According to the Integral Theory, urgence may be caused by deficency of igaments and fascia, this would explain why organ pelvic prolapse sugeries can improve this symptoms. Second generation non ablative radiofrequency, induces collagen formation resoring espeacilly bladder support improving the urgency. This paper evaluated this technology in patients with refractary urgency ony, that is no urinary incontinence associated.

This study enrolled 30  menopaused patientswith OAB symptoms from november 2022 to november 2023. the mean age was 51 yo, varing from 37 to 88 yo.
The inclusion criteria was  symptoms of OAB syndrome refractary to anti muscarinics and with no stress urinary incontinence associated.
 Exclusion criteria were clinically significant bladder outflow obstruction, significant post-void residual PVR < 200 ml, associated SUI ,diabetic neuropathy, UTI, active genital infections, previous pelvic radiation therapy, current malignant diseases and pelvic organ prolapse POP stage > ll HWS classification and or  the use  of HRT (systemic or local) up  to 6 months before the study  recruiment  period.
GSU symptoms was also evaluated at T0 and T1 (vaginal itching, vaginal burning, vaginal dryness and dyspareunia) using a visual analog scale (VAS), which is based on a score from 1 to 10, where 1 indicates the absense of symptoms .
At T0 and T1, eligible patients adduced a micturition diary, which was to be completed during the 3 days preceding the visit.In the diary , patients were asked in specify the number of micturitions,number of urgency episodes and number of incontinence episodes,for every considered day.
Overactive bladder symptoms were assessed using the validated Overactive Bladder Quetionnarie Short Form (OAB-Q SF).
Eventual adverse events which occurred or were referred by the patients  were recorded. We considered any disorder, disconfort local and general, arising in relation to the non ablative RF as an adverse event. All patients underwent 5 sessions of 15 minutes once a week for 5 weeks of capacitive radiofrquency intravaginally.  C-500 Capenergy device was used. No local anesthetic was necessary. Statistical analysis was performed with SPSS for Windows (version 17.0, SPSS Inc., Chicago, IL, USA). Data were presented as median /IQR. Differences between VAS at T= and T1 were analyzed with Wilcoxon test. Statistical significance was set at p<0.05.Statistical analysis was performed with SPSS for Windows (version 17.0, SPSS Inc., Chicago, IL, USA). Data were presented as median /IQR. Differences between VAS at T= and T1 were analyzed with Wilcoxon test. Statistical significance was set at p<0.05.
Statistical analysis was performed with SPSS for Windows (version 17.0, SPSS Inc., Chicago, IL, USA). Data were presented as median /IQR. Differences between VAS at T= and T1 were analyzed with Wilcoxon test. Statistical significance was set at p<0.05.

In the study period, 30 patients were enrolled.  All patients included into the study completed the study-protocol and carried out the final evalueted at T1 .We observed  a statistically  significant  improvement  in VAS parameters  concerning  dryness (8\3 vs 2\1.25; p<0.0001), burning (8/2.25 vs. 1/1) p<0.0001), itching (8/2 vs. 1/2; p<0.0001), and dyspareunia (9/5/1.25 vs. 2/1.25; p<0.0001) .
We also reported a significant improvement in VHI at T1 (11/3 vs. 22/3.25; p<0.0001) (Figure 2B), in micturition diary (10/2.5 vs. 6/2; p<0.0001) (Figure 1B), in number urge episodes (3/1; p<0.0001)  and in OAB-q (18.5/4.25 vs. 8/2.25; p<0.0001) .
No significant differences were observed between patients the sessions for the same patients. No adverse events due to non ablative RF treatment occurred. In no case it was necessary to stop the procedure because of patient pain or intolerance. No local therapies were prescribed to any patient after the sessions of RF treatment.

The improvement in all domains eveluated in this study showed that second generation, non ablative radiofrequency is a promoting alternative in post menopause patients (fig 1). Surprising was the improvement is the sexuality (fig 2 ), what confirms the negative impact of the urgency in female sexuality.
As an outpatient procedure in wich no local anesthesia is necessary, no complication reported, as well as no anbitiotics prophilaxis is required, we concluded that this alternative is a promising alternative in the management of refractory overactive blader in post menopause patients

Non ablative radiofrquency is an useful alternative in the management of refractary overacyive bladder , in an selected group of post menopause patients. Further studies with large numebers of patiente and longer follow up are neede to include second generation, non ablative radiofrequency in the clinical armamentarion of treatment of refractory overactive bladder.

inheiro C, Costa T, Amorim de Jesus R, Campos R, Brim R, Teles A, Vilas Boas A, Lordêlo P. Intravaginal nonablative radiofrequency in the treatment of genitourinary syndrome of menopause symptoms: a single-arm pilot study. BMC Womens Health. 2021 Oct 30;21(1):379. doi: 10.1186/s12905-021-01518-8. PMID: 34717608; PMCID: PMC8557609.
Non-Ablative Transvaginal Radiofrequency in the Treatment of Stress Urinary Incontinence: Review of the Literature Open Journal of Obstetrics and Gynecology, 2023, 13, 133-141 https://www.scirp.org/journal/ojog ISSN Online: 2160-8806 ISSN Print: 2160-8792
elickson BD, Kist D, Bernstein E, et al. Histological and Ultrastructural Evaluation of the Effects of a Radiofrequency-Based Nonablative Dermal Remodeling Device: A Pilot Study. Arch Dermatol. 2004;140(2):204–209. doi:10.1001/archderm.140.2.204  Manage citations: