Laser treatment of urinary incontinence

Urinary incontinence, or involuntary urination, is a problem that affects about 30% of middle-aged women. It is a problem of an intimate as well as social nature. The latest treatment used in the treatment of urinary incontinence, which is burdened with the lowest risk of complications is the laser treatment of urinary incontinence.

Characteristics of laser treatment of urinary incontinence

What is incontinence?
Urinary incontinence or urinary incontinence is an involuntary, urine-independent urge.
Under physiological conditions, urination, i.e. the so-called micturition, is regulated by several mechanisms. Urine produced in the kidneys is collected in the bladder. The bladder is a stretched bag made of muscle fibers located in the lower abdomen. From the bladder, urine is excreted through the urethra, which is much shorter in women than in men. The bladder located in the pelvis lies on the muscular pelvic diaphragm. The pelvic diaphragm is made of several muscles, some of them surround the urethra and tighten it, conditioning the urinary incontinence in the bladder, so-called sphincters. The correct tension of these muscles is regulated by the nervous system, as well as the tension of the urinary bladder. When the bladder is full, the brain sends a signal to the sphincter to relax and thereby stop the urethra. At this point, the urine has the opportunity to go outside. In addition, there is also a bladder tension that displaces urine.

We distinguish several types of urinary incontinence:
• stress urinary incontinence,
• urinary incontinence due to urgency (often associated with bladder overactivity),
• mixed
• rinary incontinence - associated with blockage of the outflow, usually in men as a result of prostatic hypertrophy,
• reflex urinary incontinence - disorder associated with nervous system dysfunction,
• non-urinary incontinence - associated with the presence of a fistula through which the urine leaves the bladder, can pass outside but also into the abdominal cavity, vagina or rectum. It is the rarest type of urinary incontinence.

In women suffering from urinary incontinence, the most common pathology is in the urethra, and less often in the nervous system.
The main indication of the use of laser treatment of urinary incontinence is stress incontinence, which is the most common cause of urinary incontinence in women.

What is stress incontinence?
This is the involuntary urination of a woman as a result of a sudden increase in pressure inside the bladder, for example as a result of sneezing, laughter, coughing or lifting. Stress incontinence is a social and hygienic problem. This intimate and persistent problem affects many women in different age groups. Most often it affects women between 50 and 80 years of age. In this age group, about 40 percent of people suffer from this condition, women aged 25 constitute as much as 10% of patients.
The cause of stress urinary incontinence are long-term deliveries through nature and extensive operations in the pelvic area. Another reason is the exposure to frequent effort associated with carrying, for example, at work or hobby, as the cause is also given hormonal disorders.

The benefits of laser treatment of urinary incontinence

Women suffering from urinary incontinence have problems with maintaining proper hygiene. It is also a social and psychological problem. These patients feel embarrassed, tend to be uncertain and withdraw from social life.
Laser treatment of urinary incontinence in the early phase makes it possible to completely cure the disease. Thanks to the treatment, the vaginal wall becomes more durable, thicker and more elastic, so-called revitalization or rejuvenation of the vagina comes. After the laser treatment of urinary incontinence, the quality of everyday and intimate life improves.
In relation to surgery, laser treatment of urinary incontinence is a procedure with a significantly smaller risk of complications is additionally short and painless.

Indications for the procedure

Qualifications for laser treatment of urinary incontinence are made by a gynecologist or a urologist.

The indication for the procedure is to make a correct diagnosis and to assess the severity of the disease. The basis for the diagnosis of stress urinary incontinence is history and physical examination. The main symptoms are:
• complaints about wetting during coughing, laughter, effort,
• in the interview many deliveries, long-term births,
• no other accompanying symptoms such as excessive pressure or pain during urination.

During the physical examination, the doctor:
• examine the vagina externally,
• performs a colonoscopy,
• performs a coughing test - during the vaginal evaluation, the patient coughs, the test is positive when urine is involuntarily urinated,
• in addition, radiological examinations, for example, cystouretrographs, can be performed.

