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#Grand Rounds

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

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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”

METHODS:

  • 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

RESULTS:

  • 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

CONCLUSION:

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

Learn More – Primary Sources:

Laser therapy for urinary incontinence and pelvic organ prolapse: a systematic review

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Related ObG Topics:

VeLVET Trial: Does Laser Therapy Work for Treating Vaginal Atrophy in Menopause?
Cochrane Review: Best Treatment Options for Stress Urinary Incontinence
Is Pelvic Muscle Strengthening Effective Following Pelvic Surgery for Prolapse and Incontinence?

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