Women with stress urinary incontinence (SUI) who undergo vaginal lasers do not seem to fare any better than those who received sham, control, or topical treatments in the short term, suggests a study.
“[W]e found that there was no evidence of a difference in the number of continent women between those who underwent laser and those who underwent sham,” said lead study author Dr Giulia M Ippolito, Department of Urology, University of Michigan, Ann Arbor, Michigan, US.
“[T]his was very low certainty of evidence due to the risk of bias between studies and also the inconsistency or the width of the confidence interval that spanned the null,” she added. [https://www.urotoday.com/video-lectures/lower-urinary-tract-conditions/video/5270-systematic-review-of-vaginal-lasers-for-stress-urinary-incontinence-giulia-ippolito.html]
Nine randomized trials, involving a total of 689 women with SUI, that assessed therapy with vaginal laser vs sham, control, or topical therapies were included in this systematic review and meta-analysis.
Laser types
“When we think about lasers, there are many different types. We know the medium can change, there are CO2 lasers or Er:YAG. Both of these are used for vaginal procedures,” Ippolito said.
“[A]blative lasers are generally harsher; they vaporize the tissue and they cause a surface reaction that requires more recovery time, whereas nonablative lasers, which are what typically used for vaginal procedures for stress incontinence, heat deeper and leave the superficial skin intact so that there's less of a reaction and less local side effects, but it takes more time to achieve that effect,” she added.
Furthermore, conventional and fractional lasers also exist. The former applies treatment to the entire surface, while the latter only covers a certain part of the surface.
“[I]t's important to know that there are these differences because when we think about systematic reviews and meta-analysis, every time there's heterogeneity in how something can be done, then that adds a little bit of heterogeneity and uncertainty to our results,” Ippolito said.
Incontinence measures
Overall, data on vaginal laser compared with sham treatments were uncertain, and most studies did not examine outcomes beyond 1 year. Short-term results showed no difference in the number of continent women between those who underwent vaginal laser vs sham (risk ratio, 1.50, 95 percent confidence interval [CI], 0.72‒3.10; I2=81 percent; n=196). [J Urol 2026;214:474-486]
Compared with sham, vaginal lasers appeared to improve patient-reported incontinence measures, but the point estimate for improvement did not meet the prespecified minimally clinical importance difference (mean difference, ‒1.42 points, 95 percent CI, ‒2.41 to ‒0.43; I2=54 percent; n=632). In addition, only one study had evidence comparing vaginal laser with topical oestrogen.
“[W]hile vaginal lasers may improve patient-reported incontinence measures, the point estimates … didn’t meet the previously published thresholds of the minimally important difference, which is usually a 5-point decrease,” Ippolito said.
“So while it could have an improvement in patient-reported urinary incontinence, that improvement might not be clinically significant and patients might not be able to detect that difference,” she added.
With regard to safety, vaginal laser did not lead to any major adverse event at any time point, similar with other treatment groups.
“[T]here were no major adverse events reported among any of the studies, [s]o that means that it's unlikely that you're going to suffer a major adverse event from this therapy based on the data that we have,” Ippolito said.