Dr. Silvia Orucheva is an obstetrician-gynecologist and head of the “Obstetrics and Aesthetic Gynecology” department at AestheLine Clinic. Since 2010 she has been a member of the Spanish Medical Association. Dr. Orucheva has a purely practical focus on laser treatment for post-traumatic childbirth dysfunctions, age-related changes and decreased sexual satisfaction.


On the path of lasers

I have been working with Fotona’s most innovative and non-invasive IncontiLase technology for several years now. However, I have been seeing patients suffering from stress incontinence since the beginning of my practice as an obstetrician-gynecologist. Before the era of lasers, we treated conservatively with various methodologies from physiotherapy, insertion of vaginal pessaries supporting the bladder, to various surgical techniques. There are now more painless solutions.

From the forums to the doctor

In Bulgaria, the level of awareness is increasing, albeit slowly. Today’s patients draw their impressions mainly from the internet. They come to the doctor already partially informed and with additional questions regarding the condition and methods of treatment. And that’s okay, because stress incontinence is a problem that impairs quality of life and there’s no shame in discussing it in specifics and looking at different options.

Problem within a problem

In Bulgaria, laser therapy for stress incontinence is a new treatment perspective. In most cases, patients are embarrassed to share the problem or report it only when specifically asked during their annual gynecological checkup: Does sneezing, coughing sometimes cause urine leakage? In 90% of cases the answer is positive.

Mild to moderate stress incontinence remains undiagnosed in time precisely because of worry and they come to us with an already advanced problem. Then laser treatment is not always appropriate.

In context

In Bulgaria, the procedure is carried out in a limited number of places with the necessary equipment and a qualified specialist. In Sofia it is offered in several private medical practices, one of which is the Esteline Clinic. In my observation, the prices range between 400-700 BGN for a single procedure and 1100-1600 BGN for a package offer including three treatments per protocol per month needed for the treatment of stress incontinence. Currently, the procedure is not reimbursed by the Health Insurance Fund. Given the fact that it is curative and not aesthetic, I hope this issue is revisited.


Dr. Ivan Fistonic is among the leading gynecologists in Croatia and a pioneer in non-invasive laser treatment of various gynecological conditions. He summarizes his practical experience in several key scientific papers for the guild with significant contributions to the development of laser treatment in gynecology. Lecturer at several universities, founder and president of women’s health organizations, member-adviser in several international professional organizations.

Laser treatment

It can be very effective in some patients with stress urinary incontinence. Here, the laser reaches a high temperature in milliseconds and affects the collagen without damaging the surface tissue. Shrinkage and stretching of collagen is achieved with a photothermal effect, resulting in “tightening”, better support of the bladder neck and urethra, reducing the amount and frequency of unwanted urine leakage, contributing to sexual satisfaction.

Who are the patients

Patients with different profiles seek non-invasive treatment for the problem of uncontrolled urine output. Not all of them, however, can expect improvement. The best results were achieved in younger women (<47.5 years) with a body mass index <of 23.3, mean newborn birth weight > of 3.6 kg, with mild to moderate problems. This means that earlier consultation and earlier intervention are critical to the success rate of laser treatment.


The laser is a perfect tool for the treatment of a wide range of gynecological pathology: vaginal relaxation with early stage prolapse, treatment of genital warts, erythroplakia, labiaplasty, etc. Unfortunately, the level of familiarity is still low. In Croatia, the service is offered by 6 medical centres. A good awareness campaign to achieve early reporting of symptomatology in stress urinary incontinence will help to reduce the cost of treatment as well as the risks of surgery in older patients with a more severe problem.


The average cost of the package of procedures, including diagnosis, accompanying manipulations and follow-up examinations over 6 months does not exceed 800 euros.

In Croatia, laser treatment of incontinence is still not covered by public health insurance, although the Medical Chamber has published a catalogue and price list for laser treatment of this condition. The first step should be an initiative to private insurance companies who will be the first to understand that timely early non-invasive intervention can reduce the cost of major surgery in the future.


Dr. Cesar Aroyo is an expert in the field of medical lasers, with over 20 years of experience in aesthetic and medical laser procedures and aesthetic gynecology. President of the Spanish Society of Aesthetic, Functional and Regenerative Gynaecology, member of the scientific committee of the International Association of Aesthetic Gynaecology and Sexual Health IAAGSW and also of the International Society of Aesthetic, Genital Surgery and Sexology (ISAGSS). President of the Scientific Committee of the Portuguese Association of Aesthetic Gynecology. Dr. Cesar Aroyo is the director of the Spanish branch of the Ibero-American Laser Academy and head of the Medical, Regenerative and Aesthetic Lasers Department at HM Monteprincipe Hospital. He also has his own practice in Madrid, Spain.


The Beginning

7 years ago, when in Spain the medical problem of incontinence was taboo even in medical circles and was only approached conservatively, my business partner and I created the first laser treatment option in the country’s history. There is no point in describing with what incredulity I looked at this. But we recognized the need, trusted the method and believed in its potential. Today our centre is one of the leading in Western Europe. We are grateful to each of our patients for their trust.


There are two main groups of patients who undergo laser treatment. In the first group fall young women, after childbirth, who are active in sports and this problem seriously affects their activities. The second group are postmenopausal women with more than one birth.

At least 60% of women suffer from such discomfort at some time in their lives, but only 25% of them seek a solution. And laser treatment is usually not the first thing they turn to. Most often they start with pelvic floor physiotherapy, which requires serious discipline and more than half never continue beyond the second month.


The level of awareness in Spain, and I dare say in Portugal, where I have extensive observations and also practice, is quite unsatisfactory. Women still shy away from talking about these issues, even though society is not conservative on topics such as sexuality and sexual pleasure. And it suffers as a result of the incontinence problem.

The cost of the procedure varies between 400 and 600 euros. Currently, in Spain only private clinics offer laser treatment for stress incontinence. The possibility of this type of treatment being reimbursed by the Health Funds is seriously discussed.

If you are experiencing symptoms of stress incontinence, come in for a consultation at the Esteline Clinic.
Book an appointment at tel. 02/405 8000 or directly from the button at the top of the page.