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Archive for the ‘Pacientes’ Category

I-PDT intralesional photodynamic therapy for anal fistulas, at the XXI Meeting of the Spanish Association of Coloproctology (RNAEC)

Innovative intralesional photodynamic therapy I-PDT with Multidiode ™ 630 PDT laser for non-surgical treatment of anal fistulas will be the protagonist of INTERmedic’s stand at the XXI Meeting of the Spanish Association of Coloproctology (RNAEC). This year, the convention will be held from 17 to 19 May 2017 in Almeria (Spain). This laser equipment will be exposed in the INTERmedic booth, where you will be able to know the advantages of this revolutionary therapy, which is already being used with excellent results at the University Hospital of Elche (Spain), by the team of Dr. Antonio Arroyo.

Round table on perianal fistula treatments

The scientific program devotes a roundtable discussion on Friday, May 19 morning to the treatment of the perianal fistula, using laser energy devices or photodynamic therapy. Spanish surgeon Dr. Antonio Arroyo will expose his experience with both techniques and will talk about the results of the study carried out at the Hospital of Elche (Spain) with the I-PDT technique.

More information at www.rnaec2017.com  

 

XXI Meeting of the Spanish Association of Coloproctology (RNAEC)

Almeria (Spain), 17-19 May 2017

Palace of Exhibitions and Congresses El Toyo Cabo de Gata

INTERmedic Stand: No. 2  

 

Roundtable: Perianal Fistula: Biology or energy sources

Friday, 05/19/2017 – 9:30 a.m. to 11:00 p.m. – Parallel Room

Speaker: Dr. Antonio Arroyo

 

 

Intralesional photodynamic therapy, new technique for anal fistulas limiting potential lesions

Spanish medical magazine DiarioMedico.com collects in a report the work of Spanish surgeon Dr. Antonio Arroyo and his team at the General University Hospital of Elche (Alicante, Spain), in the investigation and application of a new treatment technique for anal fistulas using photodynamic therapy with INTERmedic’s Multidiode ™ 630 PDT laser.

Among the main advantages of this new technique are the patients’ cure rate – 80% according to the initial experience of Dr. Arroyo – and the lack of the complications caused by the common surgical treatment techniques for anal fistulas that usually cause injuries in the musculature of the anus and adjacent tissue. According to Dr. Arroyo in the report, these lesions “condemn the patient to global fecal incontinence rates of 10% to 20%, with recurrence rates of 20% to 40%.”

On the other hand, photodynamic therapy “is a safe and reproducible technique” in which “no side effects have been observed, except for mild pain in some patients,” Dr. Arroyo says. The data of this innovative technique, of which Elche Hospital is a pioneer, have been published in the prestigious medical publication Techniques of Coloproctology and have been awarded at the XXV International Conference on Coloproctology.

Click on the link to read the full article (in Spanish):

Intralesional photodynamic therapy, new technique for anal fistulas limiting potential lesions  (DiarioMedico.com)

Diario Medico pdt fistulas

 

 

 

Pseudogynecomastia: Lipodefine™ laser solution

Pseudogynecomastia is hypertrophy of the male breasts due to fat accumulation. This abnormal development may occur in both breasts or it may be asymmetrical.

It should not be confused with gynecomastia, as the two conditions have different origins; in the case of gynecomastia, the growth occurs in the mammary gland.

According to studies, these disorders affect an estimated 40-60% of men. In the case of pseudogynecomastia, there is no defined age range, as its main cause is excess weight. It can therefore manifest any time between childhood and adulthood.

Pseudogynecomastia does not entail any medical complications, but it does represent an aesthetic problem. When the breasts increase in size, the torso loses its masculinity and this can create insecurities and self-esteem problems in the men who suffer from the condition.

Generally speaking, aesthetic problems in men are still something of a taboo area, as such treatments are usually associated with a woman’s strive for beauty. However, men do not have to live with this problem, as there is a solution that is simpler than people may think.

To deal with the fat located in difficult areas, as is the case with male breasts, INTERmedic has developed a minimally invasive laser solution with effective results. This is the “mini-lipo laser” with Lipodefine™.

Lipodefine™ is the laser tool indicated for body remodelling. Its minimally invasive system facilitates fat elimination from the most difficult areas, as is the case with male breasts. Furthermore, it is the only laser on the market which causes skin retraction through its thermal effect. This means that the patient not only manages to eliminate the fat, but their torso will also appear firmer, thereby regaining their masculinity.

