Radiofrequency has been proposed in the treatment of SUI, since one of the pathophysiological factors of stress urinary incontinence was the reduction of collagen in 30% of case with loss urethral support  ,thus reducing the urethral closure mechanism. Thermal effect produced by RF causes denaturation of collagen,ìmmediate and effective contraction of the fibers, local and acute inflammatory process, activation of fibroblasts, generating neocollagenogenesis. Collagen denaturation is performed circumferentially within the bladder neck and proximal urethral submucosa, with a reduction or inhibition of inappropriate bladder neck and proximal urethral luminal opening during bladder descent.

We selected 17 patients mean Age 51 years (range 33-87), Parity 2 ,5 (range 0-4), Menopause 10 patients (58,8%), Previous surgery procedure 17,6% (3-Hyst.), Post-menopausal pts   were taking systemic or local estrogen therapy pts N= 17 Symptoms SUI grade l 11 pts(64,7%) gradell 5(29,4 %) grade lll 1(5,8 %) ingelman Sundberg score.  Exclusion criteria: pacemaker or internal defibrillator or other implanted  metallic  or electronic device,permanent implant in the treated area,current or history of cancer or prelignant conditions, cardiac disorders, hormone replacement therapy,pregnancy or lactation, Impared immune response, History of  current diseases stimulated by heat,diabetes active skin  condition, in the treatment area, Skin disordes, Bleeding disorder, Any therapies or medications  that may  interfere with radiofrequency. Radiofrequency consists in the application of an electrical high frequency current ,ranging from 30KHz to 3000 KHz, The passage of electric current produces three physical phenomena that  generates  heat in the body tissues  as a result of the resistance put up by those same tissues as the current passes through, low-temperature RF delivery results in thermal collagen denaturation elongated, crystalline collagen becomes random-coil gel, Collagen denaturation/healing phase occurs, results in reduced compliance of denatured tissue sites. lndications of radiofrequency:  patients with type 1-2 sui,frail elderly population,after undergone multiple failed procedures,after radioterapy and\or radical hysterectomy,where the urethra is fixed and scarred,SUI after genito-urinary fistula surgery. Passive plate is applied in contact with the body  in the sacral area without gel ,electrode active in different size with temperature sensor are applied  in the  external urethral meatus for 2 minutes and in the  third middle urethra for 4 minutes,energy heats the connective tissue , shrink and stabilize endopelvic fascia and strengthen pubo-urethral ligaments,  monouse  covering used,automatic safety  features monitor tissue temperatures and impedence is monitored on the display and temperature  must always  be  in a range of 39-41  degrees.We use monopolar radiofrequency with 5 sessions once a week, don’t  take anti -incontinence  drugs , diuretics ,local or sistemic hormone therapy for menopause can be used, RF does not require anesthesia or  antibiotic prophylaxis . Criteria to evaluate the result  before and after Radiofrequency procedure, Standardized questionnaire, Urodynamic findings  (VLPP), Subjective evaluation of leakage, 48 hours micturition diary, 24 hours pad-test, Cough test with a bladder filling of 300 ml

VLPP  significantely improved at urodynamics, Pre-treatment  VLPP  was 13.2  cm H2O, Post-treatment  VLPP at 6 months was15.20  cm H2O without  urinary leakage, Pad test loss(gr) 24 hours, Pre-treatment              85gr range(32-168), Post-treatment 5 gr range(3-12).

Radiofrequency Outcomes  follow-up after six months
Follow-up,  (No. Of Patients 17 )	1-6  months 
Subjective outcome cured/no leak	10 (58.8%)Q-max 17.5ml\sec
Improved	6 (35.29%)
Invariated	1 (5.88%)

Radiofrequency  is a promising technique to treat female type 1-2 incontinence ,but may be  useful in case of previous  failed  anti-incontinence  procedures and in obese patients. RF is a safe, nonsurgical, outpatients procedure , no risk of adverse events ,reduced urinary loss in women and improvement in quality of life. Therefore randomized, controlled, comparative trials should be valuable

Gynecology Obstetrics FIGO 202Physical methods for the treatment of genitourinary syndrome of menopause.A systematic review (Ayanec Sarmento,Juliana F. Lirio Kleyton S.Medeiros et al)
Radiofrequency for the treatment of stress urinary incontinence in women Curr urol rep. 200sep; 10(5):369-7Dai: 10.1007/s11934-009-0058-z (Benjamin Dillon, Roger Dmochowski et al)