Subject(s)
Carcinoma, Squamous Cell/diagnostic imaging , Carcinoma, Squamous Cell/therapy , Uterine Prolapse/diagnostic imaging , Uterine Prolapse/therapy , Vaginal Neoplasms/diagnostic imaging , Vaginal Neoplasms/therapy , Aged, 80 and over , Brachytherapy , Carcinoma, Squamous Cell/radiotherapy , Carcinoma, Squamous Cell/surgery , Female , Humans , Magnetic Resonance Imaging , Neoplasm Invasiveness , Positron Emission Tomography Computed Tomography , Uterine Prolapse/radiotherapy , Uterine Prolapse/surgery , Vaginal Neoplasms/radiotherapy , Vaginal Neoplasms/surgeryABSTRACT
AIM: To evaluate the effectiveness of a new method of treatment for stress urinary incontinence in women using an ER: YAG laser in SMOOTH mode and investigate pathophysiological and pathomorphological changes induced by erbium laser. MATERIALS AND METHODS: This study comprised 98 women aged 37-63 years, who between 2014 and 2016 were diagnosed with SUI (type 1 and 2a, 2b) and grade 0-2 vaginal prolapse. The treatment was performed with a 2940 nm Er:YAG laser (Fotona, Slovenia) using a SMOOTH mode. Clinical assessment included PFIQ-7 and PISQ-12 questionnaires, uroflowmetry, laser Doppler flowmetry and biopsy of the anterior vaginal wall. The examination was carried out at baseline and 1-2 months after the treatment. RESULTS: The effectiveness of treatment was 73%. There was no deterioration after the procedure. Analysis of PFIQ-7 and PISQ-12 questionnaires showed that patients with mild incontinence had the greatest difference between pre- and posttreatment results. Uroflowmetry parameters improved in a majority of patients. Results of laser Doppler flowmetry demonstrated the improvement of blood flow in the microvascular bed. An important feature of the vaginal biopsy after laser exposure was an increase in neoangiogenesis. DISCUSSION: The findings of questionnaires and clinical evaluation of patients with SUI and vaginal prolapse before and after treatment with Er: YAG laser showed high therapeutic effectiveness of this treatment modality. CONCLUSION: Clinical effectiveness of ER: YAG laser in SMOOTH mode was 73%. Patients with type 1 and 2a SUI and mild or moderate incontinence have the best prognosis after treatment with this method.
Subject(s)
Low-Level Light Therapy , Surveys and Questionnaires , Urinary Incontinence, Stress , Uterine Prolapse , Vagina , Adult , Female , Humans , Laser-Doppler Flowmetry , Middle Aged , Urinary Incontinence, Stress/diagnostic imaging , Urinary Incontinence, Stress/metabolism , Urinary Incontinence, Stress/physiopathology , Urinary Incontinence, Stress/radiotherapy , Uterine Prolapse/diagnostic imaging , Uterine Prolapse/metabolism , Uterine Prolapse/physiopathology , Uterine Prolapse/radiotherapy , Vagina/diagnostic imaging , Vagina/metabolism , Vagina/physiopathologyABSTRACT
We report on a patient with a total prolapse of the uterus and extensive local vaginal carcinoma. The different therapeutic possibilities are discussed with reference to the case in hand. The primary therapeutic considerations encompass surgery, radiotherapy or chemotherapy. Surgery is preferred in early cases especially when the tumor is located high in the vagina. Due to early invasion of bladder or rectum and particularly in older patients primary radiotherapy is very common. In this case radiotherapy and not surgery was performed in spite of total uterine prolapse, thus achieving a NED-stage of tumor together with retraction of the prolapse.