Contraindications for the procedure

The main contraindications to the procedure are:
• vaginal infection, discharge,
• general inflammation with fever,
• local occurrence of inflammation, purulent lesions,
• pregnancy,
• incorrect test results, e.g. cytology, general urine tests,
• the use of some groups of drugs: anticoagulant, photosensitive,
• tendency to form keloids,
• anticoagulants (discontinue or change 7 days before surgery).

Before the surgery

During the consultation before the laser treatment of urinary incontinence, the doctor collects the interview and examines the patient. It is also the best time to ask questions to your doctor. It is important then to inform the doctor about all diseases, medicines and allergies you have.

Before laser incontinence treatment, the doctor may order the following tests:
• cytology
• urinalysis
The gynaecologist may also order a medical consultation with another specialist, such as a cardiologist in case of a chronic heart disease. Before surgery, consent for the surgery is signed. When signing consent, the doctor informs the patient about how the procedure will be performed, what will be done, what are the possible complications and other treatments.
During the consultation before the laser treatment of urinary incontinence, the gynaecologist collects the interview and performs a full gynaecological examination together with the vaginal speculum for the purpose of correct classification for the procedure

Type of anaesthetic

Laser treatment of urinary incontinence is a painless procedure. The patient does not require anaesthesia. If the patient is very nervous, the doctor can give sedatives before the procedure.

How does the procedure work?

A laser is a device emitting appropriate length electromagnetic waves. The laser emitting beams of properly selected length has the option of heating only selected structures without exposing others. The energy emitted by the laser during the laser treatment of urinary incontinence affects the collagen, which is the main component of the connective tissue (this tissue strengthens the structure of the organism) and shortens its bundles, and stimulates the production of new. the most popular device for performing a laser treatment of urinary incontinence is MonaLisa Touch - an innovative laser for the revitalization of intimate female organs.
During the procedure, the vagina shrinks, the laser beam forms microbubbles, which strengthen the structure of the vaginal wall and at the same time restore the proper anatomical relations. The formation of microblasts contributes to the increase of collagen and connective tissue, which makes the vaginal wall not only more durable, but also more elastic comes to the so-called revitalization or rejuvenation of the vagina.
Laser treatment of urinary incontinence is performed with vaginal access. The patient is placed in a gynecological position. The laser head is inserted into the vagina. During the therapy, the doctor moves the head in the vagina, targeting the vaginal wall with the laser beam.
Treatment time - on average, about 30 minutes.

Time and course of convalescence

On the day of the procedure the patient can go home. Before leaving, he should receive an information card with all recommendations. The most important is to follow the instructions of the attending physician, because he knows the clinical situation of the patient best.
In the first day, the patient may feel a slight degree of discomfort within the vagina and at the bottom of the abdomen.
In the first days after the procedure there may be serous exudation from the vagina, therefore it is recommended to wear sanitary napkins.
For about a month, you must abstain from sexual intercourse.

Effects after surgery

All patients after the use of laser treatment of urinary incontinence feel the difference in relation to the original condition. Depending on the severity of the disease, there is a cure to varying degrees.
In light and medium steps, it is sufficient to perform the procedure once. In heavier steps, an additional surgery is often required about 2 months after the first one. In some situations, when the degree of disease is very large, laser treatment may be ineffective and surgical treatment may be needed, for example with the use of tapes.
The effect of laser incontinence is not felt immediately, changes are noticeable only when the connective tissue of the vaginal wall undergoes appropriate reconstruction. The first effects are noticeable after about a month. However, it should be remembered that the scar in the human body is formed for several months to even a year and at that time we can only talk about the full assessment of the treatment.
As a result of laser incontinence, not only the problem of involuntary urination is removed but also the quality of the vaginal wall is improved. The vagina becomes more elastic, better moisturized, which also improves the quality of sexual intercourse.