How does Lipodefine™ work?

The LipoDefine™ 980 4G procedure involves inserting a small cannula, 1-mm thick, with a versatile, flexible laser fibre, through a small incision in the skin up to the adipose tissue. This cannula remains in constant movement, to allow the fibre to deliver the laser energy to the area to be treated.

The laser heat causes the adipocyte to tear. The fat cells absorb the energy, increasing their volume until they break, without damaging other tissues in the process. In turn, the thermal effect coagulates small blood vessels, remodels the collagen and causes skin retraction, which cannot be achieved with conventional liposuction (skin tightening).

Lipodefine™ is also indicated for eliminating fat from the following areas:

  • Buttocks
  • Internal area of the thighs
  • Stomach with or without flaccidity
  • Neck area (double chin)
  • Arms
  • Knees and calves

For more information about LipoDefine™, visit: http://www.inter-medic.net/es/producto/lipodefine/

 

Intralesional photodynamic therapy: the light healing from within the lesions

The Spanish newspaper Diario de Soria dedicates an extensive report to the intralesional laser photodynamic therapy for the treatment of precancerous and cancerous skin lesions, a new technique developed by Spanish dermatologists Dr. Manuel Ángel Rodríguez Prieto and Dr. María Jesús Suárez Valladares in the Dermatology Service of the Hospital de León (Spain).

“The original and novel is the use of a laser and the introduction of the sensitizing substance and / or the light into the lesions, improving the limitation of skin penetration of the prior technique,” the doctors explain in the article. The laser used in this new technique is INTERmedic’s Multidiode ™ 630 PDT, a diode laser with 630nm wavelength.

Dr. Rodríguez Prieto and Dr. Suárez Valladares have international publications in high-level dermatology journals that support a cure of 93.7% of patients with basal cell carcinoma treated with this technique after a six-year follow-up. The article also highlights the good results obtained by dermatologists in treating other pathologies such as fistulas, synovial cysts, or suppurative hydrosadenitis: “With the new treatment, about 80% of the treated lesions are cured, and in their own words, with less than two of these treatments the equipment is amortized,”they explain in relation to hydrosadenitis.

To end, the journal emphasizes that this new therapy has multiple possibilities of application, not only in Dermatology, but also in other medical specialties such as General Surgery, Gynecology, Digestive, Urology, Plastic Surgery or Traumatology.

Click on the link to read the full article (in Spanish):

Luz que cura desde dentro las lesiones ( Diario de Soria – 14/02/2017 )

Diario de Soria-PDT

 

 

First patients treated with intralesional i-PDT photodynamic therapy in the Balearics

The Son Espases Hospital in Palma de Majorca (Spain)  is already successfully applying intralesional photodynamic therapy (i-PDT) in patients with hidradenitis suppurativa. In an interview published in the Spanish daily Última Hora, the first patient treated with this new therapy in the Balearic public health service is very satisfied with the results. “The first PDT session was made on December 19th and since then I feel much better,” she says.

The Son Espases Hospital, together with the León Hospital where the technique was first developed, are pioneers in the implementation of intralesional laser photodynamic therapy in Spain. The I-PDT consists in the application of a photosensitizing substance to the ill tissue, which is then activated by the 630nm laser light of INTERmedic’s Multidiode ™ 630 PDT system.

 NOTICIA PRENSA PDT

Podylas™ solution: the laser that meets the needs of each podiatrist

The 1064nm laser technology developed by INTERmedic helps podiatrists tackle treatment-resistant disorders, such as onychomycosis, plantar warts and intractable plantar keratosis (IPK), and perform LLLT and small podiatric surgery. Podylas™ brings to consulting rooms the advantages of the very latest laser technology for podiatric applications. The goal: to meet the specific needs of all podiatrists and their patients, with a multi-application platform for foot care.

Gold-standard in lasers for podiatry

Portable, expandable and no consumables. Podylas™ is a benchmark laser system for onychomycosis, featuring numerous advantages. Its 1064nm solid state laser has the optimum wavelength to effectively eliminate fungal infections, thanks to a controlled thermal effect. The flat front beam of the Podylas™ laser reaches the deepest layers of the nail, ensuring good laser penetration and a therapeutic effect that leaves the surrounding tissue unharmed.

