In the clinical management of SUI, a meticulous approach is essential, commencing with comprehensive preoperative assessments. Ideally, these assessments incorporate urodynamic studies, considered the gold standard for diagnosis. However, the fiscal constraints associated with urodynamic studies in some healthcare settings may necessitate the utilization of alternative diagnostic methodologies, including physical examinations, cough tests, or the Q-tip test.
Within the confines of our clinical institution, we have documented a noteworthy success rate of approximately 80% in the context of SUI resolution following vaginal laser treatment, with durability of results extending up to one year. Nonetheless, there exist instances where certain patients exhibit recalcitrant symptoms, enduring persistent urinary leakage post-treatment. In such cases, the hypothesis emerges that these individuals may be afflicted with ISD or type III SUI, thus prompting an imperative reevaluation of their therapeutic trajectory. It is our recommendation that intraurethral laser therapy be contemplated as a subsequent therapeutic modality. This decision is ideally preceded by meticulous consideration of the patient's clinical profile, alongside judicious utilization of urodynamic evaluations. It is noteworthy that certain patients may not invariably meet the conventional diagnostic criteria for ISD, specifically pertaining to parameters such as maximum urethral closure pressure (MUCP) <20 cmH2O and Valsalva leak point pressure (VLPP) <60 cmH2O. However, the clinical adoption of this therapeutic strategy has yielded promising results among individuals grappling with persistent urinary leakage.
With the informed consent and shared decision-making of our patients, coupled with the judicious execution of intraurethral laser therapy, we have been able to realize a commendable amelioration rate of approximately 80% among individuals previously refractory to initial treatments. These outcomes highlight the potential of this intervention as a valuable therapeutic adjunct in the management of SUI patients, offering renewed hope and improved quality of life to a subset of individuals who may have otherwise been confronted with prolonged incontinence-related challenges.
Written by: Chi-Feng Su1 & Yung-Ling Tsen2
- Chief of Gynecology and Obstetrics Department, Kuang Tien General Hospital, Taiwan
- Department of Education, Kuang Tien General Hospital, Taichung, Taiwan