A growing body of evidence indicates that a non-invasive erbium yttrium-aluminum-garnet (Er:YAG) laser may be an effective and highly tolerable treatment for stress urinary incontinence (SUI) in women. The primary objective was to identify pre-intervention predictors of short-term Er:YAG outcomes. The secondary objective was to identify patient segments with the best Er:YAG laser treatment short-term outcomes.
A prospective cohort study performed in 2016 at Ob/Gyn Clinic, Zagreb, Croatia, recruited 85 female patients who suffered from SUI. The intervention was performed with a 2940 nm wave length Er:YAG laser (XS Dynamis, Fotona, Slovenia). Outcomes were absolute change in the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-UI SF) and a relative decrease in ICIQ-UI score of ≥30% 2-6 months after the intervention.
Age and pre-intervention ICIQ-UI values were independent significant predictors of laser treatment efficacy for SUI. A decrease in ICIQ-UI score (minimum important difference, MID) of ≥30% was independently significantly associated with body mass index and ICIQ-UI values before the intervention. All patients with four or five positive predictors saw a clinically relevant decrease in ICIQ-UI of ≥30%. The total accuracy of the predictive model defined by the area under the curve was 0.83 (95%CI 0.74-0.91). At the cut-off ≥3 positive predictors, C-index was 0.80 (95%CI 0.71-0.90), positive predictive value was 0.97 (95%CI 0.87-0.99), and negative predictive value was 0.53 (95%CI 0.45-0.55).
A relevant decrease in ICIQ-UI (MID) of ≥30% can be predicted based on age, body mass index, average birth weight, perineometer squeeze duration, and ICIQ-UI scores before the intervention. The association between Q-tip test and treatment outcome was moderated by age. Q-tip was a significant predictor for patients between 44 and 53 years of age. The best results should be expected in younger women with a body mass index of ≤23.3, average birth weight of >3.6 kg, ICIQ-UI at a baseline of ≤10, and perineometer squeeze duration at a baseline of ≥3.51 seconds. The critical age for Er:YAG laser effect is 47.5 years. Lasers Surg. Med. © 2018 Wiley Periodicals, Inc.
Lasers in surgery and medicine. 2018 Jan 23 [Epub ahead of print]
Ivan Fistonić, Nikola Fistonić
Institute for Women's Health, Zagreb, Croatia., Departments of Obstetrics and Gynecology, Merkur University Hospital, Zagreb, Croatia.