Laser therapy as a treatment modality for genitourinary syndrome of menopause: a critical appraisal of evidence.

Interest in laser therapy as a nonhormonal option for the treatment of genitourinary syndrome of menopause (GSM) has increased. We conducted a systematic review of the use of laser therapy for the relief of GSM symptoms. Six electronic databases were searched and conference abstracts were searched manually from the introduction of laser therapy to the present date. The keywords used were: "genitourinary syndrome", "vulvovaginal atrophy", "postmenopausal symptoms", "laser therapy" and "fractional laser treatment". Of the 165 articles identified in the search, none was a randomized controlled trial. As a result, we included three observational studies without a control group and one case-control study that met our inclusion criteria. The total number of women included in the four studies was 220. The collated data suggest that laser therapy may be valuable as a nonhormonal therapeutic modality in the management of GSM. Higher quality of evidence from randomized controlled trials is required to establish the efficacy of laser treatment in the management of GSM.

Urethral Diverticulum in Women: Retrospective Case Series.

PURPOSE: We present the management of 17 cases of urethral diverticulum in our department. We describe the various clinical presentations of urethral diverticulum, which may mimic other pelvic floor disorders and result in diagnostic delay. MATERIALS AND METHODS: We reviewed 17 cases of urethral diverticulum presented to the urogynaecology department between January 2006 and February 2011 retrospectively. Patient demographics, history, clinical evaluation, diagnostic modalities, and management plans were reviewed. All of them underwent Magnetic Resonance Imaging (MRI) prior to the procedure. RESULTS: The mean time from onset of symptoms to diagnosis of a urethral diverticulum was 24 ± 5.6 months. MRI identified the urethral diverticulum in all cases while voiding cystourethrography confirmed the diagnosis in 4 (23.5 %). They have been divided into two groups: Group A, (4-6 mm largest axis range) 5 (29.41 %) cases; Group B, (6-33 mm largest axis range) 12(70.59 %). All in Group A were symptomatic with recurrent Urinary Tract Infection (UTI), whereas only 8 (66.6 %) in Group B were symptomatic. Transvaginal diverticulectomy was done in 12 women who were symptomatic (70.5 %). Postoperative evaluation revealed complete resolution of symptoms, such as recurrent UTI, dysuria, and dyspareunia. One patient was unsure of surgery, while conservative approach was opted for asymptomatic patients 4 (23.5 %). The use of preoperative MRI altered the management in 2 (11.7 %) women. CONCLUSION: The diagnosis of urethral diverticulum should be considered in women with recurrent UTI, dysuria, dyspareunia, and irritative voiding symptoms not responding to conservative therapy.

Repeated botulinum toxin type A (Dysport) injections for women with intractable detrusor overactivity: a prospective outcome study.

INTRODUCTION AND HYPOTHESIS: We present the cohort of 33 women who underwent botulinum toxin type A (BTX-A) injections examining the efficacy and safety of BTX-A in idiopathic detrusor overactivity (IDO). The aim of this report is to describe the outcomes of those who underwent repeated injections of BTX-A. METHODS: All 33 women had 3 or more injections with an initial dose of 500 units of Dysport with subsequent injections between 500 and 750 U, administered by the classic trigone-sparing flexible/rigid cystoscopic technique. An informed consent was obtained in all cases. Efficacy was measured using voiding diaries and quality of life (QOL) assessed with the International Consultation on Incontinence Questionnaire-Short Form (ICIQ -SF). This project was approved by the Clinical Effectiveness Department and the Drugs and Therapeutics Committee (DTC). Therefore, ethical approval was not required. RESULTS: This study included 33 women who have been successfully treated with repeated intradetrusor injections of BTX-A (Dysport). Mean duration between the first and second injections was 15.2 ± 7.2 months, whereas between the second and third was 19.2 ± 10 months (P = 0.025). Two women developed urinary tract infection and required clean intermittent self-catheterization. Three women required dose escalation to 750 units. Longer duration of subjective QOL improvement was noted between the second and third botulinum toxin injections compared to duration between the first and second injections. CONCLUSIONS: BTX-A appears to be effective and safe after repeated administration in women with IDO. The duration of the injection tends to get prolonged after the second injection.

Evaluation of safety and efficacy of single-incision mid-urethral short tape procedure (MiniArc™ tape) for stress urinary incontinence under local anaesthesia.

