Recurrent Urinary Tract Infections (UTIs) in women is a prevalent disease worldwide. In the UK, near 50% of all women experience at least one episode of UTI in their lifetimes, with UTI being the most common reason women present to ambulatory care (Al-Badr et al 2013, Foxmann et al 2014). Of these women, 20-30% will experience recurrent UTIs, as defined by “three of more episodes of UTI during a 12-month period or two or more within 6 months” (Albert et al 2004).
The prevalence of UTI increases with age. The underlying pathophysiology behind this lies in the fact that postmenopausal women have lower oestrogen levels, depressing proliferation of the commensal bacteria Lactobacillus within the vaginal microenvironment. Lactobacillus is essential in the synthesis of lactic acid, maintaining the normal low pH environment within the vagina that prevents colonisation by uropathogens (Al-Badr et al 2013).
Patients suffering from recurrent UTIs, often require continuous prophylactic antibiotics long term treatment, however, the consequence of antibiotic overuse resulted in the rapid emergence of multi-resistant bacteria. Multi-resistant bacteria is such an emerging risk, that the World Health Organisation issued a global action plan to combat antibiotic resistance, declaring this deadly issue as one of the greatest threats to global health in our lifetime (WHO GAP 2015). As a result, there is a global imperative and urgency to finding alternative therapies that avoid the use of antibiotics, such as by reinforcing the natural mechanisms of defence.
Fractional CO2 lasers, when applied to the vaginal lining, have been histologically proven to induce changes to the vaginal lining, similar to oestrogen therapy (Zerbinati et al 2015, Salvatore et al 2015). This is seen by the restoration of the thick squamous epithelium, intra-cellular glycogen storage and synthesis of new components for the extra-cellular matrix. The consequence of this not only restores the natural lubricated vaginal microenvironment, but also restores the commensal lactobacillus colonisation, allowing for the re-establishment of the natural protective acidic pH environment within the vagina.
Here we used the FemTouch™ delivery system to provide fractional treatments to the vaginal wall. Through the use of the FemTouch™ probe, laser energy was delivered in a fractional manner, selectively treating less than 100% of the tissue surface.
We present the first experience in the United Kingdom of using the CO2 vaginal laser FemTouchTM to treat a preliminary cohort of post-menopausal women with recurrent UTIs.