Application of Ultra Pulse CO₂ Lattice Laser in the Treatment of Female Urinary Incontinence

Discussion

Women with SUI may leak urine during coughing, laughing, vigorous exercise, and so on. Severe SUI can involve urine leakage when standing or walking, which can seriously affect daily work and life, and reduce the quality of life. It has been shown that women with urinary incontinence have lower collagen content in the pubic cervical fascia,^[11] and that women with SUI have lower collagen content in the anterior vaginal wall.^[12] Figure 1 shows a vagina after the first CO₂ lattice laser treatment, in which prominent vaginal wall enlargement can be observed and dotted marks made by the laser beam can be observed. The photograph in Figure 2 was taken after the second treatment, and the enlargement of the vaginal wall has improved significantly. The vaginal images in Figures 3 and 4 were taken 3- and 6 months after treatment, and it can be clearly seen that the vaginal wall swelling had basically disappeared; interview with the patient also revealed that the symptoms of urinary incontinence had completely disappeared.

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Figure 1.

Changes of vagina after the first time of laser therapy.

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Figure 2.

Changes of vagina after the second therapy (one month) of CO₂ laser.

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Figure 3.

Changes of vagina after three months' of treatment with CO₂ laser.

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Figure 4.

The changes of vagina after finished with six months' of treatment.

In this study, CO₂ lattice laser was used to stimulate tissue remodeling by burning superficial cells and activating deep cells. This process involved a small family of proteins, HSPs. Once activated, HSPs can cause changes in cell metabolism and selectively induce the expression of cell surface receptors in treated tissues. The key cytokine TGF-β plays an important role in collagen and extracellular matrix production during inflammation and fibrosis. It can stimulate the metabolism and nutritional recovery of vaginal mucosa, thus improving elasticity and moisture. Local normal tissue cells and blood vessels can quickly promote the local tissue thickness and elasticity.^[13] The pathological mechanism of SUI is that the loss of urethral supporting structures causes the urethra and bladder neck to descend to different degrees and the closure of bladder neck and urethra to decrease.^[14] The CO₂ lattice laser can cause collagen and elastic fibers to proliferate and reorganize locally, which both increases the stability and reduces the mobility of the urethra. To enhance the local connection of the vaginal wall and urethral wall, the elasticity of the anterior vaginal wall was increased, and local thickening also improved the stability of the urethra, which achieved good urinary control.^[15]

In this study, we used the Spearman method to study the correlation of etiology, age, grade of urine leakage, disease duration, obesity index, preoperative pad test, and so on. The results showed that the grade of leakage (r=−0.348, P<0.05) showed a certain correlation with the ICIQ-SF score after treatment; that is, patients with grade II leakage or moderate or severe leakage before treatment had lower comprehensive scores after treatment. Domestic and foreign guidelines also recommend weight loss and continuous pelvic floor exercises to improve mild urinary incontinence. Cumulative studies have shown that patients with mild to moderate SUI experience more benefit after treatment, those with normal BMI benefit more than obese patients, and young patients benefit more than older patients. In addition, CO₂ lattice laser is a precise and minimally invasive tool, which can improve the clinical symptoms and quality of life for women with SUI. It can provide a new and convenient treatment to improve urinary incontinence symptoms. The CO₂ lattice laser has many strengths, including being safe, easy to operate, easy to start, painless (no need for local anesthesia), minimally invasive, and time-saving. In recent years, extensive studies and investigations of laser therapy have been made by researchers in China and internationally. The shortage of this study was that, the sample size is relatively small, and more patients should be recruited to verify the current conclusions.

Transl Androl Urol. 2021;10(6):2471-2477. © 2021 AME Publishing Company