Urinary incontinence is a socially disabling disorder that affects a large proportion of women around the world and it is a common symptom after multiple vaginal deliveries, after the delivery of a large baby as well as after an instrumental delivery (such as a forceps delivery) but it also occurs as a result of normal aging. Loss of urinary control and decreased sexual activity results in a negative body image as well as a decreased quality of life and it is not well evaluated in most exams and women do not offer to bring it up spontaneously at medical interviews.
Surgical correction has been the standard treatment for incontinence and more recently a sling procedure with insertion of a mesh have been used. Surgery is expensive and has the disadvantage of creating considerable downtime and is not a good choice if more children are planned. Some patients also hesitate to receive mesh implants for treatment of urinary incontinence because of the risk of erosion, infections, and tearing of organs. Therefore, office based procedures have become more popular and at the same time they have become more efficient particularly when radio frequency (RF) energy is used because the RF energy penetrates deeper into the tissue than other types of energy.
RF energy is delivered fractionated using a grid in small portions to the epidermis and dermis as microablative energy and leaves most of the tissue intact, so that no pain is generated. When the RF energy reaches sensitive nerves and vessels nitrous oxide is released that stimulates local stem cells to produce a large number of growth factors that increase the production of fibroblasts, elastin and collagen. Studies have also shown how the RF energy stimulates the release of cytokines, metallo proteinasers, heat shock proteins and other extracellular proteins. Heating of tissue to the correct temperatures cause the breakage of intramolecular hydrogen bonds and induce immediate tissue tightening which results in thickening and shortening of the collogen fibers with more filling volume than the native molecules. The remodeling of the subcutaneous tissue occurs and result in a thickened epithelium and stroma with increase in strength of the underlying tissue and also an improvement of lubrication.
Multiple clinical studies over the past few years have shown the efficiency of RF to improve or cure urinary stress incontinence. The treatment is performed with a special probe inserted into the vagina and also applied on the urethra and periurethral tissue. RF energy is applied in pulses for 1 – 2 seconds. No anesthesia is needed and no incision is made. A slight vibration but no pain is created and occasionally a warm feeling is noticed from the energy application. The vulvar, periurethral and perivaginal temperatures reach between 40 – 45 °C ( 105 – 115°F ) for approximately 5 minutes. One treatment session typically takes about 15 minutes and the patient can resume regular activities immediately afterword. After one treatment results may be noticeable but the best results are achieved with 3 treatments performed 4 weeks apart. The benefits continue to increase for about 5 – 6 months following treatment and can then be improved by a repeat treatment. In order to follow the progress of the treatment we ask the patient to fill out a couple of questionnaires before each individual treatment. A few contraindications to the treatment exists such as active infection, taking immunosupportive drugs, severe prolapse of the uterus, presence of a pacemaker, automatic implantable cardioverter defibrillator (AICD) or other electrical health maintenance devices.
The insurance industry is still considering RF treatment of urinary incontinence experimental and therefore does not include it in their reimbursement. We charge $700 for one treatment and $1,500 for a series of 3 treatments.