MonaLisa Touch Expertise

Is vaginal fractional CO2 laser treatment effective in improving overactive bladder symptoms in post-menopausal patients? Preliminary results

For some time I along with other gynaecologists that use the MonaLisa Touch system have noticed an improvement in bladder symptoms. This awareness came about through the use of 'standardised questionnaires' on bladder/bowel/s*xual function both before and after treatment. Many patients reported an improvement in symptoms.

A recent publication has explored this in more detail.

30 women were enrolled in the study - with the following characteristics - menopausal status, symptoms compatible with vaginal atrophy (eg burning and dryness), NON RESPONSE TO EOSTROGEN and a diagnosis of an overactive bladder (8 trips to the loo and 3 episodes of urgency within 24 hours).

The women needed to be off HRT and also not taking other medications that altered bladder overactivity.

There were marked improvements in the reduction of 'frequency of visits' to the loo - there were also marked reductions in the number of bladder leakage episodes within 24 hours.

Not only were the results 'statistically significant' - meaning that we feel that this is a genuine improvement rather than just due to chance - but the improvements were 'clinically important'. (Eg on average people were going to the loo 6 times rather than 12 times per day on average - with the average number of leakage episodes going from 3 down to less than 1 episode every second day). Some of these women were completely dry.

To put this in perspective - the therapy seems more effective than anticholinergics, seems better tolerated because a large proportion of patients choose not to continue with anticholinergics due to side effects and could well be cost neutral or cheaper to the patient over the longer term when compared to other medications such as vesicare or mirabegron.

Future studies may perhaps have 'extra arms' - where patients are assigned to either laser treatment or medication to attempt to ellicit which is more effective on a head to head comparison. However - the criteria for entry into the study did include patients who had tried and had not responded to oestrogen therapy.

The article is quite balanced, and points out that s*x education discusses reproduction and child birth, but fails to address the changes that happen to women in later life. I often find that women come not realising that there were a range of solutions to painful in*******se, dryness, and other problems of aging.

http://www.bbc.com/news/health-38729240

S*x is painful for nearly one in 10 women, study finds - BBC News Nearly one in 10 British women finds s*x painful, according to a large study.

Lichen sclerosis is an inflammatory condition of the v***a – with a number of clinical features – these include itching/soreness/non healing abrasions as well as progressive narrowing/loss of elasticity.
The main stay of treatment is high dose topical steroids and observation to assess for progression to v***al cancer(every year or so).
Certain patients may not respond to steroids/or have v***al atrophy as a side effect of this.
PRP (platelet rich plasma) has been used for a number of years as a ‘non standard’ therapy for lichen sclerosis. (along with fractional CO2 laser).
I have included a link to a paper (with a small number of patients) that assesses the skin response to PRP objectively.
The ‘entry criteria’ were biopsy proven (ie a certain diagnosis) of lichen sclerosis.
Treatment was 2 shots of prp into the affected area 6 weeks apart.
Assessment was by a dermatopathologist (a doctor that looks at skin samples under the microscope) or the v***al skin both before and after treatment.
The pathologist was ‘blinded’ ie they did not know whether the skin sample was from someone that had PRP or steroids, and therefore could not have a bias into suggesting that the PRP was better than it was.
In patients given PRP – 7 out of 12 patients that completed follow up had ‘objective improvement’ in terms of inflammation when looked at under the microscope. For the record, 3 had no improvement and 2 patients had minimal worsening. 2 patients never turned up for follow up.
The role of this paper is as a pilot study. It does not suggest that PRP is better than steroids, nor does it suggest that it should be used as a first line treatment. There was not a placebo arm to the study. (so it could be argued that perhaps 7 out 12 patients not given anything would also have perhaps improved due to the effects of time). It does support that in patients given PRP, over 50% of patients will find improvement in histological evidence of lichensclerosis. If you are a patient with lichen sclerosis and you are not responding to steroids or are getting side effects from your current therapy – then you may wish to look into this PRP therapy further.
http://www.jaad.org/article/S0190-9622(16)30588-6/pdf

Intradermal injection of autologous platelet-rich plasma for the treatment of v***ar lichen sclerosus Pretreatment biopsy demonstrates hyperkeratosis with flattening of the epidermis, homogenization of the upper dermis with vascular dilation, and focal inflammation in the mid-dermis. (Hematoxylin-eosin stain; original magnification ×100.)

