Pelvic organ prolaps (POP), stress urinary incontinence (SUI), dyspareunia, genitourinary syndrome of menopause (GSM) and interstitial cystits (IC) affect many women nowadays especially including the ones in the postpartum and menopause periods. Pregnancy and especially vaginal delivery are risk factors for increasing the hiatal space, losing vaginal support and decreasing collagen levels. The aim of this study is to observe the high-intensity focused ultrasound (HIFU) therapy outcomes and its benefits in the treatment of the patologies already mentioned, and also if modifying the standard protocol decreases the effect of the final result.

This prospective study included 33 patients who experience conditions as SUI, POP, dyspareunia, IC and GSM. For the therapeutic approach we used a medical device based on ultrasound technology using a fluence of maximum 2.0J and transmits impulses at different frequences levels depending on the depth of ultrasound shot. The 3 parameters – power, spacing and length were checked and adjusted before each session depending on the protocols (Table 1). Each protocol has been applied by deviding the vaginal tube in 3 different zones where Zone A represents the deepest one, Zone B is the middle one and Zone C is the superficial area. Taking in consideration the caracteristics of the patologies we applied the procedure on different zones by spinning the cartridge at 360° once or twice on each zone starting with a power of 7 and decreasing it if the patient couldn’t manage de pain.  To evaluate the outcomes the patients had to fill the following questionaires – the International Consultation on Incontinence Questionaire short form (ICIQ SF), Female Sexual Funtion Index (FSFI), O’Leary Sand, PUF and Pelvic Floor Distress Inventory 20 (PFDI-20). In addition to this, they were also evaluated by the urologist before and after 6 weeks from the procedure. Another scope was to observe the otucomes regarding the possible differences between patients under the age of 50 and those above this age.

No significant difference between initial (M=15.45, SD=11.42) and final modified protocol score (M=12.82, SD=7.73); t(10)=0.87, p=0.40 in what concerns symptoms at 6 weeks. Also for initial (M=21.83, SD=15.14) and final unmodified protocol score (M=13.50, SD=12.34); t(5)=4.90, p=0.004 there were no differences for quality of life. For the patients under and over 50 years old initial U50 ICIQSF score (M=14.00, SD=9.87) and final U50 score (M=10.20, SD=8.98); t(4)=1.50, p=0.206 showed no significant difference. On the other hand initial Ov50 ICIQSF score (M=14.33, SD=2.08) and final Ov50 (M=10.33, SD=6.03); t(2)=1.73, p=0.22 showed better improvements for this category of patients.

A percentage of 54.5% presented with significant incontinence relief, a percentage of 9% had mild symptom relief while the rest of the parient did not completed the 6 weeks post procedure survey.
In what concernes the dyspareunia, all the patients included in the study presented with complete remision at 6 weeks after HIFU procedure.

When comparing the modified and unmodified intervention protocols, no initial differences were found between the groups regarding their baseline well-being scores. Similarly, final scores after the intervention did not differ between the two groups, reinforcing the observation that neither protocol was particularly superior in terms of improving self-reported well-being. 
Overall, the findings indicate that while the intervention protocol contributed to symptom improvement over time in older women, its effects were less pronounced in younger participants. The modified protocol did not demonstrate an advantage over the unmodified version, suggesting that the additional modifications did not enhance the effectiveness of the intervention.