Fractional‐Pixel CO₂ Laser Treatment in Patients With Urodynamic Stress Urinary Incontinence: 1‐Year Follow‐Up

Abstract

Background and Objectives Vaginal pixelated low power and long pulses (LPLP) CO2 laser has been suggested as an optional treatment for stress urinary incontinence (SUI) with many studies reporting short‐term improvements. The objective of this study was to assess the 1‐year subjective and objective efficacy of vaginal CO2 laser in women with urodynamic SUI. Study Design/Materials and Methods This was a prospective multicenter study. Patients with confirmed urodynamic SUI graded as mild or moderate were included. We used three sessions of fractional pixelated CO2 laser for vaginal application and followed up the patients at 6 and 12 months. We used the following measures at follow‐up: 1‐hour pad test (ICS protocol), questionnaires including Pelvic Floor Distress Inventory 20 (PFDI‐20), Pelvic Floor Impact Questionnaire (PFIQ), Patient Global Impression of Improvement (PGI‐I), and a 3‐day urinary diary. The urodynamic assessment was repeated at 6 months. Results Fifty‐two patients with SUI had three laser treatments, of whom 48 completed a 6‐month follow‐up and 42 patients completed 12‐month follow‐up. No serious adverse events were recorded during the study period. A significant reduction on the 1‐hour pad test was found from baseline (6.3 ± 1.6 g) to the 12‐month follow‐up (3.7 ± 1.4 g, P < 0.05) was found. PGI‐I showed 75.0%, 61.9%, and 64.3% improvements at 3, 6, and 12 months, respectively. PFDI improved significantly and consistently from baseline until 12 months (37.2 ± 3.89 to 16.1 ± 3.7, P < 0.05). Similarly, PFIQ showed significant improvements from the first treatment up to 12 months. Urodynamic assessment at 6 months showed that 41.4% of patients had no stress incontinence. Conclusion The vaginal CO2 laser was found to be effective for mild‐to‐moderate SUI over a follow‐up period of 1 year, according to a variety of objective and subjective parameters. The wide range of parameters enables optimal patient consultation and subsequent treatment. Lasers Surg. Med. © 2020 Wiley Periodicals LLC

Pixel-CO2 laser for the treatment of stress urinary incontinence

“…The pattern of a slow return towards pre-treatment symptoms is visible by all monitoring tools and may suggest the need for a touch-up session at around 9–12 months. Similar trends of improved SUI symptoms and slow return towards baseline levels between 6 and 12 months are reported by Alcalay et al [ 20 ] following a similar treatment protocol of fractional/pixel-CO 2 laser treatment with additional serial urodynamic monitoring. Dabaja et al [ 17 ] described similar improvements following fractional/scanning-CO 2 laser treatments around the 6-month follow-up time point.…”

“…Demographics of patients are summarized in Table 1. The patients' mean age was 51.0 ± 1.4 (range: 32-70), parity was 1.7 ± 0.1 (0-3), mean BMI was 26.1 ± 0.4 (19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34). The group consisted of 68% high school education graduate women and 32% were academics.…”

“…Fistonic and Fistonic [ 23 ] concluded that treatment outcomes with Er:YAG laser is likely to be better in women with BMI < 23.3 kg/m 2 , which was below the average of their studied patients. Blaganje et al used the same laser wavelength with a different fractional technology and concluded that BMI had no significant effect on the outcome [ 7 ], while Alcalay et al who used pixel-CO 2 laser excluded patients if their BMI was greater than 38 [ 20 ]. Interestingly, our results may indicate that the moderately overweight patients benefit from this treatment.…”

“…The laser intensity was adjusted according to patient's tolerability and the level of vulvo-vaginal atrophy (VVA), ranging from 70 to 120 mJ/ px. The laser beam is fractionated into 81 "px" per cm 2 at each emission, and the expected depth of microablation varies between 300 and 500 μm with increased thermal margins of 150-200 μm (20,21). Following introitus lubrication with "baby oil", and gentle insertion of the laser probe, the lasing procedure is performed by rotating the probe clockwise to cover the entire vaginal wall (360°) and then this maneuver is repeated three times ("passes").…”

“…Recent publications with various treatment protocols highlighted the effective use of fractional-scanning CO 2 laser [16][17][18][19], and a fractional-pixel CO 2 laser [20] for SUI symptoms; however, randomized trials are urgently needed.…”