Assignment 3: Creating an Intervention
Assignment 3: Creating an Intervention
The prevalence of stress urinary incontinence increases with age. It impacts the physical, social, emotional, and mental aspects of many women, leading to poor quality of life. A safe and effective method of treating the condition should be devised. This paper proposes that laser therapy should be administered to postmenopausal women attending acute care facilities. The intervention is likely to yield a range of benefits including thickening of epithelial layer and increased volume density of blood capillaries. The recommended laser therapy is Er:YAG laser SMOOTH. Laser spot should 7 mm, with a frequency of 1.6Hz, and fluence of 6.0J/cm2. Participants should go through three sessions, with assessments being made after 6 months to tests the intervention’s efficacy. Potential barriers include resistance to change among clinicians, high cost of purchasing equipment and lack of skills and experience in its use. Increased stakeholder engagement is vital in addressing the weaknesses and barriers.
Assignment 3: Creating an Intervention
Approximately 25 million patients suffer from urinary incontinence in the United States. Of these, over 75% of them are women (Palacious & Ramirez, 2020). Stress urinary incontinence is the commonest type of incontinence, with pregnancy, menopause, and childbirth being the leading risk factors. Prevalence figures increase with age, with 75% of older women suffering from the problem, compared to 25% of young women (Mousa et al. 2021). It is characterized with involuntary loss of urine on effort or while coughing. Milsom and Gyhagen (2018) explain that the condition has profound impact on the welfare and quality of life for women. Accordingly, it is vital to find amicable solutions to the problem. This study focuses on non-invasive method of treating urinary incontinence. The previous research on topic sought to answer the PICOT question of: Does targeted gynecologic laser therapy decrease incidence of stress urinary incontinence and improve quality of life in women? The rationale of choosing the topic is based on the fact that the condition impacts physiological, emotional, social, and psychological aspects of women. While treatment options are available, few patients are willing to seek help because of stigma and the invasive nature of treatment options such as surgery. Previous research revealed that Laser therapy is one of the most effective treatment options to treat stress urinary incontinence. Palacious and Ramirez (2020) expound that it involves applying energy on the tissues, causing a tightening and formation of new collagen and elastic fibers. This paper provides details on the intervention and how it can be adapted to suit older women. Its strengths, weaknesses, and potential barriers in implementing it in a local context are also discussed.
The Intervention
Historically, invasive surgical procedures have been utilized in for stress urinary incontinence. The methods may have adverse impacts due to the longer hospital stays, high morbidity rates, and increased costs of operations. Other non-invasive procedures such as pelvic exercises are ineffective for women with limited skills and time to go through the procedures. Laser therapy is recommended as an effective procedure to treat incontinence (Palacious & Ramirez, 2020). LASER is an acronym for light amplification by stimulated emission of radiation. Lasers emit light energy from a device, giving laser the name CO2, eribium. Medical lasers target blood, water and melanin, which absorb light energy differently. The optimal absorption spectra depend on the incident photon energy’s wavelength. It is also worth noting that lasers have been utilized safely and effectively in different areas of medicine including aesthetics, dentistry and dermatology. Recently, the methods are being explored for gynecologic related treatment because of their effectiveness. Its increased use in vulvovaginal areas is attributed to three factors. First, lasers have minimal micron ablation while the second one is that their absorption coefficient is remarkable. Third, lasers are fractional, which means that the surrounding tissues recover well and without discomfort. Lasers are effective in three areas in gynecology field namely vaginal hyperlaxity syndrome, vulvobaginal atrophy geritourinary syndrome and stress urinary incontinence.
Laser therapy for treating urinary incontinence involves the use of pulsed laser photothermal energy to enhance collagen structure and commence neocollagenesis in the pelvic floor. Increased temperature of up to 630C can speed up the contraction of collagen fibers and initiated neocollageneisis, neoangiogenesis and fibroblast pool (Franic & Fistonic, 2019. The process is also associated with the thickening of epithelial layer and increased volume density of blood capillaries. The recommended laser therapy for this study is Er:YAG laser SMOOTH. Laser spot should 7 mm, with a frequency of 1.6Hz, and fluence of 6.0J/cm2. General anesthesia is not required and the treatment regime should involve three sessions after every three weeks. Taking patients through more than one session ensures that collagen fibers are completely captured, helping patients reach collagen remodeling capacity.
