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Clinical efficacy of two new energy techniques in the treatment of stress urinary incontinence
Xiao-hua ZHENG, Yan-feng SONG, Chun-hua CHEN, Xiao-xiao WANG, Chao-qin LIN, Ying XU
Chinese Journal of Practical Gynecology and Obstetrics ›› 2025, Vol. 41 ›› Issue (6) : 658-661.
PDF(849 KB)
PDF(849 KB)
Clinical efficacy of two new energy techniques in the treatment of stress urinary incontinence
Objective To compare the mid-term and long-term clinical efficacy of transvaginal dot-matrix CO2 laser with that of AI temperature-controlled radiofrequency in the treatment of stress urinary incontinence. Methods Complete data of 100 patients who received treatment for stress urinary incontinence in outpatient department from January 2020 to May 2022 were retrospectively analyzed.Among them, 46 patients received dot-matrix CO2 laser therapy（laser group）and 54 patients received AI temperature-controlled RF therapy（RF group）.At 6 and 12 months after the end of treatment the clinical efficacy（1-hour urine pad）and the Urinary Incontinence Questionnaire（ICI-Q-SF）score of the International Urinary Incontinence Committee were compared between the two groups. Results At 6 months，the effective rate of laser group and RF group was 91.3%（42/46）and 72.2%（39/54）.The total effective rate in laser group was higher than that in RF group（P<0.05），especially in patients with mild urinary incontinence（96.4% vs. 60.0%）or age > 40 years old（88.5% vs. 60.0%）.The ICI-Q-SF score of the two groups was lower than before treatment，and the score of the laser group was lower than that of the RF group[（5.21±3.07）vs. (6.59 ± 3.64）, P<0.05].At 12 months，the effective rate in laser group was lower than that at 6 months（91.3% vs. 65.2%, P<0.05），but there was no significant difference in RF group（72.2% vs. 68.5%, P>0.05）. There was no significant difference in effective rate or ICI-Q-SF score between the two groups. Conclusion Both transvaginal dot-matrix CO2 laser and AI temperature-controlled radiofrequency therapy are effective in the treatment of stress urinary incontinence，and the effect of laser therapy is better than that of radiofrequency after 6 months，especially for patients with mild urinary incontinence or age > 40 years，but the effect of them are similar after 12 months.
stress urinary incontinence / transvaginal / CO2 laser / temperature-controlled radiofrequency
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Lasers and energy-based technologies have been developed for genitourinary applications over the past several decades.This consensus article aims to categorize the published articles and clinical trial data that culminated in protocol development of technology for genitourinary applications, and to develop consistent parameters in future clinical trials.The published articles and clinical trials data on lasers and energy-based devices applied to genitourinary conditions were categorized according to device and condition and consensus developed on protocols and parameters.The devices in genitourinary applications were classified as fractional lasers, radiofrequency and high-intensity focused electromagnetic field therapy. The consensus of the protocols and parameters based upon the published clinical trials of their application to the vaginal and urologic conditions associated with genitourinary syndrome of menopause was developed and organized according to device and condition.The status of FDA clearances and future pathways are discussed.This consensus article categorizes and presents the protocols and practices for the main classes of lasers and energy-based devices for genitourinary applications in future clinical trials.© 2023 Wiley Periodicals LLC.
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Conservative treatment is recommended as first-line therapy for stress urinary incontinence (SUI). We hypothesized that CO laser treatment would demonstrate safety and efficacy for women with SUI.A prospective, open-label, cohort study of 33 women (mean age 43 years) referred from a continence clinic after urologist/urogynecologist assessment, with a verified stress urinary incontinence diagnosis based on urodynamic testing. The participants completed three outpatient treatments with laser therapy and were subsequently evaluated at 1, 3 and 6 months. The independent t and chi-square tests were used to assess changes in sanitary pad usage and SUI symptoms.Sanitary pad usage decreased from a median of 12 per day at baseline to 7 at 1-3 months post-treatment (P < 0.0001) and returned to 12 at 6 months post-treatment. Scores on the Urogenital Distress Inventory and the International Consultation of Incontinence Questionnaire decreased (improved) significantly at 1-3 months post-treatment: from 45 ± 2 and 16 ± 4, respectively, to 29.3 ± 14.7 and 8.15 ± 3.1, respectively (P < 0.0001). The scores returned to levels similar to baseline at 6 months after treatment. Participants reported mild and transient side effects, with significant improvement in quality of life.Laser therapy can be an optional conservative treatment for women who seek minimally invasive non-surgical treatment for the management of SUI. No serious adverse effects were reported though the sample size was not large, a possible limitation of the study. Further large randomized control trials are needed to appraise the efficacy and safety of laser therapy for stress urinary incontinence and to demonstrate the ultimate utility of this modality.
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Vaginal rejuvenation is a topic of interest to multiple specialties, including dermatologists, plastic and reconstructive surgeons, urologists, and gynecologists. Evidence suggests that minimally invasive, energy-based devices-radiofrequency and laser therapy-are effective at vaginal tightening and decreasing symptoms of genitourinary syndrome of menopause (GSM) and/or vulvovaginal atrophy (VVA).A systematic review was completed using PubMed in November 2018 with search terms "vaginal" or "vagina" and "rejuvenation" or "tightening" or "laxity" or "radiofrequency" or "laser," as well as "genitourinary syndrome of menopause," "pelvic prolapse," "atrophic vaginitis," "vulvovaginal atrophy," "sexual function," "urinary incontinence," and "radiofrequency" or "laser." Inclusion criteria were articles written in English and clinical trials or case reports/series dealing with human subjects.We identified 59 studies (3,609 women) treated for vaginal rejuvenation using either radiofrequency or fractional ablative laser therapy. Studies report improvement in symptoms of GSM/VVA and sexual function, high patient satisfaction, and minor adverse events, including treatment-associated pain, swelling, or vaginal discharge.This review demonstrates radiofrequency and laser are efficacious for the treatment of vaginal laxity and/or atrophy. Further research needs to be completed to determine which specific pathologies can be treated, if maintenance treatment is necessary, and long-term safety concerns.Copyright © 2020 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.
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