Ivan Fistonic: Prediction of Er:YAG Laser Treatment Short-Term Efficacy on Stress Urinary Incontinence (SUI) in Women - Prospective Cohort Study
Aim: To find the pre-intervention predictors of short-term outcomes with non-invasive laser treatment for mild-to-severe SUI, and to identify female patient segments with the highest Er:YAG laser treatment short-term efficacy.
Methods: A prospective cohort, single-center study at an Ob/Gyn Clinic in Zagreb, Croatia, recruited a consecutive sample of 85 female patients suffering from SUI. The procedure was performed with a 2940 nm Er:YAG laser (XS Dynamis, Fotona, Slovenia) designed to achieve heating up of vaginal mucosa to around 60°C, 500-700 microns in depth. The key outcome was a relative change of ICIQ-UI ≥ 30%. We decided to use the ≥ 30% cut off point based on Nystrom et al. 2015 (1). In this study this was the mean ICIQ-UI change at the first follow up, four months from the intervention in women that received pelvic floor muscle training, the standard non-invasive SUI therapy.
Results: In the total sample, the mean relative decrease of ICIQ-UI one month after the intervention was 50% (SD 46%). After adjustment for age, body mass index, parity, average birth weight, perineometry average pressure, and baseline residual urine by multivariate binary logistic regression, the factors of lower age and lower Q-tip test angle significantly increased the probability of effective intervention (P=0.049; P=0.010 respectively). Bellow the age of 44 and after the age of 57, only age was a significant predictor. Both age and Q-tip test result were significant predictors if women were 45-56 years old. The patient segment with the highest treatment efficacy was women younger than 48 years whose average birth weight was >3.61 kg. The mean ICIQ-UI relative decrease in this segment was 92% (SD 19%), which was 84% more than the average of the whole sample.
Conclusion: Age and Q-tip test results, and their interaction, may be used as predictors of laser treatment efficacy on SUI. The highest Er:YAG laser treatment short-term efficacy may be expected at women younger than 48, whose average birth weight was > 3.61 kg.
