PD06-05: Fractional Carbon Dioxide Vaginal Laser for the Treatment of Urinary Symptoms: 12 Months Results

Ly Hoang Roberts*, Royal Oak, MI, Annah Vollstedt, Iowa City, IA, Hailey Eisner, Royal Oak, MI, Lauren Tennyson, Fair Haven , NJ, Evelyn Shea, Lisa Vargos, Danielle Tenney, Royal Oak , MI, Bernadette Zwaan, Larry Sirls, Priya Padmanabhan, Kenneth Peters, Royal Oak, MI

Introduction: Fractional carbon dioxide (fCO2) has been suggested to alleviate urinary symptoms such as frequency, urgency, urge urinary incontinence (UUI), and stress urinary incontinence (SUI) given its therapeutic effects on genitourinary symptoms of menopause (GSM). In a previous pilot study, we did not observe objective or subjective improvement in SUI at 6 months; however, there was a trend towards improvement for UUI. The goal of this study was to measure the effect of vaginal fCO2 laser therapy on SUI and OAB symptoms at 12 months.

Methods: After IRB approval, women > 18 years with urogenital symptoms were enrolled in an open-label prospective trial. A 3-month washout period was mandated for patients previously on vaginal estrogen therapy. Participants underwent 3 laser treatments, each 6 weeks apart from the previous. With baseline at time of treatment 1, cough stress test (CST) was performed at every visit while a voiding diary was completed at baseline, 6- and 12-months. Subjective data was obtained using the Incontinence-Quality of Life (I-QOL), Overactive Bladder Questionnaire short form (OABq-SF), Questionnaire for Urinary Incontinence Diagnosis (QUID), and Female Sexual Function Index (FSFI) at 6- and 12-months. ANOVA analysis with Dunnett’s multiple comparison was used to compare means at each time point.

Results: At time of analysis, 85 patients were enrolled. Of these, 36 patients had 12-month data and reported baseline SUI (n=25; 29%), frequency (n=28; 33%), urgency (n=29; 34%), or UUI (n=24; 28%). There was no statistically significant difference in number of SUI leaks (p=0.569) or rates of positive CST over time. Patients reported improvement on the I-QOL (mean ± SD diff: 12.23±10.90, p<0.0001) and QUID SUI sub-section (mean ± SD diff:-1.65±2.48, p=0.0065) at 12 months. There were no objective changes in frequency or UUI episodes, but urge intensity was significantly decreased at 12 months (mean ± SD diff: -0.28±0.51, p=0.0008). This correlated with a similar improvement in the OABq-SF and QUID UUI subsection (p=0.0003 and 0.002 at 12 m, respectively).

Conclusions: In this study, we have demonstrated that vaginal fCO2 laser therapy significantly reduces urge intensity and improves patient reported symptom scores up to 12 months after onset of treatment. However, objective outcomes for SUI did not improve. Vaginal fCO2 laser may be a viable treatment option for women with GSM who suffer from urinary urgency, but it does not improve SUI.

Source of Funding: Susan Cooper Fund/Women's Urology Center