Female s*xuality is now getting awareness in mainstream media.!

http://www.bbc.com/news/magazine-38170324

100 Women 2016: Meet the or**sm doctors - BBC News Women's s*xuality is a little-studied area of science and new research is revealing that much of what we thought we knew was wrong.

https://www.youtube.com/watch?v=s0BBaEMVIio

Dr Mickey Karram interview about MonaLisa Touch at HuffPost Live Dr. Mickey M. Karram and Lisa Elliot join HuffPost Live to explain how "MonaLisa Touch", the innovative procedure introduced by DEKA laser for vaginal laser ...

Newsflash; for our Newcastle, Maitland and Tamworth : MonaLisa Touch patients.

Great News for Breast Cancer Survivors - latest study shows MonaLisa Touch (fractionated CO2) is effective at relieving pain and discomfort during in*******se for breast cancer survivors

https://www.ncbi.nlm.nih.gov/m/pubmed/27170261/

Fractional CO2 laser for vulvovaginal atrophy (VVA) dyspareunia relief in breast cancer...
Arch Gynecol Obstet. 2016 May 12. [Epub ahead of print]
NCBI.NLM.NIH.GOV|BY PIERALLI A , ET AL.

Fractional CO2 laser for vulvovaginal atrophy (VVA) dyspareunia relief in breast cancer... Arch Gynecol Obstet. 2016 May 12. [Epub ahead of print]

I have placed a link, (From America), where a group of American clinicians describe their experience with Monalisa Touch.
Their experience echoes my experience.

Almost all women I have treated have completed their course of therapy - as typically they start to feel well so soon after,

The link also describes and illustrates the fact that even if women are on eostrogen - it can often not work well enough or as well as Monalisa Touch.

I was pleased to see acknowledgement of the fact that for women who needed surgery - the improvement in vaginal health and vaginal skin thickness served as an aid to facilitating surgery, and the surgery being successful.

www.monalisatouch.com

We are setting up further outreach clinics in the upper Hunter.
Patients in Tamworth and Armidale will no longer need to travel 6 hours for their MonaLisa Touch Treatments.

Address: Ground Floor, 3 Fitzroy St, Tamworth NSW 2340
Phone: (02) 6761 2612

We continue to experience very satisfying results using Monalisa Touch alone or in combination with standard therapies.

Case study
New onset vaginal symptoms - with onset of menopause with typical painful in*******se, burning, itchyness, discomfort and dryness - resistant to vaginal oestrogen with v***al discomfort exacerbated by vaginal oestrogen.

Good resolution of vaginal dryness and general comfort but in*******se remained painful with marked v***al burning. The introitus improved in terms of no longer fissuring following a localised PRP injection - but discomfort with in*******se was still an issue.

Vulval appearance - non specific but appeared erythematous. Partial response to topical hydrocortisone but secondary atopy (worsening rebound v***al burning after a few days).

Biopsy showed a non specific mild inflammatory response. A stronger steroid injection (Kenacort) into the v***a settled down the localised inflammation without a secondary reaction (as this was not applied topically).

After some further trials and tribulation and using versabase as a local emolient the v***al irritation settled further.

The moral of the story is that either alone, or as part of a bigger strategy - the V2lr Monalisa Touch treatment can bring significant symptom relief. There is definite benefit however in treatment being carried out by a gynaecologist or at least a dermatologist with an interest in v***al pathology. It is also is important to understand that the journey to recovery is not a clearly delineated journey from the outset but a winding path that explores and trials various treatment strategies.

I look forward to being on this journey to recovery with you.

Dr Jonathan...

Just finished the video's on the biology behind the MonaLisa Touch