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Versatility for numerous indications

INTERmedic’s laser solution is ideal for the treatment of onychomycosis, plantar warts, neurovascular corns, intractable plantar keratosis (IPK), low-level laser therapy (LLLT) and small podiatric surgery.

  • Highly effective in onychomycosis: Podylas™ destroys nail fungus by selective photothermolysis without damaging the nail plate or skin. It is highly effective, has no side effects and the procedures are very fast.
  • Also for plantar warts: Podylas™ vaporises lesions effectively, quickly and safely, even in multiple plantar wart cases, and without side effects.
  • Non-surgical solution for corns and IPK: The INTERmedic laser shortens recovery time after corn and IPK treatment. It also precludes the need to administer drug therapy and achieves visible improvement from the first session. Its use is indicated in both acute and chronic cases. It produces no residual pain or side effects.
  • LLLT anti-pain therapy: The application of Podylas™ in LLLT mode produces an anti-inflammatory, analgesic and tissue regeneration effect in ulcers, post-surgical hallux valgus and painful and inflammatory conditions such as plantar fasciitis, Achilles tendinitis and metatarsalgia. LLLT shortens recovery time, precludes the need to administer drugs and can be combined with other treatments.
  • Podiatric laser surgery: Another indication for Podylas™ is podiatric surgery. Its great cutting and coagulation capacity makes it a powerful surgical tool that minimises bleeding and provides high precision in procedures such as matricectomy.

Why choose Podylas™?

  • Highly effective in the treatment of onychomycosis
  • Can be used in young and diabetic patients
  • Can be used as a base treatment or in combination with other therapies
  • Multi-application expandable platform for podiatric surgery
  • Medical laser system manufactured in Spain

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The experts say: “Undoubtedly, the Podylas ™ laser is also a very effective treatment for plantar warts”

Interview with Spanish Podiatrist, Peña Martín. Complutense University of Madrid. (Spain)

After two years of using the Podylas™ system in her consulting room, the Spanish podiatrist, Peña García, says that she can achieve “very effective results after just one session” in the treatment of plantar warts. Her secret: the Peña technique, a revolutionary sublesional papule application system developed by herself, which enables her to remove warts in a single laser session.

What do you mainly use the Podylas™ laser for?

It’s difficult to choose one main use. I actually use it for numerous treatments to exploit its full potential. But if I had to pick one, I’d probably say for LLLT. The results of this laser in the treatment of onychomycosis are very satisfactory.

In your experience, is the same true for the treatment of plantar warts?

The laser is also, without doubt, a highly effective treatment for plantar warts. I use the two techniques that exist; the simplest technique is vaporisation and it is the one I use as my first choice. In cases where it is not possible to remove the lesion using this technique, and it is small or medium size, I use the sublesional papule method, or Peña technique, which has a 100% success rate.

What are the difficulties of treating this disorder?

There are certain factors that can cause the lesion to persist. A common factor is emotional, for example in patients suffering from stress or anxiety whose defences have been lowered, which often hinders the rapid resolution of this disorder. Because of this, in stubborn cases or in severe cases of papillomatosis, it is advisable to use medication to strengthen the defences.

What are the advantages of Podylas™ compared to conventional treatment methods?

Mainly its high effectiveness. It is also virtually painless and enables patients to get on with their normal lives during treatment.Yes, absolutely all of them. Provided, of course, that the most appropriate technique is used for each kind of wart.

It is suitable for all patients (adults, children)?

Yes, for everybody. The parameters of the Podylas™ laser can be set according to each patient’s level of tolerance. This is how we individualise laser treatment while maintaining the same effectiveness.

Is it necessary to use anaesthesia?

With the vaporisation technique, no. But, with the sublesional papule method, or Peña technique, it is.

What does treatment involve and how long does a laser session last?

For plantar warts, we perform two techniques, both with a 3 mm handpiece. The first technique is called vaporisation. This involves applying dye to the lesion and then cooling the treatment area before and after each laser shot. The cold is used as an anaesthetic as we penetrate deeper into the lesion with each shot. After laser treatment, we apply an occlusive dressing containing povidone iodine and, if necessary, unload the support area with adhesive felt. One treatment session with this technique usually lasts 15 to 20 minutes.

