{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:19:09Z","timestamp":1787026749579,"version":"build-2736575974"},"reference-count":20,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T00:00:00Z","timestamp":1769990400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>This study aimed to evaluate the effects of low-molecular-weight hyaluronic acid (LMWHA) solution and high-concentration oxygen (HCO) through a specific medical device (Caress Flow\u00a9), compared to topical administration of hyaluronic acid (HA) alone, on symptoms of mild and moderate stress and mixed urinary incontinence in women with genitourinary syndrome of menopause (GSM).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A total of 68 postmenopausal women were registered (from October 2021 to September 2023). Patients were divided into two groups: one group received therapy with LMWHA solution and HCO combined, and the second group received HA therapy alone. The primary outcome was the Patient Global Impression of Improvement (PGI-I). Secondary outcomes included the International Consultation on Incontinence Questionnaire\u2013short form (ICIQ-SF) questionnaire and the International Quality of Life (IQoL) questionnaire.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of the 68 women, 35 (51%) and 33 (49%) were treated with LMWHA solution and HCO combined and HA alone for 10\u202fweeks, respectively. A total of 28 (80%) vs. 7 (21%) women reported an improvement (PGI-I score \u22643) of the symptoms in the LMWHA solution and HCO combined group vs. the HA alone group. According to the ICIQ-SF, a statistically significant difference was observed between the two groups after treatment (median, 7 [5\u201311] vs. 10 [8\u201311];\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.03). The IQoL questionnaire recorded a statistically significantly lower median score in the LMWHA solution and HCO combined group compared with the HA group, before (71 [IQR 55\u201381] vs. 89 [IQR 67\u201394];\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.01) and after (78 [IQR 65\u201386] vs. 88 [IQR 72\u201399];\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.04) treatment.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>LMWHA solution and HCO combined might improve mild and moderate stress and mixed urinary incontinence in women with GSM and appear superior to HA therapy alone. However, these results need to be confirmed in further studies with a controlled design and a larger population.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1739601","type":"journal-article","created":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T06:32:41Z","timestamp":1770013961000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Topical hyaluronic acid and oxygen for urinary incontinence: a double-center retrospective study"],"prefix":"10.3389","volume":"13","author":[{"given":"Paolo","family":"Manna","sequence":"first","affiliation":[{"name":"Department of Clinical and Experimental Medicine, Obstetrics and Gynecology Unit, \u201cMagna Graecia\u201d University","place":["Catanzaro, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Basilio","family":"Pecorino","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynecology Umberto I Hospital, Kore University of Enna","place":["Enna, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabiola","family":"Perrone","sequence":"additional","affiliation":[{"name":"Department of Clinical and Experimental Medicine, Obstetrics and Gynecology Unit, \u201cMagna Graecia\u201d University","place":["Catanzaro, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marika","family":"Di Blasi","sequence":"additional","affiliation":[{"name":"Department of Clinical and Experimental Medicine, Obstetrics and Gynecology Unit, \u201cMagna Graecia\u201d University","place":["Catanzaro, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Scollo","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynecology Cannizzaro Hospital, Kore University of Enna","place":["Catania, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Scibilia","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynecology Giovanni Paolo II Hospital, Kore University of Enna","place":["Ragusa, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fulvio","family":"Zullo","sequence":"additional","affiliation":[{"name":"Department of Clinical and Experimental Medicine, Obstetrics and Gynecology Unit, \u201cMagna Graecia\u201d University","place":["Catanzaro, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,2,2]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"e7586","DOI":"10.7759\/cureus.7586","article-title":"The genitourinary syndrome of menopause: an overview of the recent data","volume":"12","author":"Angelou","year":"2020","journal-title":"Cureus"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1592","DOI":"10.1001\/jama.2017.12137","article-title":"Urinary incontinence in women: a review","volume":"318","author":"Lukacz","year":"2017","journal-title":"JAMA"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"40","DOI":"10.1016\/j.maturitas.2015.10.005","article-title":"Vaginal atrophy of women in postmenopause: results from a multicentric observational study (the AGATA study)","volume":"83","author":"Palma","year":"2016","journal-title":"Maturitas"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"737","DOI":"10.1016\/j.ogc.2018.07.008","article-title":"Genitourinary