Uro-Gyn.Net Health Care Cooperation, Dr. Okuis' Urogynecology and Urology Clinic, Ootaki 2-6, Yokosuka, Kanagawa, 238-0008, Japan.
World J Urol. 2019 Nov;37(11):2459-2466. doi: 10.1007/s00345-019-02644-7. Epub 2019 Jan 28.
To examine the efficacy and safety of non-ablative vaginal erbium:YAG laser (VEL) for the treatment of overactive bladder syndrome (OAB) compared with those of two other common pharmacotherapies, namely, anticholinergics and β3-adrenoceptor agonists.
Female subjects aged 60-69 years who presented with symptoms of OAB from 2015 to 2017 were assigned to three groups (n = 50) receiving treatment with an anticholinergic agent (4 mg fesoterodine), a β3-adrenoceptor agonist (25 mg mirabegron), or VEL (20 min/session of VEL performed thrice). The OAB symptom score (OABSS), Vaginal Health Index Scale (VHIS), and occurrence of adverse effects were examined prior to and at 1 year following treatment initiation.
The three groups showed significant improvement (p < 0.001) for all items of the OABSS questionnaire. Improved VHIS scores were observed only in the VEL group. Furthermore, after VEL treatment, a negative correlation was observed between questions 3 (urinary urgency) and 4 (urgency urinary incontinence) of the OABSS and VHIS. Regarding safety, no adverse events were observed in the VEL group. However, subjects in the other two groups complained of constipation, as indicated by the Constipation Assessment Scale scores, and mouth dryness. The therapeutic effects were inadequate for one and two subjects in the VEL and β3-adrenoceptor agonist groups, respectively.
VEL safely and effectively improved OABSS through a different mechanism than that involved in pharmacotherapy. We propose the use of VEL as a novel surgical treatment option in the field of urology.
研究非剥脱性阴道铒：YAG 激光（VEL）治疗膀胱过度活动症（OAB）的疗效和安全性，并与两种常用药物疗法（抗胆碱能药物和β3-肾上腺素能受体激动剂）进行比较。
2015 年至 2017 年间，60-69 岁出现 OAB 症状的女性患者被分为三组（每组 50 例），分别接受抗胆碱能药物（4mg 非索罗定）、β3-肾上腺素能受体激动剂（25mg 米拉贝隆）或 VEL（3 次，每次 20 分钟）治疗。在治疗开始前和 1 年后，检查 OAB 症状评分（OABSS）、阴道健康指数评分（VHIS）和不良反应的发生情况。
三组患者的 OABSS 问卷各项评分均有显著改善（p<0.001）。仅在 VEL 组观察到 VHIS 评分改善。此外，VEL 治疗后，OABSS 问卷第 3 项（尿急）和第 4 项（急迫性尿失禁）与 VHIS 之间呈负相关。关于安全性，VEL 组无不良事件发生。然而，其他两组患者的便秘评估量表评分显示存在便秘，且有口干症状。VEL 组和β3-肾上腺素能受体激动剂组各有 1 例和 2 例患者疗效不佳。
VEL 通过与药物治疗不同的机制安全有效地改善了 OABSS。我们建议将 VEL 作为泌尿外科领域的一种新的手术治疗选择。
