Charles Ascher-Walsh, MD on treating stress incontinence with lasers

Charles J Ascher-Walsh, MD is an associate professor of obstetrics, gynecology and reproductive sciences; the Director of the Division of Gynecology, Director of the Division of Urogynecology, and Director of the Division of Minimally Invasive Surgery in the Department of Obstetrics, Gynecology, and Reproductive Science at the Mount Sinai Health System, New York.

So, the CO2 lasers became more popular in the last few years treating vaginal atrophy as an alternative to estrogen treatments, which are both expensive and sometimes controversial, as far as patients with breast cancer, and just the fears of post-menopausal estrogen treatments in general. There’s been some concern lately, and the FDA actually put out a warning because a lot of the companies that produce these lasers have been touting them for a variety of things, including the treatment of stress incontinence, treating premenopausal women for what is, essentially, vaginal laxity. And so there’s a dearth of research that has been done. Actually, the atrophy research is pretty convincing, but there’s been a dearth of research as far as treating incontinence. And so we did a recent pilot study looking at the treatment of incontinence, for mild to moderate stress incontinence in these patients, and we actually just presented the abstract recently that showed that there was an improvement in stress incontinence, so far up to 1 year. So, we don’t have long term data on it, but we did show some improvement, and this will just add to the research available and sort of help women have different options for treatment, other than just surgery for stress incontinence.

The lasers, I think, initially, the data was just looking at atrophy. But stress incontinence is such a common problem in women that it was sort of a natural thing to sort of take this forward. And for stress incontinence, there really is no medical therapy for it. And so the options for stress incontinence are either pelvic floor exercise therapy or surgery with not much in between. So this is a potential way of providing patients with some relief who don’t have significant stress incontinence without having to undergo surgery.