And what does the Peña technique involve?

The sublesional papule method, or Peña technique, takes a little longer because it is necessary to anaesthetise the area of the lesion. A small anaesthetic papule is injected under the wart and the laser is applied. The wart is separated from the healthy skin and debrided with a scalpel, leaving a clean ulcer in its place. We then help close the ulcer with the application of LLLT using the ulcer settings. We also help unload the area of the lesion with felt. One session is usually enough to resolve the patient’s dermal problem, with the skin normally taking around three weeks to heal.

What do patients feel?

With the vaporisation technique, they feel a burning sensation, which is rapidly relieved by applying cold. It only lasts while the laser is being applied and, at the end of the session, patients do not usually report any discomfort; they can normally put on their shoes and walk without pain. Similarly, with the sublesional papule method, or Peña technique, after the effects of the anaesthesia have worn off, patients do not usually report pain and can walk normally.

How long does it take to see the results?

With the vaporisation technique, sessions are every two weeks. The average number of sessions necessary to remove a plantar wart is three. With the sublesional papule method, or Peña technique, it is resolved quicker because the wart is removed in one session. The small ulcer produced usually closes up within three weeks.

What’s the success rate for plantar warts?

In my experience, it’s high – 70-80% with the vaporisation technique and 100% for cases treated with the sublesional papule method, or Peña technique. Podylas™ is also very useful as a tool for the treatment of pain in cases of fasciitis and trigger points, thanks to LLLT (low-level laser therapy) mode.

How does the laser help improve these disorders?

It does it very effectively and painlessly. Before having the Podylas™ system in my consulting room, I had to refer many patients to physiotherapist colleagues who applied effective but very painful techniques. Now, we have a system that benefits the patient, by offering very effective and painless treatment, and the podiatrist, by providing a remarkably rapid and efficient solution that precludes the need for referral. In the treatment of myofascial trigger points, the patient can leave the consulting room pain free.

How many LLLT sessions are necessary to achieve results?

One session is usually sufficient to treat trigger points. If two or more sessions are required, it is necessary to investigate why the disorder is persisting. I’ve had two cases, for example, in which a vitamin D deficiency was perpetuating the trigger points and causing the relief to be short-lived. By normalising the vitamin D levels in these patients, the effect of the laser treatment was ensured without relapse.

On the whole, what do you think of the Podylas™ laser platform?

INTERmedic’s Podylas™ laser therapy platform has become an essential tool for me in my consulting room. It provides simple and effective solutions to very common disorders among our patients that are difficult to tackle without the laser.

The experts say: “I-PDT therapy is safe, secure, reproducible and has encouraging results in the healing of the fistulas”

Interview with Dr. Antonio Arroyo. Specialist in Surgery and Gastroenterology. (University Hospital of Elche, Spain)

Dr. Antonio Arroyo, an expert in the use of intralesional photodynamic therapy, I-PDT, in anal fistulas, explains his experience with this technique at the University Hospital of Elche (Spain).

What is a complex fistula and where does the complexity lie in the treatment of this pathology?
Anal fistula is a connection inside the anus with the outer skin. The aetiology of anal fistulas is not definitively clarified but it is assumed to occur as a result of an infection of the anal glands, due to its high prevalence. These formations are located in the anal canal at the level of the pectinate line. Its inner orifice is at the level of the crypts of Morgagni. According to this hypothesis, the infection of these glands by enteric bacteria results in the formation of an abscess that can spread through the different areas of the anal canal, appearing when they are drained or when opened spontaneously to the external orifice of fistulas. The problem is that these fistulas traverse the anal muscles that we use for fecal continence and any intervention thereon may be problematic.

What impact is there on the population?
The incidence rate of anal fistula is about 10/100,000. That is, it affects 10 out of every 100,000 people.

What is life like for people with this disease?
They have a very poor quality of life, with pus spots and faeces stains appearing daily on their underwear.

What is the conventional treatment for fistulas?
The classic surgical techniques – fistulectomy, with or without flaps, fistulectomy-sphincteroplasty and looping, employed as a means of drainage or cutting, “condemn” the patient to overall fecal incontinence rates of between 10% and 20%, with recurrence rates ranging from 20% to 40%.

