Baseline ICIQ-UI score, body mass index, age, average birth weight, and perineometry duration as promising predictors of the short-term efficacy of Er:YAG laser treatment in stress urinary incontinent women: A prospective cohort study

Fistonic, I. & Fistonic, N.
Lasers in Surgery and Medicine. 2018

Background and Objective
A growing body of evidence indicates that a non‐invasive erbium yttrium‐aluminum‐garnet (Er:YAG) laser may be an effective and highly tolerable treatment for stress urinary incontinence (SUI) in women. The primary objective was to identify pre‐intervention predictors of short‐term Er:YAG outcomes. The secondary objective was to identify patient segments with the best Er:YAG laser treatment short‐term outcomes.

Methods
A prospective cohort study performed in 2016 at Ob/Gyn Clinic, Zagreb, Croatia, recruited 85 female patients who suffered from SUI. The intervention was performed with a 2940 nm wave length Er:YAG laser (XS Dynamis, Fotona, Slovenia). Outcomes were absolute change in the International Consultation on Incontinence Questionnaire—Short Form (ICIQ‐UI SF) and a relative decrease in ICIQ‐UI score of ≥30% 2–6 months after the intervention.

Results
Age and pre‐intervention ICIQ‐UI values were independent significant predictors of laser treatment efficacy for SUI. A decrease in ICIQ‐UI score (minimum important difference, MID) of ≥30% was independently significantly associated with body mass index and ICIQ‐UI values before the intervention. All patients with four or five positive predictors saw a clinically relevant decrease in ICIQ‐UI of ≥30%. The total accuracy of the predictive model defined by the area under the curve was 0.83 (95%CI 0.74–0.91). At the cut‐off ≥3 positive predictors, C‐index was 0.80 (95%CI 0.71–0.90), positive predictive value was 0.97 (95%CI 0.87–0.99), and negative predictive value was 0.53 (95%CI 0.45–0.55).

Conclusions
A relevant decrease in ICIQ‐UI (MID) of ≥30% can be predicted based on age, body mass index, average birth weight, perineometer squeeze duration, and ICIQ‐UI scores before the intervention. The association between Q‐tip test and treatment outcome was moderated by age. Q‐tip was a significant predictor for patients between 44 and 53 years of age. The best results should be expected in younger women with a body mass index of ≤23.3, average birth weight of >3.6 kg, ICIQ‐UI at a baseline of ≤10, and perineometer squeeze duration at a baseline of ≥3.51 seconds. The critical age for Er:YAG laser effect is 47.5 years. Lasers Surg. Med. © 2018 Wiley Periodicals, Inc.

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