Laser therapy will be targeted to older women rather than younger women for several reasons. First, stress urinary incontinence is likely to affect older women at the menopausal stage and beyond and as such, providing a non-invasive yet effective treatment option is critical. Second, finding non-invasive interventions to urinary incontinence is more helpful for older women since they tend to have other complications. They may also not respond to invasive treatments better when compared to younger women (Palacious & Ramirez, 2020). Third, older women are unlikely to find help for urinary incontinence because they do not have resources and information on available treatments. They are also uncomfortable discussing the issue when compared to younger women. They are often subject to stigma and self-esteem issues if the problem is untreated for a long time. It is therefore important to encourage them to try less invasive yet effective method of treatment such as laser therapy.
Laser therapy must be adapted to suit the population of study. Foremost, it must be combined with conservative management for effectiveness. Conservative strategies involve pelvic floor exercises, bladder training, weight loss, and fluid optimization. Doing so ensures that the patient’s quality of life is improved sustainably. Further, all patients must be subjected to pretreatment assessment. The clinician must determine the severity of stress urinary incontinence and patient’s ability to tolerate lasers. Doing so ensures that the number of sessions align with individual patient needs. Still, patients with specific conditions should be excluded from the treatment. This is inclusive of women with diabetes mellitus, undiagnosed vaginal bleeding, neurologic disease and urinary tract infection. The vagina must be free of creams and gels during the procedure. It is also important for doctors to follow the instructions by device’s manufactures for safety reasons. Follow up must done after six months to determine whether the method is effective and possibility of adverse effects. Therapy must be ceased if women develop complications in the course of treatment.
The population of study for the intervention is postmenopausal women. They must have had cases of untreated stress urinary incontinence. They must also be informed about the procedure and the risk factors before implementing the intervention. The group is chosen because the quality of life for such groups is often low due to the changes occurring during menopausal stage. They tend to have difficulties adjusting socially as issues such as hair loss, loss of skin elasticity, reduced sexual drive, and irritability become evidence. The additional issues associated with stress urinary incontinence will impact their quality of life significantly. Accordingly, providing laser therapy may help them solve physical, social, emotional, and mental issues. Clinicians in the community delivering acute care will be requested to identify the population and enroll them for treatment. Involving their care givers and family members is also important as it will pave the way for the necessary support. The participants must sign documents showing that they have consented to trying the new treatment method.
Additionally, the implementation process must involve all stakeholders. Lavery (2018) affirms that stakeholder engagement in clinical projects is important because it ascertains that necessary support is availed from the onset. Stakeholders in this case include postmenopausal women attending acute care facilities, management in the facilities, community leaders, and medical practitioners. Clinicians should go through training on laser therapy to ascertain that they deliver quality services. The management will be involved in providing resources for training and purchase of equipment. It is also important to inform patients on the benefits of laser therapy and how they can access services. Effective communication is important in this case. Communication may involve the use of emails, brochures, and acute care’s website. Seeking feedback is vital as it allows for the evaluation and improvement of the project.
Project implementation will involve five steps. First, data on menopausal women attending acute care facilities in the community must be gathered. Critical information must include their age, severity of SUI, their medical history, social supports, and current treatment plans. It is also important to gather information on the availability of laser therapy devices in the acute facilities. The second step will involve seeking funding for the project from stakeholders. The equipment should be purchased from credible vendors and delivered to the facilities within the shortest time possible. Third, patient-centered goals will be established, where patient characteristics are identified. The plan must be individualized to meet specific needs. The forth step will involve implementing the project in acute care facilities. Training must be done to ensure that clinicians are knowledgeable on how to use the devices. The fifth step involves evaluating the project’s efficacy. Key metrics to measure success include increased patient satisfaction, improved SUI symptoms, and reduced costs of care among patients. Surveys should be conducted to gather this information, where questionnaires are administered to different stakeholders. it is also important to go through different reports from the hospital to determine changes that may have taken place after the use of laser therapy.
