Women with urinary incontinence (stress) and mixed urinary incontinence (urgency plus stress) with or without prolapse, with vulvovaginal dryness-atrophy and with vaginal laxity and dyspareunia.
Stress urinary incontinence occurs from increased pressure in the abdominal cavity as occurs with coughing, sneezing, laughter, and physical exertion (or sexual intercourse). Such incontinence implies a very great change in the psychological and social aspects of many women who see major adjustments they have to make their behavior, their habits, and their lifestyle. Vaginal atrophy is an involution of the mucosal tissue of the vulva and the vagina caused by the decrease of estrogens, which occurs during menopause and in some cases in young women. Vaginal Relaxation Syndrome, also known as Vaginal Laxity, is a condition characterized by altered vaginal shape and atrophy of the vaginal mucosa. This syndrome is associated with factors such as aging and menopause, but may also be due to distention of the vagina during labor. The diameter of the vaginal canal in a young woman is on average about three centimeters, but after a couple of natural births or following weight gain or loss of more than 10 kg, its diameter can expand to about twelve centimeters. Certainly, natural aging, sedentary life and lack of exercises that strengthen the pelvic floor also contribute to the relaxation of these tissues. The muscles lose their tone, their strength and their support structure and the internal and external diameter of the vagina increases. The walls of the vagina also thin out. The pubocervical fascia (connective tissue that attaches the side of the cervix to the pelvis) in these women show a decrease in the collagen content which contributes to the weakening support of the bladder neck. Urinary incontinence symptoms have been detected in almost half of the women who go to a general gynecology appointment (gynecological examination or to be attended for another gynecological problem).
Patients complete a questionnaire before and after treatment (with or without a urodynamic study) on urinary incontinence, quality of life and sexual activity. This is the Blaivas classification.
This international questionnaire-ICIQ-SF (International Consultation on Incontinence Questionnaire-Short Form) is of great assistance in determining the severity of symptoms, impairment of quality of life and efficacy of the method. Patients classified with incontinence problems (Blaivas 0, I, or IIa) are undoubtedly ideal for fractionated laser treatment with about 85% efficacy. If the levator ani muscle (broad, thin muscle, situated on either side of the pelvis) is healthy and has good contraction and strength, the results reach 90% efficacy. For patients with urinary urgency where classic treatments with anticholinergics and pelvic floor re-education do not resolve, the laser can be an alternative.
Patients with mild genital prolapse obtain better results than those with marked prolapse.
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