#Grand Rounds

Laser Therapy for Urinary Incontinence and Pelvic Organ Prolapse: What is the Evidence?

BACKGROUND AND PURPOSE:

Safety and efficacy for the use of laser therapy for urinary incontinence (UI) and Pelvic Organ Prolapse (POP) is uncertain
Mackova et al. (BJOG, 2020) sought to answer the question “What is currently known on laser therapy in women with urinary incontinence and/or pelvic organ prolapse”

Systematic review
Data sources
- PubMed | Web Of Science | Embase
Inclusion criteria
- Full-text clinical studies in English investigating the effects of laser therapy on UI or POP
Study design
- The following were collected by two researchers
  - Patient characteristics
  - Laser setting
  - Treatment outcome
  - Adverse events
- UI outcome measures: International Consultation on Incontinence Questionnaire‐Urinary Incontinence Short Form (ICIQ-UI SF) and the 1‐hour pad test
There was a lack of methodological uniformity so meta-analysis was not possible and the results are presented narratively

Total 31 studies | Total of 1530 women
- 1 randomized controlled trial (RCT) | Controlled against sham procedure
- 30 cohort studies (2 controlled)
Laser type
- Er:YAG (n = 21) or CO2 laser (n = 9), or both
- Lasers primarily used vaginally (29 studies) and on the vulva (21 studies) and/or urethra (2 studies)
- Settings were varied
All studies showed significant improvement for UI or POP with laser therapy
- Lower cystocele grades associated with a higher success rate
- However, there were large heterogeneities in laser settings, applications, and outcome measures
Risk of bias in the RCT was low | 2 controlled cohort studies had a serious risk of bias
No major adverse events were reported
- Most common adverse events: Mild pain and burning sensation

The studies examining laser therapy for UI or POP all report improvement, but the quality of the studies was low

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