FemTouch For the treatment of recurrent urinary tract infections in post-menopausal women
Introduction
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 or 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 active rejuvenation of the vaginal wall lining as well as the loss 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 may result 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). There is a global urgency to find antibiotic-free therapies, for instance reinforcing natural mechanisms of defence.
Fractional CO2 lasers, applied to the vaginal lining, induce histological changes, resembling oestrogen therapy (Zerbinati et al 2015, Salvatore et al 2015). Biopsies from treated patients demonstrate the restoration of thick squamous epithelium, intra-cellular glycogen storage and synthesis of new components for the extra-cellular matrix. Fractional
Bob Yang — Urology Specialist Registrar Steve Foley — Urology Consultant Claire Foley — Aesthetic Nurse Practitioner
CO2 laser treatment restores the natural lubricated vaginal microenvironment, leading to commensal lactobacillus colonisation, which in turn re-establishes 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 to induce vaginal restoration.
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 over a 1 year period
