Kliničke indikacije za IntimaLase

Kliničke indikacije za IntimaLase

IncontiLase and IntimaLase Guidelines for Treatment

Clinical Indications for IncontiLase

Stress Urinary Incontinence (SUI) mild to moderate, or leaking of urine with coughing, sneezing, exercise     Mixed Urinary Incontinence

Clinical Indications for IntimaLase

Vaginal Relaxation Syndrome, stretching, looseness of the vaginal canal generally related to childbirth and aging

Contraindications

  • Pure Urge Incontinence/OverActive Bladder/Bladder overcapacity/Spastic bladder/ Bladder stones
  • Infections of urinary tract, vaginal canal
  • Any strictures, conditions or abnormalities within the urinary system
  • Positive PAP smear, or other pathology
  • Impaired integrity of the of the vaginal mucosa, irritation, open areas
  • Active menstrual bleeding
  • Pregnancy
  • Any conditions or abnormalities of the reproductive system
  • Oral isotretinoin (Accutane)  and Vit  A use
  • Anticoagulant therapy/ Bleeding disorders
  • Clear signs of abnormal skin sensitivity
  • Morbid obesity  BMI >40 –  less possibility for success
  • Severe prolapse-less possibility for success
  • Severe neurological conditions associated with incontinence (multiple sclerosis, spinal cord injury, stroke, Parkinson’s disease)
  • Insulin-dependent diabetes mellitus

Precautions

  • Post-menopausal women with vaginal atrophy symptoms, impaired blood flow to vaginal mucosa require assessment by gynaecologist and conservative laser approach
  • Use of photosensitive medications

Pre-screening

  • Normal PAP smear within last 12 months
  • Clear urine culture, no UTI’s or vaginal infections
  • Not pregnant
  • Not a heavy smoker  – decreased vascularity
  • Not a lifestyle with daily heavy lifting ,  Incontinence may return after treatment with increased pressure
  • Not obese BMI < 33 is best
  • No chronic cough,  increases abdominal pressure
  • No menstrual bleeding at time of treatment
  • First phase of menstrual cycle is best to treat
  • Start Voiding diary 2 weeks before scheduled treatment ( IncontiLase)
  • Discuss all aspects of laser treatment , procedure , pre and post care with patient

Pre treatment preparation

  • Fotona G set needs to be autoclaved prior to treatment (not gold mirrors or hand piece body)
  • Use of speculum to assess vaginal canal integrity of mucosa
  • No anesthesia or local are required,  however a numbing cream can be used if thoroughly removed prior to treatment
  • Vaginal canal and introitus are to be cleansed and thoroughly dried prior (not Betadine or Providine become chromophores)
  • Consent to be signed

Post treatment recommendation

  • No special after care of medication or special accessories is required
  • There will be mild swelling and erythema of the treated area
  • Take care to prevent trauma to the treated area
  • Abstain from sexual intercourse for 2 weeks after treatment
  • Refrain from inserting  tampons into the vagina for 4 weeks
  • Avoid activities that increase pressure on bladder and treatment area  for one month such as heavy lifting
  • Maintain voiding diary for 2 weeks after treatment or as long as directed ( IncontiLase)
  • Appointment for reassessment after 1 month, may require second treatment in case  of IncontiLase
  • Patient should make appointment to be seen in case of adverse or unexpected effects
  • Prolonged periods of sustained exercise are not recommended for 2 weeks

Expectations

  • The treatment takes about 15-20 minutes
  • Walk in, walk out procedure with no sedation required
  • Some patients may experience mild pain or burning, itching sensation during treatment at the entrance to the vagina and /or vestibular area, however it is generally well tolerated
  • No continuing or lasting post- treatment pain has been noted
  • Having the treatment has no effect on subsequent pregnancy and delivery
  • Patients can be treated safely with an existing sling in place, should it fail and they begin leaking again
  • May require a second treatment, to be discussed with Physician
  • All patients’ questions will be addressed