questionnaire (PGI-I) defined objective and subjective outcomes, respectively. RESULTS 25 consecutive patients were enrolled. A statistically significant reduction in the IIQ7 and ICIQ-SF scores was noticed at T1 returned to levels comparable to the baseline at T2. However, objective improvement remained significant even at a 3-month follow-up. Moreover, the PGI-I scores at T1 and T2 were comparable, demonstrating stable subjective satisfaction. CONCLUSION despite a certain persistence of the objective and subjective continence improvement, the urinary-related quality of life decreases and returns to baseline values three months after the end of flat magnetic stimulation. These findings indicate that a further cycle of treatment is probably indicated after 3 months since benefits are only partially maintained after this timespan.
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Affiliation(s)
- Marta Barba
- Department of Gynecology, IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, 20900 Monza, Italy
| | - Alice Cola
- Department of Gynecology, IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, 20900 Monza, Italy
| | - Giorgia Rezzan
- Department of Gynecology, IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, 20900 Monza, Italy
| | - Clarissa Costa
- Department of Gynecology, IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, 20900 Monza, Italy
| | - Tomaso Melocchi
- Department of Gynecology, IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, 20900 Monza, Italy
| | - Desirèe De Vicari
- Department of Gynecology, IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, 20900 Monza, Italy
| | - Stefano Terzoni
- Department of Urology, ASST Santi Paolo e Carlo, San Paolo Hospital, 20142 Milano, Italy
| | - Matteo Frigerio
- Department of Gynecology, IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, 20900 Monza, Italy
| | - Serena Maruccia
- Department of Urology, ASST Santi Paolo e Carlo, San Paolo Hospital, 20142 Milano, Italy
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Serati M, Braga A. Re: CO 2 Surgical Laser for Treatment of Stress Urinary Incontinence in Women: A Randomized Controlled Trial. Eur Urol 2023; 83:373. [PMID: 36604274 DOI: 10.1016/j.eururo.2022.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 12/19/2022] [Indexed: 01/04/2023]
Affiliation(s)
- Maurizio Serati
- Department of Obstetrics and Gynecology, Del Ponte Hospital, University of Insubria, Varese, Italy
| | - Andrea Braga
- Department of Obstetrics and Gynecology, EOC-Beata Vergine Hospital, Mendrisio, Switzerland; Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland.
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Barba M, Frigerio M, Melocchi T, De Vicari D, Cola A. Urethral Injury After Vaginal Birth and Stress Urinary Incontinence: Bulking Agents are Feasible Options. Int J Womens Health 2023; 15:725-729. [PMID: 37193222 PMCID: PMC10183179 DOI: 10.2147/ijwh.s405636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 05/05/2023] [Indexed: 05/18/2023] Open
Abstract
Introduction and Hypothesis Lower urinary tract tears after vaginal delivery are a very rare event, estimated to occur in 0.03-0.05% of women and may be associated with severe stress urinary incontinence, due to great reduction of urethral resistance resulting in a significant intrinsic urethral deficit. Urethral bulking agents represent an alternative, minimally invasive anti-incontinence procedure in the management of stress urinary incontinence. Our aim is to present the management of severe stress urinary incontinence in a patient with concomitant urethral tear caused by obstetric trauma using a minimally invasive treatment option. Methods A 39-year-old woman referred to our Pelvic Floor Unit for severe stress urinary incontinence. Our evaluation demonstrated an undiagnosed urethral tear involving the ventral portion of the middle and distal urethra, for about 50% of urethral length. Urodynamic evaluation confirmed the presence of severe urodynamic stress incontinence. After proper counseling, she was admitted to mini-invasive surgical treatment with urethral bulking agent injection. Results The procedure was completed in 10 minutes and she was successfully discharged home on the same day, and no complications occurred. The treatment resulted in total relief of urinary symptoms, which persists at 6-month follow-up. Conclusion Treatment with urethral bulking agent injection represents a feasible mini-invasive option to manage stress urinary incontinence related to urethral tears.
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Affiliation(s)
- Marta Barba
- Gynecology and Obstetric Department, University of Milano-Bicocca, Monza, Italy
- Correspondence: Marta Barba, University of Milano-Bicocca, ASST Monza, Ospedale San Gerardo, via G.B. Pergolesi, 33, Monza, 20900, Italy, Tel +39 2339434, Email
| | - Matteo Frigerio
- Gynecology and Obstetric Department, Fondazione IRCCS San Gerardo Dei Tintori, Ospedale San Gerardo, Monza, Italy
| | - Tomaso Melocchi
- Gynecology and Obstetric Department, University of Milano-Bicocca, Monza, Italy
| | - Desirèe De Vicari
- Gynecology and Obstetric Department, University of Milano-Bicocca, Monza, Italy
| | - Alice Cola
- Gynecology and Obstetric Department, Fondazione IRCCS San Gerardo Dei Tintori, Ospedale San Gerardo, Monza, Italy
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Long CY, Lee JP, Loo ZX, Liu YY, Yeh CL, Feng CW, Lin KL. The Clinical Effects of Pixel CO(2) Laser on Bladder Neck and Stress Urinary Incontinence. J Clin Med 2022; 11. [PMID: 36078900 DOI: 10.3390/jcm11174971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 08/21/2022] [Accepted: 08/22/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Our study aims to assess Pixel CO2 laser efficacy for female stress urinary incontinence (SUI). Methods: In the study, 25 women with SUI were included and scheduled for vaginal Pixel CO2 Laser (FemiLift™, Alma Lasers, Israel) treatment. All subjects had a baseline and 6-month post-treatment assessment that included three-dimensional perineal ultrasound and validated questionnaires. Results: Data showed that monthly three-session vaginal Pixel CO2 Laser treatment significantly improved SUI symptoms, as evidenced by validated questionnaires, including UDI-6, IIQ-7, ICIQ, and vaginal laxity questionnaire (p < 0.05). The Pixel CO2 Laser efficacy in vaginal treatment was 20/25 (80%), and the perineal sonography showed that laser treatment significantly decreased bladder neck mobility and middle urethral area (during resting and straining). Permanent adverse events were not found. Conclusions: The results of our study suggested that for the treatment of mild to moderate SUI symptoms, Pixel CO2 Laser is effective and safe; however, more studies and a longer follow-up should be conducted to confirm its efficacy and durability.
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