Chang Chun-Hung, Fried Nathaniel M
Department of Physics and Optical Science, University of North Carolina at Charlotte, USA.
McKay Department of Urology, Carolinas Medical Center, Charlotte, NC, USA.
J Miss Acad Sci. 2018 Apr;63(2 Suppl 1):202-205.
Over 6.5 million women in the United States suffer from female stress urinary incontinence (SUI). Only ~200,000 women choose surgery. There may be a role for a non-surgical, minimally invasive procedure that provides thermal shrinkage/remodeling of submucosal collagen in the endopelvic fascia. This study describes design, characterization, and preliminary testing of a novel probe with integrated contact cooling for potential use in transvaginal laser treatment of SUI. Laser energy at a deeply penetrating, near-infrared wavelength of 1075 nm was delivered through a 600-μm-core fiber optic patchcord into a 90° side-firing probe head (19 × 22 mm) with integrated flow cell and sapphire window cooled to -2°C by circulating an alcohol-based solution. An inflatable balloon attached to the probe insured contact with vaginal wall. A force sensor and thermocouples monitored pressure and temperature. Thermal lesions were created in vaginal tissue of three cadavers (power = 4.6-6.4 W; spot diameter = 5.2 mm; time = 30 s). Thermal lesion areas measured 3.1-4.6 mm, while preserving the vaginal wall to a depth of 0.8-1.1 mm. Consistent tissue contact and cooling was maintained using the force sensors. Preliminary cadaver studies demonstrated subsurface treatment of endopelvic fascia with partial preservation of the vaginal wall. Future studies will optimize parameters for thermal remodeling with further tissue surface preservation.
美国有超过650万女性患有女性压力性尿失禁（SUI）。只有约20万女性选择手术治疗。对于一种非手术的微创治疗方法可能存在需求，该方法可对盆腔内筋膜中的黏膜下胶原蛋白进行热收缩/重塑。本研究描述了一种新型探头的设计、特性及初步测试，该探头集成了接触式冷却功能，有望用于经阴道激光治疗SUI。波长为1075nm的深穿透近红外激光能量通过一根600μm芯的光纤跳线传输到一个90°侧射探头头部（19×22mm），该探头头部集成了流通池和蓝宝石窗口，通过循环一种酒精基溶液将其冷却至-2°C。连接在探头上的可充气气球确保与阴道壁接触。一个力传感器和热电偶监测压力和温度。在三具尸体的阴道组织中制造热损伤（功率 = 4.6 - 6.4W；光斑直径 = 5.2mm；时间 = 30s）。热损伤区域为3.1 - 4.6mm，同时将阴道壁保留至0.8 - 1.1mm的深度。使用力传感器维持了一致的组织接触和冷却。初步的尸体研究表明，盆腔内筋膜得到了皮下治疗，同时阴道壁得到了部分保留。未来的研究将优化热重塑参数，进一步保留组织表面。
