Vaginal laser therapy may reduce stress urinary incontinence symptoms slightly in the short term (as well as reduction in 1-hour pad weight). However, two sham-controlled trials measured the effect in 6 months follow up and found no meaningful benefit. Serious adverse events were rare.
The evidence was limited by imprecision.
Evidence was limited to CO2 laser therapies, so the assessment may not apply to newer methods.
| Reference | Study type | Population | Intervention and comparison | Outcomes | Risk of bias |
|---|---|---|---|---|---|
| RCT=randomized controlled trial; SR=systematic review; MA=meta-analysis | |||||
| «Aguiar LB, Politano CA, Costa-Paiva L, et al. Effi...»1 | RCT | Women over 50 years old and urinary symptoms or complaints of vaginal dryness | Fractional CO2 laser, promestriene, or vaginal lubricant. | ICIQ-UI SF, ICIQ-OAB |
High |
| «Alexander JW, Karjalainen P, Ow LL, et al. CO(2) s...»2 | RCT | 18-80 years old women with stress urinary incontinence | Fractional CO2 laser vs sham | ICIQ-UI SF, ICQ-OAB, 1-hour pad weight |
Moderate |
| «Lauterbach R, Aharoni S, Justman N, et al. The eff...»3 | RCT | 40-70 years old women with positive experience from previous CO2 laser therapy | CO2 laser mainantance vs sham | ICIQ-UI, 1-hour pad weight, UDI-6, PISQ-12 | Low |
| «Seki AS, Bianchi-Ferraro AMHM, Fonseca ESM, et al....»4 | RCT | Women with stress urinary incontinence | CO2 laser vs sham | ICIQ-UI SF, I-QOL, FSF-I, 1-hour pad weight | Moderate |
| Reference | Comments |
|---|---|
| «Aguiar LB, Politano CA, Costa-Paiva L, et al. Effi...»1 | Fractional CO2 laser vs lubricant included. The study inclusion criteria were: age
50+, amenorrhoea for at least 1 year, with clinical complaints of vaginal dryness
or urinary symptoms related to GSM, no hormonal treatment for at least prior last
6 months and any kind of medication for OAB. Risk of bias: no blinding of participants/data collectors, 14/72 lost to follow up (included with LOCF in the analysis). |
| «Alexander JW, Karjalainen P, Ow LL, et al. CO(2) s...»2 | Inclusion criteria: symptomatic (urinary leakage on exertion) and objective SUI (a
positive cough stress test (CST) with a comfortably full bladder followed by a uroflow,
urodynamic stress incontinence, or positive 24-hour pad weight test) Participants received the treatment 3 times with 4 week interwals. Risk of bias: data collection/analysis not blinded, dropouts at 1 month 10/101 and at 3 months 4/101. |
| «Lauterbach R, Aharoni S, Justman N, et al. The eff...»3 | Inclusion criteria: a temporary signifcant improvement in symptoms following previous
CO2 laser treatment.
One time laser treatment. Risk of bias: Adequate randomization procedure, analysis blinding not reported, dropouts 3/134. Unclear statistical analysis. Mean differences were probably converted to Odds ratios. |
| «Seki AS, Bianchi-Ferraro AMHM, Fonseca ESM, et al....»4 | Inclusion criteria: Stress urinary incontinence diagnosis was confirmed by a stress
test.
Risk of bias: Adequate randomization procedure. Analysis not blinded. Drop outs 25/139 (included in the ITT, not reported how). Median ISIQ-SF at baseline: intervention 11.5, control 13.5. |
Results
| Reference | Number of studies and number of patients (I/C) | Follow-up time | Mean (sd) I | Mean (sd) C | Mean difference (95% CI) |
|---|---|---|---|---|---|
| Level of evidence: very low The quality of evidence is downgraded due to study limitations, inconsistency, and imprecision. I=intervention; C=comparison; CI=confidence interval |
|||||
| «Aguiar LB, Politano CA, Costa-Paiva L, et al. Effi...»1 | 24/24 | 14 weeks | 6.45 (4.67) | 11.47 (5.95) | not reported, P-value = 0.116 |
| «Alexander JW, Karjalainen P, Ow LL, et al. CO(2) s...»2 | 47/42 | 3 months | Mean change from baseline 10.95 (4.65) | Mean change from baseline 9.53 (4.22) | -0.64 (-2.09 to 0.82) favors intervention |
| «Lauterbach R, Aharoni S, Justman N, et al. The eff...»3 | 63/68 | 3 months | ISIQ-UI (not SF?) 16.5 (3.3) |
10.3 (2.8) | not reported, p-value 0.003 |
| Reference | Number of studies and number of patients (I/C) | Follow-up time | Mean (sd) I | Mean (sd) C | Mean difference (95% CI) |
|---|---|---|---|---|---|
| Level of evidence: moderate The quality of evidence is downgraded due to imprecision. I=intervention; C=comparison; CI=confidence interval |
|||||
| «Lauterbach R, Aharoni S, Justman N, et al. The eff...»3 | 63/68 | 6 months | ISIQ-UI (not short form?) 8.8 (3.6) | 8.6 (3.1) | not reported, p-value 0.64 |
| «Seki AS, Bianchi-Ferraro AMHM, Fonseca ESM, et al....»4 | 42/50 | 6 months | Median 8 (range 0–20) | Median 11 (range 3–20) | not reported |
| Reference | Number of studies and number of patients (I/C) | Follow-up time | Mean (sd) I | Mean (sd) C | Mean difference (95% CI) |
|---|---|---|---|---|---|
| Level of evidence: high I=intervention; C=comparison; CI=confidence interval |
|||||
| «Alexander JW, Karjalainen P, Ow LL, et al. CO(2) s...»2 | 48/49 | 3 months | Median 8 (IQR 6-35) | Median 10 (IQR 6-60) | Relative reduction 0.82 (0.47-1.43) |
| «Lauterbach R, Aharoni S, Justman N, et al. The eff...»3 | 63/68 | 3 months | 2.3 (1.3) | 5.6 (1.1) | - |
| «Seki AS, Bianchi-Ferraro AMHM, Fonseca ESM, et al....»4 | 42/50 | 6 months | Median 0 (range 0–60) | Median 2 (range 0–46) |
- |