Evidence show that laser therapy is effective in treating stress urinary incontinence. A study conducted by Pitsouni et al. (2019) reveals that laser therapy for post-menopausal women with urinary incontinence can reduce symptom severity, enhance the quality of life, and increase vaginal mucosa. It involved a search from credible databases, with GRADE approach being used to determine the quality of evidence. Results show that most studies determined that urinary incontinence symptoms had improved including dryness, itching, dysuria, and urgency. Similarly, a study by Gaspar et al. (2022) shows that non-abalative Er: YAG laser improves the symptoms. A total of 43 patients had participated in the study, with the participants being required to go through three sessions of laser therapy. Statistical analysis was done using ANOVA and patients questioned on discomfort during treatment. Side effects reported were mild. While the symptoms improved after three sessions, researchers determined that the treatment option was more effective if patients went through one session after every three months. The study by Sathaworawong et al. (2021) affirms that the method is effective and not associated with adverse effects. Forty two patients with descried sexual sensation were involved in a randomized study. An intervention group received two laser therapy sessions while the control group went through a placebo treatment. Evaluations were done after one, three, and six months. Patient satisfaction improved among participants in the intervention group. No improvement was noted in the control group. It confirmed that laser therapy is not only effective, but it also safe for use.
In its position statement, the American College of Obstetricians and Gynecologists indicated that there are potential benefits of using the technology in treating patients. Specifically, the method was associated with increased sexual satisfaction, reduced vaginal dryness, and patient satisfaction (Pessoa et al., 2021). Even so, its efficacy is still questionable given that long-term follow up has not been done on many studies. The method is relatively new in treating SUI and therefore, increased research in the area is required. Focus must be given on long-term benefits of using laser therapy.
Strengths and Weaknesses of Laser Therapy
Laser therapy is more preferable than other forms of urinary incontinence treatments for several reasons. First, the method is less invasive than other treatment options. Pessoa et al. (2021) explain that women may avoid treating the condition to avoid pain and discomfort associated with surgery and other methods. Laser therapy improves the quality of life for patients without unnecessary discomfort and pain. Embracing a patient-centered approach in treating the condition is critical because it helps resolve the issue amicably. The patient has a chance to participate in managing the condition and improving their lifestyle, leading to patient satisfaction. Moreover, the method will lead to reduce costs of care since the length of hospitalization is reduced significantly. Even further, medical practitioners are likely to work at higher levels of precision (Palacious & Ramirez, 2020). Traditional surgical methods tend to have deeper and longer cuts; it implies that the healing process is daunting. The treatment can be done from an outpatient facility, which is more cost efficient and preferable for older women.
Nonetheless, laser treatment for stress urinary incontinence is still at its formative stages and as such, safety issues have been raised. Surgeons must follow instructions given by the manufacturers to avoid complications. The aspect of repeating treatment may be disadvantageous for some patients (Palacious & Ramirez, 2020). The treatment option requires patient to go for more than three sessions for effectiveness. Older women may find the process tedious and time-consuming. It is also worth noting that the procedure may be more expensive than other forms of treatment. Older women without sufficient insurance cover may be restricted from using it. Besides this, the treatment option is yet to be endorsed by government agencies. In 2018, the US Food And Drug Administration (FDA) indicated that laser therapy and other energy-based devices are unsafe (Pessoa et al., 2021). The agency warned that these therapies could lead to adverse outcomes such as scarring, vaginal burns, and sexual discomfort. Failure to address such concerns could have negative impact on patient outcomes.
