intraurethral/intravaginal 2940 nm erbium laser treatment for stress urinary incontinence

Conditions: Stress Urinary Incontinence

Summary: primary objective is to assess the tolerability and safety of the intraurethral 2940nm er:yag laser technique in combination with intravaginal 2940nm er:yag laser method for the treatment of stress urinary incontinence.

this study is a prospective, randomized, 3-arm parallel pilot study. study subjects will be women currently experiencing female stress urinary incontinence (sui) and stress-predominant mixed urinary incontinence (smui) with a degree of intrinsic sphincter deficiency for a minimum duration of 6 months prior to enrolment. diagnosis of sui with a degree of intrinsic sphincter deficiency will be performed using urodynamic and clinical assessment. subjects will undergo sham, intravaginal, and the combination of intravaginal and intraurethral treatment with the 2940 nm er:yttrium aluminum garnet er:yag laser at two time points, 4 weeks apart. primary objective is to assess the tolerability and safety of the intraurethral 2940nm er:yag laser technique in combination with intravaginal 2940nm er:yag laser method for the treatment of stress urinary incontinence through 6 months follow-up and extend to 12 months follow-up. secondary objective is to assess the effectiveness of the intravaginal and combination of intraurethral/intravaginal laser treatments using subjective and objective measures, as well as improvement in quality of life through 6 months follow-up and extend to 12 months follow-up.

Eligibility criteria:
inclusion criteria: * female between 18 and 80 years * sui or mui with predominantly stress symptoms for more than 6 months * has failed 2 previous non-invasive therapies for three (3) months each (e.g. behavioural modification, electrical stimulation, pelvic muscle exercise, biofeedback, and/or drug therapy) * confirmed sui through cough stress test or urodynamics * has at least one incontinence episode per 24 hour period measured over three days * valsalva leak-point pressure (vlpp) ≤100 cm h2o * has a baseline 24h pad weight test ≥ 10 gm * has maximum cystometric capacity ≥250 ml * no pelvic surgery within last 6 months (including prolapse repair, subjects who have residual or recurrent sui following colposuspension or a sling procedure may be included in the study if the procedure was conducted at least 6 months prior to screening /baseline visit) * willing to give informed consent and complete the follow up schedule exclusion criteria: * active urinary tract or vaginal infection or other active infections of urinary tract or bladder (urethritis, cystitis or vaginitis) * has had three (3) or more cultured-proven bacterial urinary tract infection (uti) in the last 12 months * clinical diagnosis of urge incontinence or urge predominant mixed incontinence * has detrusor overactivity on urodynamics * postvoiding residual (pvr) \> 100 ml * has had previous urethral surgery (i.e. fistula or diverticula) * grade 2 or higher pelvic organ prolapse (pop) or pelvic organ prolapse grade \> 2 as defined by pop-q and symptomatic * suffers from known polyuria (\>3l/24h) * has a bmi ≤35 kg/m2 * has unevaluated hematuria * has a neurogenic bladder * evidence of dysplasia in a pap smear (done in the last 24 months) * tumours of the urinary tract * previous radiation or brachytherapy to treat pelvic cancer * has uncontrolled diabetes * has active herpes genitalis * pregnancy, lactating, or not practicing adequate contraception and/or planning to get pregnant in the next 12 months * had a vaginal delivery within 6 months prior to the screening/baseline visit * is currently participating in any other clinical trial, or has participated in another clinical trial within 3 months prior to the screening/baseline visit