Use of Non-ablative Vaginal Erbium YAG Laser for the Treatment of Prolapse: a Randomized Controlled Clinical Trial
Overview
- Phase
- Not Applicable
- Intervention
- Not specified
- Conditions
- Prolapse
- Sponsor
- Universitaire Ziekenhuizen KU Leuven
- Enrollment
- 46
- Locations
- 1
- Primary Endpoint
- Primary outcome is the subjective improvement of POP symptoms, assessed by the Pelvic Organ Prolapse Distress Inventory-6 (POPDI-6).
- Status
- Completed
- Last Updated
- last year
Overview
Brief Summary
This is a single center, investigator initiated study, sponsored by the UZ Leuven, Leuven, Belgium; comparing laser treatment to pelvic floor exercises (PFE).
Women with symptomatic prolapse (grade II-IV) who seek for a conservative treatment, with no history of previous POP-surgery will be randomised to either the laser-arm or the PFE-arm.
There are 3 visits where vaginal application of laser will be performed, with a 4-weeks interval. Each application lasts around 15 minutes. The vaginal laser procedure will be performed in an outpatient setting, not requiring any specific preparation, analgesia or anesthesia, by one of two experienced operators.
The primary objective is to evaluate the effects of VEL treatment for reduction of prolapse symptoms and as a secondary outcome objective measurements. These endpoints are in line with the recommendations by Durnea et al., as being the most relevant and patient centered outcomes.
The second goals are to register adverse events and to determine for how long the effects of laser are sustained, with a maximum of two years. To do so, the investigators will measure long term satisfaction with, and the longevity of the effect (measured by the need for repeat or alternative therapy) of laser therapy.
Duration of follow-up per patient: max 27 months
Investigators
prof. dr. Jan Deprest
MD, PhD
Universitaire Ziekenhuizen KU Leuven
Eligibility Criteria
Inclusion Criteria
- •The presence of POP symptoms
- •Diagnosis of cystocele or rectocele of grade II to IV according to the POP-Q system, leading the prolapse (i.e. C ≤ Ba/Bp)
- •Voluntary informed consent
Exclusion Criteria
- •Symptoms or anatomical evidence for intussusception / rectal prolapse
- •Leading descent of the middle compartment (C \> Ba/Bp)
- •Grade IV prolapse
- •Previous POP surgery
- •Pregnancy or \<12 months postpartum
- •Vaginal bleeding, injuries or infection in the treated area
Outcomes
Primary Outcomes
Primary outcome is the subjective improvement of POP symptoms, assessed by the Pelvic Organ Prolapse Distress Inventory-6 (POPDI-6).
Time Frame: 6 months after last treatment
Participants have to answer 6 questions concerning POP symptoms with a response scale from 0 to 4 (not present (=0), not at all (=1), somewhat (=2), moderately (=3), quite a bit (=4)). The score (range 0 to 100) is then obtained by multiplying the mean value of all of the answered items by 25. Missing items are dealt with by using the mean from answered items only. Higher scores indicate more distress. This questionnaire is available and validated in English, Dutch and French. Success is defined as a reduction in scores of at least 25% compared with baseline.
Secondary Outcomes
- Assessment of the rate of patient satisfaction by means of the Patient Global Impression of Improvement (PGI)(At every visit (ie. week 4, 8 and 12, optional: 16, 20 and 24 weeks), 6, 12 and 24 months after end of treatment)
- Assessment of the anatomical success rate by means of the POP-Q system(At every visit (ie. week 4, 8 and 12, optional: 16, 20 and 24 weeks), 6, 12 and 24 months after end of treatment)
- Assessment of the longevity of the effect of laser therapy(At every visit (ie. week 4, 8 and 12), end of treatment (ie. 4 months after randomisation), 6, 12 and 24 months after end of treatment)
- Assessment of the degree of discomfort of the treatment procedure by the patient(At every visit (ie. week 4, 8 and 12, optional: 16, 20 and 24 weeks), 6, 12 and 24 months after end of treatment)
- Assessment of urinary symptoms by means of the Urogenital Distress Inventory (UDI-6)(At every visit (ie. week 4, 8 and 12, optional: 16, 20 and 24 weeks), 6, 12 and 24 months after end of treatment)
- Assessment of sexual function, by means of the Pelvic Organ prolapse/Urinary Incontinence Sexual Questionnaire IUGA revised (PISQ-IR)(At every visit (ie. week 4, 8 and 12, optional: 16, 20 and 24 weeks), 6, 12 and 24 months after end of treatment)