Overactive bladder syndrome (OAB) is defined as urinary urgency, usually with urinary frequency and nocturia, with or without urge urinary incontinence. The prevalence of OAB in adult women ranges between 11% and 42%, is particularly...
moreOveractive bladder syndrome (OAB) is defined as urinary urgency, usually with urinary frequency and nocturia, with or without urge urinary incontinence. The prevalence of OAB in adult women ranges between 11% and 42%, is particularly common in elderly people, and can overlap with the genitourinary syndrome of menopause (GSM). There is a wide approach to the treatment of symptoms, often in a stepwise fashion, including lifestyle changes, bladder retraining and pelvic floor muscle rehabilitation, drug therapy, intra-vesical botulinum toxin injections or neuromodulation. Recently, vaginal laser therapy has been proposed as an emerging minimal invasive effective treatment option for women with OAB. We explore this further. Keywords Overactive bladder syndrome. Vaginal laser Overactive bladder syndrome (OAB) is defined as urinary urgency, usually with urinary frequency and nocturia, with or without urge urinary incontinence. The prevalence of OAB in adult women ranges between 11% and 42%, and is particularly common with age, overlapping with the genito-urinary syndrome of menopause (GSM). There is a wide approach to the treatment of symptoms, often in a stepwise fashion , including lifestyle changes, bladder retraining and pelvic floor muscle rehabilitation, drug therapy, intra-vesical botuli-num toxin injections or neuromodulation. Recently vaginal laser therapy has been proposed as an emerging minimal in-vasive effective treatment option for women with OAB [1-6]. Fractional microablative CO 2 and Er:YAG laser are the two most commonly used intra-vaginal therapy methods [7-9]. Vaginal laser aims to induce collagen remodelling and neocollagenesis processes. Histopathological studies have described: an increase in proliferation of the intermediate and shedding superficial cells as well as of the underlying connective tissue; an increase in the vaginal epithelium thickness; an increase in the fibroblast growth factor and transforming growth factor beta 1 (TGF-ß1) that have been advocated as responsible for laser-induced neocollagenesis and neo-angiogenesis [3]. However, how this laser-induced tissue effect translates into an improvement of OAB symptoms has never been explained and it is currently still questionable and unknown. Several authors to date have explored the effectiveness of vaginal lasers to treat GSM, with few studies focusing only on outcomes in women with OAB symptoms. Perino et al. carried out a pilot study treating 30 post-menopausal women with OAB symptoms with three sessions of vaginal CO 2 fractional laser over least 30 days. At 30 days, the mean OAB-q-SF scores were reduced from 18 to 8. A total of 9 women with OAB-wet also demonstrated an improvement in the incontinence episodes [9]. The absence of a randomised or a control group, the small sample size, as well as the lack of long-term follow-up, represent the main limitations of this study. Aguiar et al. conducted a similar study on 72 post-menopausal women randomised to receive either vaginal lubrication , vaginal oestrogen or three treatments of vaginal CO 2 fractional laser 30-45 days apart. In this study, up to 81% of the women experienced urge urinary incontinence. Two of the 24 women undergoing vaginal laser treatment were lost to follow-up at 14 weeks. A small but statistically significant improvement in ICIQ-OAB scores was described. No adverse effects were reported during the study period [10]. The results of Aguiar et al. show a small but statistically
