BACKGROUND AND PURPOSE:

• Alexander et al. (AJOG, 2022) compared the effects of CO2 vaginal laser vs sham therapy for treating stress urinary incontinence

METHODS:

• Multicenter, participant-blinded, sham-controlled, parallel group superiority randomized controlled trial
• Participants
  • 18 to 80 years
  • Objective and subjective stress urinary incontinence
  • All participants had either undertaken or declined supervised pelvic floor muscle training
• Intervention
  • Laser therapy: performed using a CO2 fractionated vaginal laser
    • 3 treatments, 4 weeks apart, with increasing energy and density settings
  • Sham: identical technique with a deactivated pedal
• Study design
  • Categorical outcomes were compared using the chi square test
  • Continuous outcomes were assessed using analysis of covariance, adjusting for the baseline score
• Primary outcome
  • Subjective stress urinary incontinence rate (proportion with leak with cough, sneeze, or laughter) at 3 months after completion of treatment
• Secondary outcome
  • Objective stress urinary incontinence
  • Change in the disease-specific patient-reported outcomes
  • Health-related quality of life
  • Adverse effects

RESULTS:

• Laser treatment: 52 participants | Sham: 49
  • Mean age 53 (range 32 to 79) years
  • Mean BMI 26.1 (range 18.1 to 49.6)
  • Vaginally parous: 90%
• At 3 months, there was no difference between the sham and active treatment arm in either
  • Subjective stress urinary incontinence
    • Laser: 96%
    • Sham: 98%
    • Relative risk 0.98 (95% CI, 0.91 to 1.05); P=0.55
  • Objective stress urinary incontinence
    • Laser: 80%
    • Sham: 80%
    • RR 0.99 (95% CI, 0.81 to 1.23); P=0.995
• Patient-reported outcomes and health-related quality of life were also comparable between the groups
• Adverse events
  • Vaginal bleeding
    • Laser: 3 participants
    • Sham: 1 participant
  • Pain during treatment did not differ between laser and sham

CONCLUSION:

• There was no improvement in subjective or objective stress urinary incontinence with CO2 laser therapy at 1 or 3 months after 3 treatments
• The authors state

Further trials are needed to determine if different laser modalities or treatment protocols may produce different results

Until more definitive conclusions can be made, women considering CO2 vaginal laser therapy for SUI should be advised that there is a lack of consistent high-quality evidence to support this treatment

Learn More – Primary Sources:

CO2 surgical laser for treatment of stress urinary incontinence in women: a randomized controlled trial

Related ObG Topics:

VeLVET Trial: Does Laser Therapy Work for Treating Vaginal Atrophy in Menopause?

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

RCT Results: Does Fractional Laser Therapy Actually Improve Postmenopausal Vaginal Symptoms?