And what is photodynamic laser therapy?
Photodynamic therapy (PT) is a therapeutic modality based on the photo-oxidation of biological materials induced by a photosensitizer, selectively localized in certain inflammatory cells or tumour tissues, so that when illuminated with a light of an appropriate wavelength of sufficient dose, such cells are destroyed.

What benefits does photodynamic laser therapy I-PDT offer in the treatment of fistulas?
This therapy produces a selective destruction of inflammatory fistulous tissue and causes a cure without damage to the surrounding tissues, thus preventing fecal incontinence which occurs with surgery.

What are the benefits to the patient from laser photodynamic therapy?
This therapy is harmless, safe, reproducible and offers encouraging results in the treatment of this pathology.

How is treatment with I-PDT performed?
Under spinal anesthesia, the fistulous tract is located and injected with the 5-ALA photosensitizer. Subsequently a 630 nm red laser light will be applied through a 1mm thick optical fibre (with an Multidiode™ 630 PDT, by INTERmedic Spain).

What effect does the laser have on the tissue?
The laser induces the destruction of the fistulous tissue, while preserving the healthy tissue.

The Elche Hospital is one of the first in which this technology is being used for fistulas, in a clinical trial. What results have been obtained so far?
The preliminary experience of a pilot project conducted in the Coloproctology Unit at the General University Hospital of Elche using this technique in 20 consecutive patients with complex anal fistula showed a cure rate of 80%, with a rate of incontinence of 0%.

How many sessions of I-PDT treatment are necessary to solve this condition?
So far there is only evidence of one single treatment session.

Are we talking about improvement or healing?
We’re talking about healing.

And in terms of cost, is this an affordable therapy, both for doctors and for patients?
A safe, secure therapy that cures 80% of fistulas without the complications of traditional surgery, I-PDT therapy is priceless.

Gynelase™: Excellence in laser for the genital area

Cosmetic and functional problems of the female genital area can now be solved in a minimally-invasive manner thanks to the most advanced laser technology manufactured in Spain. INTERmedic has developed the Gynelase™ platform with women and their most intimate needs in mind. This CO2 technology laser system is an indispensable tool for use in external female genitalia correction procedures – currently the most in-demand operations in the nation’s cosmetic gynaecology consulting rooms.

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The best option for the V zone

Gynelase™ combines speed, precision and total control in the execution of procedures such as labiaplasty, vaginoplasty, genital bleaching and genital wart treatment. The advantages of this laser system for the care of the V zone are many and varied:

  • Outpatient treatment that is comfortable for the doctor and patient.
  • Minimum need for anaesthesia, less pain and oedema. Reduced post-operative recovery.
  • Rapid recovery without incapacitation. Safe, effective and bloodless procedures.
  • High rate of patient satisfaction.
  • High-precision cutting.
  • Very fine incision capability with better healing and more harmonious cosmetic result.

Versatile system with a wide range of applications

Innovative design with coloured touch screen. Wide range of attachments specially designed for the female genital area. Cosmetic gynaecology, stress urinary incontinence and vaginal atrophy Gynelase™ features various treatment modes for pelvic floor disorders, such as mild to moderate stress urinary incontinence; surgery-free vaginal rejuvenation; cosmetic surgery for warts, condylomata and HPV, and other applications..

The experts say: “The laser is the best choice for intimate surgery procedures both for its accuracy and speed”

Interview with Dr. Santiago Fernández Turizo. Gynecologist. Clínica Buenavista (Spain)

www.clinicabuenavista.com

From Clínica Buenavista in Oviedo, Dr Santiago Fernández Turizo talks about his experience with Gynelase™, highlighting the value of this laser as a non-surgical solution to urinary incontinence and as a female genital reshaping tool in labiaplasty, perineoplasty and vaginoplasty procedures.

What is cosmetic gynaecology or vaginal plastic surgery?

Cosmetic gynaecology is a subspeciality of gynaecology whose purpose is to improve the quality of patients’ sex lives and the physical appearance of their intimate areas. It is currently a highly sought-after treatment that is not only related to patients’ gynaecological health, but also to sexual satisfaction and the pursuit of aesthetic beauty.

Why has this type of surgery become so popular in recent years?

Women are becoming increasingly knowledgeable about the problem and willing to face up to it and find a solution to their dissatisfaction, a result of accumulated vaginal tissue damage over the years caused by childbirth, trauma or the passage of time. Improvement in the external appearance and functioning of the intimate area helps greatly to restore women’s self-esteem and improve their sex lives with partners.

