Vaginal laser therapy (CO2) on stress urinary incontinence symptoms
Näytönastekatsaukset
31.3.2026
Level of evidence: B
Vaginal laser therapy provides little or no benefit on stress urinary incontinence symptoms.
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 | Comments |
|---|---|
| «Aguiar LB, Politano CA, Costa-Paiva L, et al. Efficacy of Fractional CO(2) Laser, Promestriene, and Vaginal Lubricant in the Treatment of Urinary Symptoms in Postmenopausal Women: A Randomized Clinica»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) surgical laser for treatment of stress urinary incontinence in women: a randomized controlled trial. Am J Obstet Gynecol 2022;227(3):473.e1-473.e12 »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 efficacy and safety of a single maintenance laser treatment for stress urinary incontinence: a double-blinded randomized controlled trial. Int Urogynecol»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. CO(2) Laser and radiofrequency compared to a sham control group in treatment of stress urinary incontinence (LARF study arm 3). A randomized controll»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. Efficacy of Fractional CO(2) Laser, Promestriene, and Vaginal Lubricant in the Treatment of Urinary Symptoms in Postmenopausal Women: A Randomized Clinica»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) surgical laser for treatment of stress urinary incontinence in women: a randomized controlled trial. Am J Obstet Gynecol 2022;227(3):473.e1-473.e12 »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 efficacy and safety of a single maintenance laser treatment for stress urinary incontinence: a double-blinded randomized controlled trial. Int Urogynecol»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 efficacy and safety of a single maintenance laser treatment for stress urinary incontinence: a double-blinded randomized controlled trial. Int Urogynecol»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. CO(2) Laser and radiofrequency compared to a sham control group in treatment of stress urinary incontinence (LARF study arm 3). A randomized controll»4 | 42/50 | 6 months | Median 8 (range 0–20) | Median 11 (range 3–20) | not reported |
References
- Aguiar LB, Politano CA, Costa-Paiva L, et al. Efficacy of Fractional CO(2) Laser, Promestriene, and Vaginal Lubricant in the Treatment of Urinary Symptoms in Postmenopausal Women: A Randomized Clinical Trial. Lasers Surg Med 2020;52(8):713-720 «PMID: 31990089»PubMed
- Alexander JW, Karjalainen P, Ow LL, et al. CO(2) surgical laser for treatment of stress urinary incontinence in women: a randomized controlled trial. Am J Obstet Gynecol 2022;227(3):473.e1-473.e12 «PMID: 35662546»PubMed
- Lauterbach R, Aharoni S, Justman N, et al. The efficacy and safety of a single maintenance laser treatment for stress urinary incontinence: a double-blinded randomized controlled trial. Int Urogynecol J 2022;33(12):3499-3504 «PMID: 35195738»PubMed
- Seki AS, Bianchi-Ferraro AMHM, Fonseca ESM, et al. CO(2) Laser and radiofrequency compared to a sham control group in treatment of stress urinary incontinence (LARF study arm 3). A randomized controlled trial. Int Urogynecol J 2022;33(12):3535-3542 «PMID: 35254473»PubMed