Barriers to Implementation
Implementing laser therapy for older women with urinary incontinence issues is subject to various barriers. Foremost, hospitals offering outpatient services may not have the resources to acquire the necessary equipment. Palacious & Ramirez (2020) indicate that many hospitals operate on a low budget. They must meet different needs such as staffing and purchase of drugs. Purchasing equipment needed for laser therapy may be difficult for smaller hospitals. Second, laser therapy will require training for clinicians and staff members. it implies that hospitals must set aside resources to find an expert in the area. Failure to do so can lead to health risks.
Third, some clinicians may resist change since they may be used to the traditional method of treating urinary incontinence. It can be attributed to the fact that efficacy of the treatment option has not been evaluated for a long time to give clinicians the confidence to use it in outpatient services. It means that the process of adopting new method may be longer than necessary. Fourth, patients may be reluctant to adopt new method of SUI treatment because of the related risks. The study conducted by Franic and Fistonic (2019) indicated that patients report minor symptoms during treatment including warmth sensation, discomfort. Some of them may also be intolerant to laser therapy. After therapy, patients may report increased vaginal discharge, burning sensation, urinary infections, and spotting. Many patients would want a reassurance that the method is effective and safe before using it. The US food and drug administration can help in this regard by endorsing its use.
Conclusion
Laser therapy can improve symptoms associated with stress urinary incontinence among postmenopausal women, which in turn enhances their quality of life. the problem impacts women’s physical, emotional, social, and mental well-being if untreated. Invasive methods such as surgery are linked to pain, increased length of stay, and discomfort. On the other hand, Evidence from various studies show that laser therapy is effective in treating SUI cost-effectively and with minimal side effects. Therefore, implementing the treatment option among older women attending acute care facilities will lead to positive outcomes. Even so, barriers to its implementation such as high cost of purchasing equipment and lack of skills must be addressed. a patient-centered approach is also worth considering to ascertain that all factors affecting patient’s well-being are incorporated in treatment plan.
References
Franic, D. & Fistonic, I. (2019). Laser therapy in the treatment of female urinary incontinence and genitourinary syndrome of menopause: An update. Hindawi BioMed Research International, 2019.
Gaspar, A., Koron, N., Wilva, J., & Brandi, H. (2022). Vaginal erbium laser for treatment of stress urinary incontinence: Optimization of treatment regimen for a sustained long term effect. Lasers in Medical Science.
Lavery, J. V. (2018). Building an evidence base for stakeholder’s engagement. Science, 6402, 554-556.
Milsom, I. & Gyhagen, M. (2018). The prevalence of urinary incontinence. Climacteric, 22(3).
Mousa, G. S., Yousef, A. M., El-Sayed, R. F., Sallam, E., Hussein, A., & Hamada, H.A. (2021). Non-ablative Er: YAG laser therapy effect on stress urinary incontinence related to quality of life and sexual function: A randomized controlled trial. European Journal of Obstetrics & Gynecology and Reproductive Biology, 224, 153-158.
Palacious, S. & Ramirez, M. (2020). CO2 laser therapy in stress and urge urinary incontinence. Gynecological and Reproductive Endrochronology And Metabolism, 1(2), 76-79.
Pessoa, L. L. M. N., Sarmento, A. C. A., Medeiors, K. S., Costa, A. P. F., Goncaives, A. K. & Cobussi, R. N. (2021). Efficacy and safety of laser therapy for the treatment of genitourinary syndrome of menopause: A protocol for systematic review and meta-analysis of clinical trials. Frontiers of Reproductive Health
Phoenix physical therapy (2022). urinary incontinence in women statistics. https://phoenixpt.com/statistics/
Pitsouni, E., Grigoriads, T., Falags, M. E., Salvatore, S. & Athanasiuo, S. (2019). Laser therapy for the genitourinary syndrome of menopause: A systematic review and meta-analysis. Maturitas, 103, 78-88.
Sathaworawong, A., Manuskiatti, W., Phatihattakorn, C., Ungaksompairote, C. & Ng, J. N. (2021). The efficacy of erbium-doped yttrium aluminum garnet(Er:YAG) laser in the treatment of decreased sexual sensation: Randomized placebo-controlled trial. Lasers in Medical Science