Is there a canon of beauty for the vagina?

In recent years, concern about the intimate area has increased. Women want their vaginas to look as aesthetically pleasing as possible. A difficult-to-attain canon of beauty is increasingly being imposed on the female body and the V zone is no exception; a well-shaven, pink, narrow and small-lipped vagina is the goal of many. In real life, women are torn between which cosmetic procedures are the best to achieve this.

Which procedures are most in demand at the moment?

At Clínica Buenavista Oviedo, we offer our patients a full range of treatments in the field of intimate surgery (vulvovaginal restructuring and rejuvenation) using state-of-the-art laser technology, in which only local anaesthesia is used, no hospital stays are necessary and post-operative recovery at home is minimal. The most sought-after procedures are hymenoplasty, labiaplasty, perineal reconstruction, removal of warts and non-surgical vaginal narrowing.

What makes women decide to have these kinds of procedure?

The female genitals experience physiological changes over time or as a result of instrumental deliveries, dystocia, multiple births or heavy babies. Structural, functional or aesthetic alterations can occur, but these can be easily corrected thanks to new technologies and ground-breaking surgical procedures.

What is the typical profile of women undergoing this kind of surgery?

These procedures are aimed at all female patients – most are aged between 30 and 60 – who have aesthetic or functional problems with their vaginas. These abnormalities not only cause physical problems, but can also have a psychological impact on women, resulting in low self-esteem and feelings of insecurity about certain aspects of their personal lives. So it is not just a physical problem that is being corrected, there is also a significant psychological component.

How has genital cosmetic surgery evolved over recent years?

Gynaecologists who specialise in these treatments are making great strides in their clinical practice to satisfy the new demands of patients. These new demands are not only related to patients’ gynaecological health, but also to sexual satisfaction and the pursuit of aesthetic beauty. The use of specific lasers in this field of intimate surgery enables us to offer more and better treatment for vaginal hyperlaxity, urinary incontinence and vaginal atrophy.

What are the advantages of laser genital reshaping over conventional surgery for the doctor and patient?

The laser has become the best choice for assisted female intimate surgery procedures because of its precision and speed. The benefits of laser-assisted female intimate surgery are numerous. Procedures are simple, painless and only require two treatment sessions lasting about 10 minutes each. No days off work are necessary, there are no complications or known contraindications and the age of the patient is immaterial. And women can usually resume sexual relations after about three days.

What type of laser is most appropriate for each cosmetic gynaecology procedure?

The carbon dioxide laser (CO2 laser), first developed by Kumar Patel at Bell Laboratories in 1964, is one of the oldest gas lasers in use and, today, still has a large number of applications. The Gynelase™ system concentrates the thermal effect of the fractional CO2 laser at vaginal mucosa level, resulting in the reshaping and strengthening of the vaginal walls to return them to a more youthful state. It also produces a reduction in vaginal dryness and synthesis of new collagen fibres along the anterior vaginal wall and the periurethral region, which helps in the treatment of mild to moderate stress urinary incontinence.

How long does it take to recovery from genital laser surgery?

Post-operative recovery is rapid, it does not affect the normal lives of patients and does not require the use of painkillers or antibiotics. And what is the result? Scientific findings from clinical trials are exceptional and show that the laser is the best treatment for mild to moderate cases of stress urinary incontinence. Data extracted from the trials showed that: 120 days after laser treatment, 94% of patients affirmed that they had experienced great improvement. 68% of patients said that they no longer suffered from symptoms of urinary incontinence and had fully recovered from it. 97% of patients expressed satisfaction with their treatment and results. No side effects were observed in any of the cases.

Clínica Buenavista now offers INTERmedic’s laser technology to its patients. Is feedback positive?

The success rate is 99%, with patients reporting great satisfaction with the cosmetic result, more comfort when wearing underwear and increased enjoyment of sex. The Gynelase™ laser system has become an essential tool for intervention in various gynaecological disorders and highly useful both inside and outside the operating theatre. For example, the laser enables outpatient procedures to be performed without surgery in cases that require vaginal tightening treatment and urinary incontinence correction. The laser has numerous advantages as it enables cleaner, more superficial and controlled cutting to be performed with adjustable power, providing greater safety in the laser strokes and speed in the procedures.