Patients seen with stress urinary incontinence (SUI) that have failed conservative treatments will be offered to participate in a sham controlled RCT of outpatient therapy with the Fotona Smooth Erbium Yag laser. Patients will be randomised to either outpatient laser treatments or sham treatments. Patients will be blinded to which arm they have been randomised. Patients will be asked to complete appropriate relevant symptom and quality of life questionnaires prior to treatment and then at 6 and 12 months following the final treatment. At 6 months Sham patients will be un-blinded and offered the laser therapy if they wish.
All patients with urodynamically proven SUI, who have failed/declined conservative therapies and their history suggests mild to moderate SUI, will be informed about the study and consented if they wish. They will be invited to attend a screening visit. At this visit, they will be asked to perform a standardised 1 hour pad test. Their medical history will be checked and they will undergo a clinical and vaginal examination, pregnancy test and dip stick urinalysis.If their 1 hour pad weight is \>2g and \<25g and they meet all other inclusion / exclusion criteria, they will be eligible for inclusion. At the Baseline visit, the patient will have medical history confirmed, and be asked to complete a standing and supine (lying) cough test. They will be given the International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF) and Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire (PISQ-12) questionnaire. Patients will be randomised using a computer randomisation programme and blinded to their allocated arm: active treatment or sham treatment. Patients will then undergo 3 outpatient treatment visits. The timing of visits will be 1 month apart. At each visit they will be asked if they have any further questions and if they are happy to continue to participate in the study. If happy to participate, they will have their urine tested for infection (dipstick urinalysis) and pregnancy test at each treatment appointment. If urinalysis is negative, they will receive an outpatient Incontilase laser treatment. At each of their 3 outpatient appointments, they will be asked about any deleterious effects since their last appointment and asked to complete an ICIQ-SF and Patient Global Impression of Improvement questionnaire (treatment 2 onwards). Patients will receive 3 treatments in total. Patients will be invited to attend a follow up visits 6 \& 12 months after the 3rd treatment and asked to complete ICIQ-SF, PISQ-12 and PGI-I symptom questionnaires and undergo a clinical examination. They will be asked to perform a cough test supine (lying) and standing and at 6 and 12 months also perform a 1 hour pad test as described earlier (see appendices). Patients randomised to the Sham arm will be un-blinded at 6 months and offered the treatment if they wish and followed up for six months.
Erbium YAG laser
Basingstoke & North Hampshire Hospital
Basingstoke, Hampshire, United Kingdom
Assessment of 1hr pad weight test
The change in standardised 1hr pad weight test from baseline to 6 months following treatment compared with the sham arm.
Time frame: 6 months
Change in cough stress test from baseline to 6 months post treatment
change in cough stress test (positive or negative, ie urine leakage or no leakage)
Time frame: 6 months
Change in cough stress test from baseline to 12 months post treatment
change in cough stress test (positive or negative, ie urine leakage or no leakage)
Time frame: 12 months
change in 1-hour pad weight test from baseline to 12 months post treatment
change in 1-hour pad weight test (urine leakage over 1hr measured in g)
Time frame: 12 months
International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF) from baseline to 6 months post treatment
Change in mean test scores range = 0 - 21; low score = mild symptoms, high score = significant impact on quality of life
Time frame: 6 months
International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF) from baseline to 12 months post treatment
Change in mean test scores range = 0 - 21; low score = mild symptoms, high score = significant impact on quality of life
Time frame: 12 months
Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire (PISQ-12) from baseline to 6 months post treatment
Change in mean test scores range = 0 - 48; Higher value = increased sexual function, lower value = less sexual function
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Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
30
Time frame: 6 months
Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire (PISQ-12) from baseline to 12 months post treatment
Change in mean test scores range = 0 - 48; Higher value = increased sexual function, lower value = less sexual function
Time frame: 12 months
Patient's Global Impression of Improvement (PGII) at 6 months post treatment
Assessments of patients' outcome of treatment; range 1 - 7; range 1 (very much worse) to 7 (very much improved)
Time frame: 6 months
Patient's Global Impression of Improvement (PGII) at 12 months post treatment
Assessments of patients' outcome of treatment; range 1 - 7; range 1 (very much worse) to 7 (very much improved)
Time frame: 12 months
Pain visual analogue scale
Patient reported assessment of pain on 10cm visual analogue scale during treatment, range 0 - 10cm; 0= no pain, 10= severe pain
Time frame: 3 months