Er:YAG laser in hysterectomized women with stress urinary incontinence: a VELA retrospective cohort, non-inferiority study.

Objective: To test whether the erbium-doped yttrium aluminum garnet (Er:YAG) SMOOTH® laser treatment efficacy on stress urinary incontinence (SUI) in hysterectomized patients is non-inferior to its efficacy in non-hysterectomized patients.Methods: In this real-world, retrospective cohort study performed in Turkey, Croatia and Italy, we enrolled a consecutive sample of 35 hysterectomized and 34 non-hysterectomized patients with SUI. We used the Er:YAG SMOOTH® laser (Fotona, Slovenia) with a wave length of 2940 nm. The primary outcome was median reduction of SUI symptoms measured by the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short-Form (ICIQ-SF) with the non-inferiority margin defined as the minimum clinically important difference of ICIQ-SF (δ < 2.52 points).Results: In hysterectomized patients, the ICIQ-SF was reduced by 5 points (95% confidence interval 3-8; p < 0.001), a reduction of 45% (95% confidence interval 36-67%). After adjustment for baseline ICIQ-SF and five covariates, the reduction of symptoms in the hysterectomized group was not inferior to the reduction in the non-hysterectomized group.Conclusion: The Er:YAG SMOOTH® laser treatment seems to improve the symptoms of SUI in hysterectomized women not clinically relevantly less than in non-hysterectomized women. It seems that the beneficial effect of Er:YAG SMOOTH® laser treatment for SUI in hysterectomized women is time-limited.

First assessment of short-term efficacy of Er:YAG laser treatment on stress urinary incontinence in women: prospective cohort study.

OBJECTIVES: This is the first assessment of efficacy and safety of the Er:YAG laser in the treatment of stress urinary incontinence. The aim of this study was to assess the short-term outcome of a non-invasive laser treatment for mild-to-severe stages of this condition and to check its applicability in different body mass index and age groups. METHODS: A prospective cohort, single-center study at the Ob/Gyn Clinic, Zagreb, Croatia recruited a consecutive sample of 73 female patients suffering from stress urinary incontinence. The procedure was performed with a 2940-nm Er:YAG laser (XS Dynamis, Fotona, Slovenia) designed to achieve heating up of vaginal mucosa to around 60°C, 500-700 µm in depth. RESULTS: The score in the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form was reduced to a median of 46% (95% confidence interval 33-67%; p < 0.001). The reduction was significantly higher in women with normal body mass index (67%) than in overweight women (25%), as well as in women younger than 39 years (100%) compared with those older than 60 years (8%) (p < 0.001). No serious adverse events were noticed. CONCLUSION: This study of Er:YAG laser therapy in women has demonstrated a clinically relevant, short-term improvement of stress urinary incontinence, with minimal adverse events of a transient nature.

Adherence with hormone replacement therapy in menopause.

OBJECTIVE: Lack of adherence to therapy is a common problem in the treatment of various diseases and conditions and there are many well-documented reasons for it. This study was conducted to assess the effect of time spent on medical consultation in relation to the duration of adherence, as well as the reasons to adhere to or drop out from hormone replacement therapy (HRT). DESIGN AND METHODS: Two methods were used, self-filled questionnaires on a sample of patients and telephone interviews on a sample of doctors. The questions dealt with a number of personal and gynecological history variables. The participants were chosen using random sampling from population lists. A total of 74 participating offices recruited all postmenopausal patients, regardless of their HRT use and whether they visited the office for a specific complaint or just for a routine check-up. The doctors were interviewed regarding the average time spent with a patient, prescribing dilemmas and counselling on sexuality. RESULTS: The main finding was that the time spent on consultation and the physicians' interest in postmenopause critically influence the patients' adherence. The effective time spent with patients was in accordance with the National Health Insurance guidelines for public sector doctors, but it was twice as long for private sector doctors. CONCLUSION: This study shows that extended medical consultation promotes better compliance by lowering patient fears, while trusted authorities seem to be more convincing to patients on the benefits of HRT and therefore more effective, even if they do not take more time to talk to patients.

Evaluation of genital human papillomavirus infections by polymerase chain reaction among Croatian women.

Infection with specific human papillomavirus (HPV) types is the strongest risk factor in cervical carcinogenesis. In this study we analysed, by means of polymerase chain reaction (PCR), cervical specimens obtained from consenting women with abnormal Pap smears collected from 1996 to 1998. Consensus- and type-specific-primers directed PCR were used in order to detect the presence and to determine the most common HPV types: 6, 11, 16, 18, 31 and 33. Out of 1874 specimens, 1207 (64%) contained one or more HPV types. Approximately half HPVs were typed (621 out of 1207) and the others remained untyped (586 out of 1207), 51% and 49%, respectively. Beside low-risk HPV 6/11 (5%), the most frequently observed HPVs were high-risk HPV types, especially type 16 (12%), while HPV types 18 (2%), 31 (5%) and 33 (3%) were less frequent. The HPV positivity rate declined with age, although all HPV types were equally distributed in different age groups. The presence of HPV DNA significantly increased from 55% to 78% along with the severity of the cervical lesions, i.e. low- and high-grade squamous intraepithelial lesions (LSIL, HSIL). Undetermined HPV types, other than 6/11, 16, 18, 31 and 33 were equally distributed in LSIL and HSIL which indicates that they represent low- as well as high-risk HPV types. Our results indicated that HPV infections, especially those with HPV 16, represent a significant public health concern in Croatia.

Transvaginal sonographic assessment of premalignant and malignant changes in the endometrium in postmenopausal bleeding.

PURPOSE: We explored the value of transvaginal sonography as a screening technique for endometrial abnormalities. METHODS: Transvaginal sonography was used to evaluate the likelihood that an endometrial abnormality was present in a group of 103 women with postmenopausal bleeding. RESULTS: Sonographic findings showed a mean endometrial thickness of 6.2 mm in patients with endometrial atrophy, 12.4 mm in patients with simple hyperplasia, 13.4 mm in patients with complex hyperplasia, and 14.1 mm in patients with endometrial carcinoma. There was no statistically significant difference in endometrial thickness measurements between the hyperplasia and endometrial carcinoma groups. However, the difference between these groups and the endometrial atrophy group was statistically significant. The mean age was significantly higher for patients with endometrial carcinoma (62 years) than for the patients in the other groups. CONCLUSIONS: Our study shows that transvaginal sonography is a useful method of screening for endometrial abnormalities.