Is Vaginal Laser Promising for Stress Urinary Incontinence Treatment? A Systematic Review

Abstract

Introduction: The treatment for stress urinary incontinence (SUI) includes conservative and surgical management. Apart from advantages and disadvantages, vaginal laser is considered as an alternative therapy for SUI. This study aims to review the effectiveness of laser therapy either erbium-doped yttrium–aluminum–garnet (Er:YAG) or carbon dioxide (CO2) laser for female SUI. Methods: We used preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines for the appraisal. Eligibility criteria was SUI women undergoing Er:YAG or CO2 lasers compared with conservative or surgical management concerning the outcome such as improvement of SUI severity, sexual function, and quality of life. Results: Three studies consisting of one randomized controlled trial (RCT) and two prospective studies were included and assessed for risk of bias using the revised Cochrane risk-of-bias tool (RoB 2) and the risk of bias in nonrandomized studies – of interventions (ROBINS-I) assessment tool. All studies showed improvement of SUI in Er:YAG laser therapy, subjectively; however, they were still inconsistent objectively. Meanwhile, based on data on sexual function, both lasers showed little improvement and were not statistically significant (p = 0.066). Conclusion: Current evidence shows Er:YAG laser has a superior effect to sham laser in SUI patients subjectively. On the contrary, there is only a little evidence comparing Er:YAG laser with both conservative and surgical management of SUI.