Conservative Management of Urinary Stress Incontinence in Selected Post Menopause Patients with Fractional CO2 Laser

Abstract

Objective: This PUBA study aims to evaluate the effectiveness of the Fractional CO2 Laser in the conservative treatment of Urinary Stress Incontinence in pre-selected Post-Menopausal Patients, with urine loss to Valsalva maneuvers. Methods: Symptoms of Urinary Stress Incontinence were evaluated before, and 1 month after the last session (3 sessions with a 30-day interval between them) in 50 post-menopausal women (Middle Age - Menopause, Interquartile Range Parity - BMI). Subjective measures (ICIQ SF, VAS) and objective measures such as PAD TEST were used (a dry diaper was previously weighed, and she was instructed to take 500 cc for 15 minutes at rest, and then for 45 minutes to perform Valsalva maneuvers, go up and down stairs, sit, stand up, etc. and then reweigh the diaper) during the study period in order to evaluate the results of the fractional CO2 laser treatment compared to the baseline. Results: Of the 50 patients enrolled, 12 patients in total who presented minimal Urinary symptoms of incontinence (USI) according to the ICIQ questionnaire, all were cured, defining this, as the no loss of urine. Of the 18 patients who presented moderate USI, 10 were cured (55%), that is, they did not present urine loss, and the other 8 patients (45%) had partial recovery, but continued losing urine. Of the 20 patients who presented severe USI, none were cured, 9 (45%) of them remained in severity, and 11 (55%) patients had partial recovery, migrating to the degree of moderate USI. An objective assessment was also performed using the PAD TEST, of the 12 patients with minimal USI, all were cured, of the 18 patients who presented moderate USI, what was found in the ICIQ was confirmed, with 10 patients cured, and 8 with partial recovery. Likewise, of the 20 patients with severe USI, none were cured. VAS (Visual Analogue Scale) was also performed at the end of the treatment and after a year by telephone call, to assess the degree of satisfaction, in regards to the minimal USI at the end of the treatment, this was 100%, and after a year it was reduced to 95%. The patients who presented moderate USI at the end of the treatment presented an average degree of satisfaction of 88.8%, and after 1 year it was 72.2%, and in respect of severe USI it was 6.5% at the end of the laser treatment, and after one year it was 0% Conclusions: In the present study, the data suggest that Fractional CO2 Laser is an effective alternative for the treatment of Minimal-Moderate Urinary Stress Incontinence in well-selected post-menopausal patients, with positive results that persist over time. Keywords (MESH): Fractional CO2 Laser; Menopause; Urinary Incontinence