INTRODUCTION AND HYPOTHESIS: The aim of this study was to assess complications and short-term results (3 months and 1 year) from a single-incision mid-urethral tape for stress urinary incontinence. METHODS: Seventy-four women underwent single-incision mid-urethral tape under local anaesthesia, 59 of whom completed a 1-year follow-up. Thirty-seven (50%) suffered urodynamic stress urinary incontinence. The International Consultation on Incontinence Questionnaire--Short Form (ICIQ-SF) was completed in the context of the case history pre-operatively and post-operatively. The duration of follow-up ranged from 91 to 466 days. RESULTS: The use of MiniArc™ tape in our study resulted in the objective cure rate (negative cough stress test) of 74% and 66% at 3 months and 1 year, respectively. Scores with ICIQ-SF questionnaire improved significantly at 3 months and 1 year (p < 0.0001). No major intra-operative complication was reported in our study. CONCLUSIONS: Despite the advantage of being done under local anaesthetic, the overall cure rate is 66% at 1 year.

Evaluation of safety and feasibility of ambulatory urogynaecological procedures in a 24-h setting.

INTRODUCTION AND HYPOTHESIS: Our aim is to assess the safety and feasibility of ambulatory urogynaecological procedures in a 24-h day case surgery setting. METHODS: We evaluated women who underwent urogynaecological procedures in the 2-year period from April 2006 to March 2008 in an ambulatory care setting. Proportion of patients being discharged within 24 h was noted. Re-admission rate, prolonged inpatient stay and post-operative complications were analysed. RESULTS: Three hundred eighteen patients underwent urogynaecological procedures during the study period. Mean age was 58 +/- 13.8 (range: 19-92) and median parity was 3 (0-10). Forty-one (12.89%) women had hysterectomy previously and 99 (31.13%) were post-menopausal. There were no intra-operative complications except bladder injury in one patient. Of the patients, 272 (85.5%) were discharged in 24-h ambulatory protocol. Remaining 46 (14.4%) required inpatient admission. CONCLUSIONS: A variety of urogynaecological procedures can be performed in a 24-h ambulatory care setting. Our study suggests that this practice is proven to be safe and feasible.

Urethral pain syndrome and its management.

UNLABELLED: Urethral pain syndrome is occurrence of persistent or recurrent episodic urethral pain usually on voiding with daytime frequency and nocturia, in the absence of proven infection or other obvious pathology. This is a condition of uncertain etiology. The objective of this article is to review etiology, diagnosis, and management of urethral pain syndrome. Since there is paucity of information on randomized trials, search of published literature has been made using keywords such as "urethral pain syndrome", "painful bladder syndrome", "urethral stenosis", and "lower urinary tract symptoms". Urethral pain syndrome is a disease of ambiguous etiology. Diagnosis is mainly based upon symptoms, and investigations are aimed to exclude other conditions affecting lower urinary tract. Various modalities of treatment including antibiotics, alpha-blockers, acupuncture, and laser therapy have been proved successful. Psychological support is very important in this group of women. Management requires multidisciplinary approach, and treatment at its best is by trial and error. TARGET AUDIENCE: Obstetricians & Gynecologists, Family Physicians. LEARNING OBJECTIVES: After completion of this article, the reader should be able to explain that the urethral pain syndrome (UPS) has specific signs and symptoms without specific responses to a variety of treatment options and recall that treatment may require a multidisciplinary approach and a lot of sensitivity by the physician.

Comparison between the levonorgestrel intrauterine system (LNG-IUS) and thermal balloon ablation in the treatment of menorrhagia.

OBJECTIVES: To compare the effectiveness of endometrial thermal ablation and the levonorgestrel intrauterine system (LNG-IUS) in the management of menorrhagia. STUDY DESIGN: Fifty women attending a gynaecology clinic at a District General Hospital in south-west England were randomised to either surgical treatment using thermal ablation (Thermochoice, Gynecare) or medical treatment using a LNG-IUS (Mirena, Schering Healthcare). A pictorial menstrual chart was completed pre-insertion/operatively and again at 6 months post-insertion/operatively. Non-parametric tests (Mann-Whitney) were used for statistical analysis. RESULTS: Follow-up analysis was possible in 23 women in the Thermochoice group and 21 women in the Mirena group. The menstrual scores were slightly higher in the Thermochoice group (median 101) than the Mirena group (median 75) (P=0.025) pre-insertion/operatively but this difference was lost post-insertion/operatively (P=0.689) with median menstrual scores of 27 for the Thermochoice group and 19 for the Mirena group, respectively. CONCLUSION: Both Thermochoice endometrial ablation and a Mirena LNG-IUS are equally effective in the management of menorrhagia. The choice of treatment should be tailored to the woman's needs and preferences.