Vaginal laser surgery may improve overactive bladder syndrome

Sep 01, 2023

Chiengthong K, et al. Menopause. 2023;doi;10.1097/GME.0000000000002159.

Chiengthong K, et al. Menopause. 2023;doi;10.1097/GME.0000000000002159.

Women who underwent a single treatment session with vaginal laser surgery reported improvements to overactive bladder syndrome with few reported adverse outcomes, researchers reported in Menopause.

"Erbium: yttrium-aluminum-garnet (YAG) vaginal laser treatment is currently applied in the treatment of menopausal genitourinary syndrome, vaginal relaxation syndrome and pelvic organ prolapse," Keerati Chiengthong, MD, and Suvit Bunyavejchevin, MD, MHS, both from the department of obstetrics and gynecology, female pelvic medicine and reconstructive surgery, Chulalongkorn University, Bangkok, and colleagues wrote. "Histological examination after nonablative erbium:YAG laser in vaginal atrophy showed increase epithelial thickness, neocollagenesis and neoangionenesis in lamina propria. Recently, vaginal erbium:YAG laser has shown benefit in treatment of stress urinary incontinence and improvement in overactive bladder syndrome."

This single-center, randomized, sham-controlled study included 50 postmenopausal women (mean age, 64.8 years) diagnosed with overactive bladder syndrome who reported one or more vaginal atrophy symptoms between July 2019 and August 2022. All participants received one treatment session of vaginal erbium:YAG laser (n = 25) or the sham procedure (n = 25).

The primary outcome was the Thai version of the Overactive Bladder Symptom Score (OABSS). Secondary outcomes included results from the Thai version Overactive Bladder questionnaire, Patient Perception of Bladder Condition questionnaire, bladder diary, Vaginal Atrophy Symptoms score and Vaginal Health Index score.

At 12-week follow-up, those who received the vaginal erbium:YAG laser, compared with women who received the sham procedure, said they experienced improvement in total OABSS (6.03 vs. 8.44; P = .015), nocturia score (1.71 vs. 2.32; P = .004) and urgency score (2 vs. 3; P = .008).

In addition, women who received the erbium:YAG laser treatment experienced significantly improved coping and social subscale of Overactive Bladder questionnaire, daytime micturition frequency, urgency and maximum urine volume, vaginal atrophy symptoms and Vaginal Health Index scores.

Regarding adverse outcomes, nine women who received the erbium:YAG laser reported mild vaginal pain immediately after the treatment session, but this pain lessened to a score of zero using the visual analog scale by 12 weeks. In the sham procedure group, one woman reported a pain score of one on the visual analog scale.

"The study had only a short-term follow-up. The long-term outcomes and complications are not addressed," the researchers wrote. "Further long-term clinical trial and a cost-effectiveness study are advocated."