changes with aging","volume":"45","author":"Mitchell","year":"2018","journal-title":"Obstet Gynecol Clin N Am"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"704","DOI":"10.1016\/j.ajog.2016.07.045","article-title":"Genitourinary syndrome of menopause: an overview of clinical manifestations, pathophysiology, etiology, evaluation, and management","volume":"215","author":"Gandhi","year":"2016","journal-title":"Am J Obstet Gynecol"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"509","DOI":"10.3109\/13697137.2010.522875","article-title":"Recommendations for the management of postmenopausal vaginal atrophy","volume":"13","author":"Sturdee","year":"2010","journal-title":"Climacteric"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"558","DOI":"10.1016\/j.sxmr.2018.02.005","article-title":"Role of androgens in female genitourinary tissue structure and function: implications in the genitourinary syndrome of menopause","volume":"6","author":"Traish","year":"2018","journal-title":"Sex Med Rev"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"74","DOI":"10.1016\/j.maturitas.2016.06.012","article-title":"Attitudes and perceptions towards vulvar and vaginal atrophy in Italian postmenopausal women: evidence from the European REVIVE survey","volume":"91","author":"Nappi","year":"2016","journal-title":"Maturitas"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"639","DOI":"10.1097\/GME.0000000000002001","article-title":"Prasterone in the treatment of mild to moderate urge incontinence: an observational study","volume":"29","author":"Coll\u00e0 Ruvolo","year":"2022","journal-title":"Menopause"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"e466","DOI":"10.1093\/milmed\/usz337","article-title":"A Supersaturated oxygen emulsion for the topical treatment of ocular trauma","volume":"185","author":"Pate","year":"2020","journal-title":"Mil Med"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"8480","DOI":"10.26355\/eurrev_201812_16548","article-title":"Vaginal natural oxygenation device (VNOD): concomitant administration of hyaluronic acid and topical hyperbaric oxygen to treat vulvo-vaginal atrophy","volume":"22","author":"Condemi","year":"2018","journal-title":"Eur Rev Med Pharmacol Sci"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"1377","DOI":"10.1089\/ars.2005.7.1377","article-title":"Oxygen: from the benefits of inducing VEGF expression to managing the risk of hyperbaric stress","volume":"7","author":"Patel","year":"2005","journal-title":"Antioxid Redox Signal"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"2011","DOI":"10.26355\/eurrev_202303_31567","article-title":"Conjugate treatment with high concentration normobaric oxygen and hyaluronic acid for vaginal atrophy: a prospective study","volume":"27","author":"Barbero","year":"2023","journal-title":"Eur Rev Med Pharmacol Sci"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"101","DOI":"10.1111\/j.1464-410X.2006.05881.x","article-title":"Italian validation of the international consultation on incontinence questionnaires","volume":"97","author":"Tubaro","year":"2006","journal-title":"BJU Int"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"1643","DOI":"10.1111\/j.1742-1241.2010.02447.x","article-title":"Linguistic validation of the NQOL (ICIQ), OAB-q (ICIQ), PPBC, OAB-S, and ICIQ-MLUTSsex questionnaires in 16 languages","volume":"64","author":"McKown","year":"2010","journal-title":"Int J Clin Pract"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"473","DOI":"10.1111\/1471-0528.16960","article-title":"The role of obesity on urinary incontinence and anal incontinence in women: a review","volume":"129","author":"Doumouchtsis","year":"2022","journal-title":"BJOG"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"CD001500","DOI":"10.1002\/14651858.CD001500.pub3","article-title":"Local oestrogen for vaginal atrophy in postmenopausal women","volume":"2016","author":"Lethaby","year":"2016","journal-title":"Cochrane Database Syst Rev"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"305","DOI":"10.3109\/13697137.2013.771415","article-title":"Non-hormonal topical treatment of vulvovaginal atrophy: an up-to-date overview","volume":"16","author":"Sinha","year":"2013","journal-title":"Climacteric"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"206","DOI":"10.12891\/ceog4893.2019","article-title":"Carbon dioxide laser as a new valid treatment of lichen sclerosus","volume":"46","author":"Teodoro","year":"2019","journal-title":"Clin Exp Obstet Gynecol"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"323","DOI":"10.3390\/diagnostics14030323","article-title":"Exploring the challenges of using minimally invasive surgery to treat stress urinary incontinence: insights from a retrospective case-control study","volume":"14","author":"Adrian","year":"2024","journal-title":"Diagnostics"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1739601\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T06:32:42Z","timestamp":1770013962000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1739601\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,2]]},"references-count":20,"alternative-id":["10.3389\/fmed.2026.1739601"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1739601","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,2]]},"article-number":"1739601"}}