Pixel CO₂ Laser for the Treatment of Stress Urinary Incontinence: A Prospective Observational Multicenter Study

Abstract

Background and Objectives Energy‐based treatments have been found to be a promising treatment modality for improving stress urinary incontinence (SUI) symptoms. This prospective two‐center study was designed to evaluate the efficacy of fractional‐pixel CO2 laser for the treatment of SUI. Study Design/Materials and Methods Eighty‐five women with SUI symptoms as per the cough stress test and validated International Consultation on Incontinence Questionnaire—Urinary Incontinence Short Form (ICIQ‐UI‐SF), were treated intravaginally with Pixel‐CO2 laser. Two treatment sessions were performed with a 1‐month interval. Safety and treatment tolerance were assessed by the visual analog scale (VAS) immediately and at 1 week after each laser treatment. Associations of age and body mass index (BMI) with the ICIQ‐UI‐SF score were statistically assessed by the Jonckheere–Terpstra test. Results The ICIQ‐UI‐SF score was 12.0 at baseline, 7.0, after the first treatment, and 3.5 after the second treatment (P = 0.001). For women with BMI (25.0–29.9), the ICIQ‐UI‐SF score was 9.0 at the baseline, 6.0 after 1 month, and 5.0 at the 6 months follow‐up visit (P = 0.04). For women with BMI ≥ 30.0, the ICIQ‐UI‐SF score was reduced from 14.0 to 8.0 1 month after the baseline and 5.0 at the 6‐month follow‐up visit (P = 0.001). SUI severity evaluation at baseline showed that 27.1% of women had mild, 24.7% had moderate, 45.9% had severe, and 2.4% had very severe SUI symptoms. SUI severity scores were significantly reduced, with 45.8% of women with no SUI symptoms, 18.8% with mild, 20.8% with moderate, and 14.6% with severe SUI symptoms at the 6‐month follow‐up. The patient's evaluation of VAS after the first treatment was 1.0–1.5 (0–10) and 0.0 1 week after the second treatment. Conclusion Fractional‐pixel CO2 laser is safe and effective for treating SUI. No adverse event or significant pain was reported during or after the procedure. Its safety and efficacy are clearly demonstrated. Lasers Surg. Med. © 2020 Wiley Periodicals LLC

The evidence behind the use of LASER for genitourinary syndrome of menopause, vulvovaginal atrophy, urinary incontinence and lichen sclerosus: A state‐of‐the‐art review

“…A total of 114 papers were included according to the eligibility criteria listed above. Of these, 111 studies investigated GSM, VVA, UI, and LS symptoms as primary indication (Tables 3–6); 15 RCT, 23–37 87 cohort studies, 38–124 eight case reports, 125–132 one case‐control study, 133 including a total of 9000 women, not accounting for overlap between the studies. Additionally, three cross‐sectional studies focused solely on the characteristics of AEs 134–136 .…”

“…Of the included studies, 81 studies investigated CO 2 ‐LASER from different manufacturers 23–31,33,35,36,38–58,66–93,95–104,122–125,128–131,133,136 . Twenty‐eight studies investigated Er:YAG LASER from different manufacturers 32,34,59–65,94,107–121,127,132,135 .…”

“…Thirty studies on the effect of vaginal LASER on UI were identified through this review (Table 5). 33,34,95–121,127 The studies include 2053 women with study sizes ranging from 1 to 327 women with a median (IQR) of 46 (31.5–72.75) women. Of these studies, 17 studies investigated the effect of Er:YAG, 34,107–121,127 and 11 studies the effect of CO 2 LASER 33,95–104 .…”

“… 33,34,95–121,127 The studies include 2053 women with study sizes ranging from 1 to 327 women with a median (IQR) of 46 (31.5–72.75) women. Of these studies, 17 studies investigated the effect of Er:YAG, 34,107–121,127 and 11 studies the effect of CO 2 LASER 33,95–104 . We identified two RCTs including 186 women, 33,34 27 cohort studies including 1866 women 95–121 and one case‐report with one woman 127 …”

The efficacy and safety of a single maintenance laser treatment for stress urinary incontinence: a double-blinded randomized controlled trial

“…Previous case series have demonstrated mixed results regarding the potential efficacy of laser therapy for treating pelvic organ prolapse, genitourinary syndrome of menopause and sexual function, and several studies that utilized sub-optimal methodology have demonstrated mixed results regarding the potential efficacy of CO 2 laser for treatment of SUI [ 10 – 17 ]. The main flaw of most studies regarding laser use for benign gynecological indications is the prominent lack of a control or sham group.…”