The most common type of urinary incontinence in women is stress urinary incontinence (SUI) which negatively impacts several aspects of life. The newly introduced vaginal laser therapy is being considered for treating SUI. This systematic review aimed to evaluate the efficacy of vaginal laser therapy for stress urinary incontinence in menopausal women.

Introduction to Stress Urinary Incontinence

The most common type of urinary incontinence in women is stress urinary incontinence (SUI) which affects up to 35% of adult women and more than 50% of postmenopausal women [3]. Urine leakage during physical activity that increases abdominal pressure, such as coughing, sneezing, laughing, or exercising, is known as SUI [1]. Damage to pelvic floor structures caused by vaginal delivery, as well as changes in the collagen composition of the endopelvic fascia due to aging or menopausal estrogen reduction, can result in insufficient urethral support [4,5]. SUI has a negative impact on many aspects of life, significantly reducing daily functioning related to work, physical activity, or intimate relationships.

Urinary incontinence in women now have an alternative treatment option other than surgery in the form of laser therapy.

Erbium: YAG-laser (Fotona Smooth™ XS) [6] stimulates non-ablative photothermal effects by transferring heat to the vaginal walls through thermal diffusion. In atrophic skin, heat triggers a wound response that leads to tissue remodeling and the neoformation of collagen and elastic fibers. Restoring the vaginal muscle tone is accomplished by tightening the vulvovaginal complex support structures [24,25]. Vaginal Erbium: YAG-laser treatment provides a minimally invasive option for patients with mild to moderate SUI who do not want to undergo an invasive procedure or have contraindications to surgery. Erbium: YAG-laser is a simple procedure. No anesthesia, or hospitalization is required [26]. No bleeding. It is recommended that patients abstain from sexual activity for three days following vaginal Erbium: YAG-laser treatment [27].

Results of Vaginal Laser Therapy for Stress Urinary Incontinence

A systematic review included 13 studies that enrolled 818 SUI patients who underwent laser therapy and reported that laser therapy might be a practical, minimally invasive treatment option for SUI.

The first study found that the ICIQ-UI SF improved significantly more after a single session of non-ablative 2,940 nm Erbium:YAG than in the sham control group months after a three-month follow-up period with no adverse events [6].

With a 14-week follow-up, the third study found that the total ICIQ-UI SF score and nocturia (Night urination) were significantly lower after fractional CO2-laser treatment compared to lubricant use. No serious complications have been reported [8].

The last study in this review showed 72.6% subjective improvement. There was a significant reduction in the number of episodes of urinary incontinence. During sexual intercourse, the laser group experienced significantly less urgency and urinary loss and improvement in quality of life. No adverse events were reported with the following up period of 12 months [15].

There have been varying reports on the number of sessions needed to alleviate the symptoms of SUI. The symptoms of SUI were reduced in certain studies after just one treatment session [6,23]. Two-session treatment was found to be more beneficial in another trial [24]. Another key issue of discussion is the laser’s maintenance effect in enhancing SUI.

Laser SUI treatment was found to be safe in this and previous studies [6,27], with no reported serious side effects. Some minor immediate adverse effects included a stinging sensation that lasted up to 2 minutes, local sensitivity that lasted up to 2 days, and lower abdominal cramping have been reported by the women following CO2-laser therapy [7].

Conclusion of Vaginal Laser Therapy for Stress Urinary Incontinence

SUI treatment with CO2-laser and Erbium: YAG-laser therapy is a quick, intuitive, well-tolerated procedure that successfully improves incontinence-related symptoms. After further refinement, it has the potential to minimize the frequency of surgical intervention for SUI patients.