CO2 Lattice Laser for Female Urinary Incontinence

In This Article

Abstract and Introduction

Abstract

Background: This study aimed to explore the application of CO₂ lattice laser in the treatment of mild and moderate urinary incontinence in female patients.

Methods: We analyzed the clinical data of 33 female patients with mild to moderate urinary incontinence from a prospective cohort study, who were treated with FemiLift CO₂ lattice laser instrument (Alma Laser Ltd, Caesarea, Israel) at our hospital from January 2018 to December 2018. All the female patients were married and fertile, with a mean age of (43.15±6.49) years old (35–62 years old). There were 18 participants with mild urinary incontinence and 15 with moderate urinary incontinence. All participants received laser treatment 3 times, with an interval of 30 days. The International Consultation of Incontinence Questionnaire- Short Form (ICIQ-SF) survey was conducted before the treatment, 3 months after, and 6 months after the treatment. A 1-hour urine pad test was used to quantify the leakage of urine. Residual urine and urine routine examination were performed to exclude other combined diseases.

Results: After 3 times of treatment with FemiLift CO₂ laser, 13 cases were cured in 3 months, and 16 cases were cured in 6 months. 10 cases and 15 cases were significantly improved in 3 or 6 months, respectively. 2 patients had no significant changes, and no adverse reactions were recorded. The pad test showed that the symptom of all 33 patients were significantly improved, and the average scores of ICIQ-SF were significantly decreased (P<0.05) from 12.36 (Grade I) and 15.67 (Grade II) (5–21) before treatment to 3.73(Grade I) and 5.49 (Grade II) (1–12) after 6 months of therapy.

Conclusions: The CO₂ lattice laser is safe and effective in the treatment of mild and moderate urinary incontinences in female patients, which can effectively improve the symptom of urinary leakage without obvious adverse reactions.

Introduction

Stress urinary incontinence (SUI) is a common disease in middle-aged and elderly women. In recent years, the incidence of SUI has been increasing alongside the continuous growth of the aging population, and it has become a common health problem for women. The term SUI refers to the involuntary outflow of urine caused by a sudden increase in abdominal pressure, but it is not caused by detrusor systolic pressure or bladder wall tension pressure on urine. It is characterized by no enuresis in normal state, and automatic urine outflow when abdominal pressure suddenly increases.^[1] According to statistics, about 23–45% of women over the age of 20 globally have urinary incontinence, of which SUI accounts for about 50%.^[2] In Chinese women, SUI has been shown to occur mostly in women aged 45–55 years.^[3] Age, pregnancy, vaginal delivery, postmenopausal status, and obesity are the main risk factors of SUI.^[4] Gynecological operations such as uterine prolapse and hysterectomy double the risk of SUI.^[5]

Therefore, timely and effective diagnosis and treatment of SUI is very important. There are various treatments for SUI, including mid-urethral sling (MUS) and vaginal suspension (Burch colposuspension). These operations have certain surgical risks, such as bleeding, infection, bladder and urethral injury, dysuria, and pain. Laser therapy has become available as a novel treatment for SUI patients in recent years.^[6–8] Thus far, Erbium:YAG (Er:YAG) laser has been widely studied, but few studies have reported on the application of CO₂ laser in the treatment of SUI, which is worthy of further research to confirm the efficacy. In view of this, we analyzed the clinical data of 33 female patients with mild to moderate urinary incontinence, who were treated with FemiLift CO₂ lattice laser (Alma Medical Laser, Caesarea, Israel) at our hospital from January 2018 to December 2018. The results indicated that CO₂ lattice laser is safe and effective in the treatment of mild and moderate urinary incontinence in female patients.

We present the following article in accordance with the STROBE reporting checklist (available at https://dx.doi.org/10.21037/tau-21-337).

Table 1. Baseline analysis
Variable	Grade I	Grade II	P value
Age (year)	36.13±5.39	45.86±7.58	>0.05

Table 2. Grading of female patients with SUI before and after CO ₂ lattice laser treatment
Time	Grade (n)
Time	No leakage	Grade I	Grade II
Before operation	0	18	15
3 months after operation	13	10	2
6 months after operation	16	15	2

SUI, stress urinary incontinence.

Table 3. Comparison of urine pad test and ICIQ-SF score of female patients with SUI before and after CO ₂ lattice laser treatment (n=33, x̄±s)
Variable	Before treatment	3 months after operation	6 months after operation
Urine pad test (g)
Grade I group	8.19±2.42	1.02±0.54	0.80±0.41
Grade II group	9.09±5.38	2.41±2.29	2.01±1.98
ICIQ-SF score
Grade I group	12.36	5.78	3.73
Grade II group	15.67	9.82	5.49

ICIQ-SF, International Consultation of Incontinence Questionnaire-Short Form; SUI, stress urinary incontinence.

Table 4. Effect of different factors on ICIQ-SF score after 6 months of operation
Factor	Value	Score
Etiology	r	0.157
Etiology	P	0.156
Age	r	−0.145
Age	P	0.191
Obesity index	r	−0.095
Obesity index	P	0.398
Disease duration	r	0.058
Disease duration	P	0.667
Grade of urine leakage	r	−0.348
Grade of urine leakage	P	0.007
Preoperative urine pad test	r	−0.321
Preoperative urine pad test	P	0.061