Is there enough evidence to justify the use of laser and other thermal therapies in female lower urinary tract dysfunction? Report from the ICI‐RS 2019

Abstract

Aims There is increasing evidence to suggest that thermomodulation may have a role in the management of women with lower urinary tract dysfunction (LUTD) and there has been widespread adoption of laser and radiofrequency (RF) therapies within clinical practice. However, in many areas of LUTD, the data are still limited and there remains a need for further evaluation of the safety and efficacy of thermal therapy. The aim of this study proposal is to report the findings of the International Consultation on Incontinence Research Society to clarify our current knowledge regarding the evidence for thermal therapy in LUTD and to set research priorities for the future. Methods Literature review based on the search terms: “laser,” “radiofrequency,” “genitourinary syndrome of the menopause” or “urogenital atrophy,” “stress urinary incontinence (SUI),” “pelvic organ prolapse,” “OAB” or “overactive bladder,” and “urinary tract infection.” Results The current available evidence, though of low or very low quality, appears promising for the use of laser therapy in the management of genitourinary syndrome of the menopause, there are some data to suggest a possible role in SUI although very little evidence for urogenital prolapse. At present, the evidence supporting the use of laser in OAB and recurrent urinary tract infection is limited or lacking, while the available evidence for RF in the management of all forms of LUTD is much less robust. Conclusions Laser and RF are being introduced clinically as a minimally invasive, low‐risk interventions for women with LUTD although at present, the evidence supporting usage is limited. Consequently, there is an urgent need to demonstrate the safety and efficacy with prospective long‐term studies including sham studies and comparative studies with current standard therapy.

Comparison of urethral sling surgery and non-ablative vaginal Erbium:YAG laser treatment in 327 patients with stress urinary incontinence: a case-matching analysis

“…Recent International Consensus Group recommendations suggest that laser therapy should be restricted to research until further robust data are available [12][13][14]. On July 30, 2018, the United States Food and Drug Administration (FDA) issued a warning against the use of energy-based devices (EBD), including laser, to perform "vaginal rejuvenation" or vaginal cosmetic procedures.…”

Recent advances in managing overactive bladder

“…Light amplification by stimulated emission of radiation (laser) was first described by Einstein in 1917 55 . It is used for different medical reasons.…”

“…It is used for different medical reasons. The two most commonly used lasers are microablative fractional CO 2 laser (SmartXide 2 -V 2 LR, MonaLisa Touch; DEKA, Florence, Italy) and non-ablative photothermal erbium:YAG (Er:YAG) laser (Fotona Smooth XS; Fotona, Ljubljana Slovenia) 55 . The laser causes thermomodulation by heating and (in the case of the CO 2 laser) ablating columns of tissue 55 .…”

The effect of dynamic quadripolar radiofrequency on genitourinary atrophy and sexual satisfaction: A systematic review and meta-analysis

“…It generates temperatures between 40 °C and 45 °C which induces collagen production through fibroblasts via the activation of heat‐shock proteins and initiation of the inflammatory cascade. [ 4 ] Among radiofrequency devices, the most novel is the dynamic quadripolar radiofrequency (DQRF) device. DQRF biophysics allow the operator to define the depth and volume of the target vulvar area and drastically reduce administered energy.…”