Recommendations after the procedure

After following the laser treatment of urinary incontinence, the following recommendations should be followed:
• follow the instructions of the attending physician,
• putting on controls on set dates,
• the use of sanitary napkins in the first days after surgery,
• if pain occurs, use of oral analgesics,
• avoiding physical activity before 1-2 weeks after the surgery,
• in the event of deterioration of the local condition, eg excessive exudation from the vagina, appearance of purulent secretion or other disturbing symptoms, try to get to the doctor who performed the procedure as soon as possible. If it is not possible to report to the nearest gynecological or urological admission center,
• in post-menopausal women, the use of hormone replacement therapy,
• doing exercises strengthening Kegel muscles.

How long do the effects last?

The healing effect lasts the longest in young women and can last even for many years. Women older after the menopausal period should maintain hormone replacement therapy for long-term maintenance of the therapeutic effect. All patients are also advised to exercise Kegel muscles.

How to avoid complications?

In order to avoid complications after the procedure:
• follow the doctor's instructions,
• put on set inspection dates,
• special care for hygiene,
• use sanitary napkins in the first days after surgery
• avoid bathing (bath, water reservoirs, eg lake, pool, sea) in the first week after the procedure
• a ban on sexual intercourse for one month after the surgery
• prohibition of using tampons, vaginal discs in the first month of surgery
• performing exercises improving the endurance of the muscles of the perineum and vagina so-called Kegel exercises
• if any disturbing symptoms appear, such as a sudden appearance of fever, redness, excessive warming or purulent leakage from the vagina and surrounding areas, immediately report to the gynecologist performing the procedure or the nearest Gynecological or Urological Board.

Possible complications

In some cases, for example, in severe incontinence levels, the patient may not notice improvement, then re-surgery or surgery is required. Immediately after the laser treatment of urinary incontinence, erythema and swelling of the vulva or vaginal mucosa may appear. Serous efflorescence often occurs after the treatment, which can last up to several days. Occasionally, patients complain of excessive vaginal susceptibility to a few weeks after treatment, among other reasons sexual intercourse should be avoided. In very rare cases, vaginal mucosa may be damaged.

Recommended additional treatments

In post-menopausal women, the use of hormone replacement therapy and exercises to strengthen Kegel muscles.

Other treatments:

Conservative:
It is recommended in the early stages of the disease, when there is a low degree of advancement, we recommend gymnastics strengthening the muscles of the perineum and abdomen and lower limbs, eg Kegel exercises - these are exercises involving alternate contraction and relaxation of the vaginal and perineal muscles. Such exercises should be performed daily for 15-20 minutes. You can use a special pressure cuff for control during exercise, which can be placed in the vagina and measure the pressure.

Pharmacological:
Alpha adrenergic drugs eg ephedrine, imipramine (not very effective).

Surgery:
There are two types of treatments - supporting and lifting the urethra.
The aim is to create a proper position of the urethra relative to the bladder. The TVT method is the most popular, it is a tension free method with the use of tape. It consists in suspending the central part of the coil on appropriately implanted polypropylene tape (TVT).
Until recently, popular treatments are, for example, the Kelli procedure, which involves doubling the wall between the bladder and the vagina, or the Marshall-Carchetti-Kranz operation during which the urethral is also suspended using appropriate sutures.

Author: Piotr Bargiel MD
Literature:
J. W. Dudenhausen and W. Pschyrembel; "Practical Gynecology"; 2004; PZWL; Eric J. Bieder, Joseph S. Sanfilippo, Ira R. Horowitz "Clinical Gynecology" ed. And Polish Romuald Dębski; vol. 1, Wrocław 2009; A. Schröder, P. Abrams (Co-Chairman), K-E. Andersson, W. Artibani, C.R. Chapple, M.J. Drake, C. Hampel, A. Neisius, A. Tubaro, J.W. Thüroff (Chairman); Rules of conduct in patients with incontinence; Developed by the European Society of Urology; 2013; Gynekologisk-obstetrisk avdeling Sentralsykehuset and Akerhus Nordbyhagen. Tidsskrift for den Norske Laegeforening: Tidsskrift for Praktisk Medicin, ny Raekke [1991, 111 (22): 2747-2750]

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