Laser Treatment for Patients With Vulvodynia and Interstitial Cystitis/Bladder Pain Syndrome: A Case Series (The UNICORN-3 Study)

Abstract

Introduction Interstitial cystitis/bladder pain syndrome (IC/BPS) is a chronic pain disorder characterized by urgency, frequency of urination, and pelvic pain. Women with IC/BPS often experience sexual dysfunction, vulvodynia, and vaginal health issues. Combined erbium and neodymium yttrium aluminum garnet (YAG) laser treatments targeting the vagina and vulva have shown promise in improving symptoms. Our study aims to investigate the effectiveness of these combined laser treatments in women with IC/BPS and vulvodynia. Methods Women diagnosed with vulvodynia and IC/BPS underwent combined laser treatment using vaginal erbium:YAG laser (VEL) and neodymium:YAG laser (Nd:YAG). Various parameters were evaluated, including the vulvodynia test, numeric rating scale (NRS-11) for pain, interstitial cystitis symptom index and problem index (ICSI and ICPI), pelvic pain and urgency/frequency symptom score (PUF), and mean urination volume/daily urination frequency in a three-day urination diary. Treatment was administered three times, with intervals of one month between each session, and follow-up evaluations were conducted at six and 12 months. All statistical analyses were designed and programmed by the AI chatbot GPT-4 (chatGPT-4). Results Fifteen female patients diagnosed with vulvodynia and IC/BPS were treated with three sessions of VEL + Nd:YAG. Significant improvements were observed in the vulvodynia test, NRS-11 scores, PUF, ICSI scores, ICPI scores, mean urination volume, and daily urination frequency at six and 12 months (p<0.01). Short-term improvements in IC/BPS pain scores correlated with improvements in the vulvodynia test (p=0.007), suggesting a synergistic effect. However, no significant correlations were found at 12 months. Conclusion Combined laser treatments targeting the vagina and vulva showed significant therapeutic effects in women with IC/BPS and vulvodynia. The addition of Nd:YAG to the VEL treatment enhanced outcomes. Short-term improvements in IC/BPS pain scores correlated with improvements in the vulvodynia test, indicating a synergistic effect. Long-term improvements in both vulvodynia and IC/BPS symptoms may occur independently. These findings highlight the importance of comprehensive approaches for treating coexisting vulvodynia and IC/BPS.

The Efficacy of CO2 Vaginal Laser in the Treatment of Recurrent, Post-Coital and Interstitial Cystitis: A Multicentric Prospective Study

“…The post-treatment reduction in dysuria, urgency, pollakiuria and the overall decrease in annual cystitis episodes suggests an improvement in patient condition and quality of life. These highlighted data are consistent with those reported in the UNICORN-2 and UNICORN-3 studies [ 45 , 46 ], despite their smaller sample sizes (12 and 15 patients, respectively), exclusively affected by interstitial cystitis/BPS and vulvodynia. Both of the aforementioned studies adopted non-ablative erbium and neodymium yttrium aluminum garnet (YAG) lasers.…”

Neodymium Laser Treatment for Overactive Bladder and Vulvodynia in Mayer-Rokitansky-Küster-Hauser Syndrome Patient: A Case Report

“…Particularly, the PIANO mode used generates heat from the reaction between the laser energy and hemoglobin, causing vascular dilation. Previous studies have shown improvement in pain for vulvodynia, but reports are limited [19,20]. In this case, significant changes were observed in urethral thickness, signal intensity ratio, and vascular signals in the perineal area after Nd:YAG laser treatment.…”

“…In this case, Nd:YAG laser treatment proved effective. This is the newest treatment for vulvodynia, promoting tissue regeneration [19,20].…”

Unsupervised Machine Learning Reveals a Vulvodynia-Predominant Subtype in Bladder Pain Syndrome/Interstitial Cystitis

“…Reports suggest that 30-50% of BPS/IC patients have comorbid vulvodynia [4], indicating that vulvodynia may be a systemic symptom of BPS/IC. Several studies have demonstrated that laser treatment for vulvodynia can lead to an improvement in BPS/IC symptoms [9,10], suggesting that vulvodynia may play a significant role in the pathophysiology of BPS/IC and could be a potential therapeutic target. Okui et al reported a case series showing the efficacy of vaginal erbium laser (VEL) treatment (RenovaLase, SP Dynamis, Fotona d.o.o, Ljubljana, Slovenia) for patients with both vulvodynia and BPS/IC [10].…”

“…Despite the importance of vulvodynia in BPS/IC patients, it may not be adequately assessed in clinical practice [3,4]. Validated questionnaires are commonly used to evaluate BPS/IC symptoms, but they may not fully capture extravesical symptoms, such as vulvodynia [9,10]. This limitation could contribute to suboptimal treatment outcomes, and addressing vulvar health may be crucial for improving symptom management and quality of life [10].…”