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

Lina Zhang; Yiqing Lai; Wenjun Pan; Beibei Zhou; Xian Qiang; Zhilei Mao; Ting Wan

Disclosures

Transl Androl Urol. 2021;10(6):2471-2477. 

In This Article

Methods

Clinical Data

A total of 33 female patients with SUI who were treated at our hospital from January 2018 to December 2018 were selected as the research cohort for this prospective cohort study. All participants were married and fertile, with a mean age of (43.15±6.49) years old (35–62 years). There were 22 participants with mild incontinence (Grade I) and 11 with moderate incontinence (Grade II), with no significant age between two groups (Table 1). All participants completed The International Consultation of Incontinence Questionnaire-Short Form (ICIQ-SF) survey before the treatment. A 1 hour urine pad test was used to quantify the leakage of urine, and other complications were excluded by residual urine examination and urine routine examination. Gynecological examination was conducted to exclude other types of incontinence, including bladder prolapse, uterine prolapse, rectocele, bladder vaginal fistula, and so on. All participants received laser treatment 3 times, with an interval of 30 days. The participants were followed up at 3- and 6 months after the treatment. The study was conducted in accordance with the Declaration of Helsinki (as revised in 2013). This study was approved by the Ethics Review Committee of Changzhou Maternal and Child Health Care Hospital (201730). Informed consent was provided by all participants.

Inclusion and Exclusion Criteria

The inclusion criteria were as follows: (I) normal cytology, human papillomavirus (HPV) and leucorrhea test; (II) negative urine culture; (III) no injury or bleeding in the vaginal cavity, vaginal orifice, and vestibule.

The exclusion criteria were as follows: (I) injury or infection of the treatment area; (II) menstruation and bleeding of the vagina; (III) bladder prolapse, uterine prolapse, rectocele, bladder or vaginal fistula; (IV) pregnancy; (V) malignant tumor, patients who used corticosteroid or sex hormone drugs in the recent 6 months.

Instruments and Methods

Instrument. The FemiLift CO2 laser (Alma Laser Ltd, Caesarea, Israel) concentrated the laser through a holographic lens (30 W, 60–100 mj/ppxl, high energy mode, 0.5 Hz), thus providing micro-burning energy on a total area of 81 mm2 (9×9 mm2).

Principle. The treatment utilized a special vaginal probe to shoot CO2 laser, then to realize the ablation of the tissue surface in a small area and the heat deposition of deeper parts, thus leading to the effect of remodeling collagen and elastic fibers, increasing glycogen synthesis and surface exudation, and so on. Meanwhile, the micro burning effect of CO2 laser stimulated the interaction of heat shock proteins (HSPs), and activated fibroblasts to produce extracellular matrix components such as proteoglycan and glycosaminoglycan. Transforming growth factor-β (TGF-β) and epidermal growth factor and fibroblast growth factor (EGF and FGF) play an important role in promoting angiogenesis. In general, the whole process of photo eutrophication involves 3 stages: early heat loss, the proliferation of collagen and extracellular matrix in the medium term, and the final remodeling stage, including synchronous maturation of collagen and neoelastic fibers.

Treatment. At the bladder lithotomy position, the vulva and vagina were cleaned and disinfected (ensuring that the vulva vaginal area was clean and dry without any cream, lotion, or other substances that affect laser emission). The treatment sites were at the 11–12-1 position of 3 planes, including a plane from bladder neck to the middle and lower part of urethra, 1 cm above, and 1 cm below the above plane. Then CO2 lattice laser was irradiated. The spot diameter was 9×9 mm2; intercourse was forbidden for 1 week after the operation, and sitting in a bath was avoided for 1 week.

Observation and Judgment Standard

Classification of Incontinence. The following grades were used to classify level of incontinence: grade I: the involuntary leakage when coughing, sneezing or carrying heavy objects forcefully; grade II: leakage when walking fast, skipping rope, and exercising slightly; grade III: leakage with the change of body position; grade IV: leakage in a resting state or at night.[9]

Questionnaire Survey. The full-time nurses were responsible for the questionnaire survey, and the survey results of ICIQ-SF and the satisfaction of patience were recorded and analyzed.

1-hour Urine Pad Test. The clean urine pad was weighed and recorded before inspection, and the participant was instructed to empty the bladder as much as possible and use the clean urine pad. After drinking 500 mL of water within 15 minutes, the patient walked for 30 minutes, including going up and down the stairs. The following exercises were performed within 30 minutes: (I) sitting position to standing position for 10 times; (II) cough exercise for 10 times; (III) running in place for 1 min; (IV) bend to pick up small objects on the ground for 5 times; (V) wash hands with water for 1 min. Then, the urine pad was removed, inspected, and recorded. The difference between the weight of the pad before and after inspection was calculated as the leakage (1 g =l mL urine). Finally the patient drained their bladder, and the amount was recorded. According to the classification of urine leakage, slight incontinence: 1 hour leakage ≤1 mL; moderate incontinence: 1 hour leakage >l mL and <10 mL; severe incontinence: 1 hour leakage >10 mL and <50 mL; extremely severe incontinence: 1 hour leakage >50 mL. Results: (I) weight gain of the urinary pad >1 g was considered positive, (II) the weight of the pad >2 g, attention should be paid to whether there were weighing errors, sweating, and vaginal secretion; (III) weight gain of the urinary pad <1 g, indicating that a basic drying or experimental error was found.[10] Efficacy of the treatment was judged by: the number of leakages, decrease of urine leakage, whether subjective consciousness was improved, and whether the grade of stress incontinence was degraded or not. In the assessment of postoperative complications, the participants were followed up regarding residual urine volume and flow rate at 3- and 6 months after the operation to further clarify whether there was urethral stricture or not. Participants were asked if they were experiencing any vaginal bleeding, altered frequency of urine, urgency, pain, itching vagina, sexual pain, and other accompanying symptoms

Statistical Analysis. Statistical analysis was carried out using the software SPSS 18.0 (IBM Corp., Chicago, IL, USA). The measurement data were expressed as mean ± standard deviation (x̄±sx̄±s), compared with t-test, and a P value <0.05 was considered statistically significant

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