Sikora Michal, Gamper Marianne, Zivanovic Irena, Münst Julia, Bischofberger Helena, Kociszewski Jacek, Viereck Volker
Department of Gynecology and Obstetrics, Spital Thurgau Frauenfeld, 8501 Frauenfeld, Switzerland.
Department of Gynecology and Obstetrics, Evangelisches Krankenhaus Hagen-Haspe, 58135 Hagen, Germany.
J Clin Med. 2024 Feb 28;13(5):1377. doi: 10.3390/jcm13051377.
Stress urinary incontinence (SUI) affects around 20% of women. In addition to the established suburethral sling insertion, two less invasive approaches are of interest today: urethral bulking agents and vaginal laser therapy. This review discusses articles through December 2023 identified by a PubMed literature search using the keywords "incontinence" and "bulking" or "laser". Although the two approaches are less effective than sling insertions, there are specific conditions in which one or the other technique is more advantageous. Injecting bulking agents into the urethra only takes some minutes and works without general anesthesia. The method is particularly suited for elderly, frail, or obese patients with multiple comorbidities, but is also applicable for all patients and in combination with other therapies. Generally, the safety profile is good but differs between bulking materials. Two laser types-the Erbium:YAG laser with SMOOTH-mode and the fractional ablative CO laser-deliver heat into the tissue to induce tissue tightening and regeneration. Intravaginal laser therapy improves mild to moderate SUI, while studies describe how intraurethral laser therapy is also beneficial for severe SUI. Young women between childbirths, as well as postmenopausal women, may benefit from laser therapy. The method is safe, can be performed on an outpatient basis, and does not require any artificial material.
压力性尿失禁（SUI）影响着约20%的女性。除了已确立的尿道下吊带植入术外，如今还有两种侵入性较小的方法备受关注：尿道填充剂和阴道激光治疗。本综述讨论了通过使用关键词“尿失禁”和“填充”或“激光”在PubMed文献搜索中确定的截至2023年12月的文章。尽管这两种方法的效果不如吊带植入术，但在某些特定情况下，其中一种技术更具优势。将填充剂注入尿道只需几分钟，且无需全身麻醉即可起效。该方法特别适用于患有多种合并症的老年、体弱或肥胖患者，但也适用于所有患者，并且可与其他疗法联合使用。一般来说，安全性良好，但不同填充材料之间存在差异。两种激光类型——具有SMOOTH模式的铒：钇铝石榴石激光和分次消融二氧化碳激光——将热量传递到组织中以诱导组织收紧和再生。阴道内激光治疗可改善轻度至中度SUI，而研究描述了尿道内激光治疗对重度SUI也有益处。处于两次分娩之间的年轻女性以及绝经后女性可能会从激光治疗中受益。该方法安全，可以在门诊进行，并且不需要任何人工材料。
