Female stress urinary incontinence (SUI) is a common lower urinary tract dysfunction, especially in postmenopausal women. Younger women get increased awareness about SUI and start to seek early treatment. Currently, there are many possible therapies for SUI including non-surgical therapies (behavioral therapy and oral medication) and surgical procedures (TOT, TVT-O, etc). Nevertheless, minimally invasive procedures with better efficacy and less complications are anticipated to be developed. Laser technology has been widely used for surgical treatments in dermatology and cosmetic medicine as stimulating the remodeling tissue properties, and inducing the production of new collagen and elastic fibers. In recent years, a series of studies provided evidence that the vaginal laser treatment may provide a new non-invasive treatment photothermal therapy for female SUI. Moreover, different types of laser were used, including Erbium and CO2. However, the effectiveness and safety of laser treatment remains to be unclear. In this systematic review and meta-analysis, we summarize the up-to-date literature reporting the results of laser treatment for female SUI, and evaluate its efficacy and safety.

Two authors searched the PubMed, EMBASE, Scopus, Web of Science and Cochrane Library databases for articles relating to laser treatment for female SUI, using the following key words “laser therapy”, “stress urinary incontinence”, “female”, “erbium”, “CO2”. The latest search was performed on 1 March 2020. Studies were included in the analysis if the following criteria were met: (1) female patients received at least one treatment of laser therapy for SUI; (2) outcomes contained Incontinence Questionnaire Urinary Incontinence Short Form (ICIQ-SF) score, 1 hour pad weight test and adverse events (AEs); (3) studies included at least 10 participants. The effect size was calculated as the standardized mean difference±standard error and 95% confidence interval for each outcome. Effect sizes were interpreted as small, >0.2; moderate, >0.5; or large, >0.8. Outcomes assessed included ICIQ-SF score, 1 hour pad weight test and adverse events. Sub-group analysis was conducted to compare the results between erbium laser and CO2 laser, and between short-term (< 12 months) and long-term (>12 months).

Thirteen studies involving 764 patients were included, with level of evidence of 1 to 3. A significant change of ICIQ-SF score and 1 hour pad weight was observed between pre and post laser treatment. Significant effect was seen in both erbium laser group and CO2 laser group. Besides, significant effect is maintained in long-term subgroup. There was no major but only minor adverse events after laser treatment, which can diminish spontaneously.

Our study demonstrates that both Erbium and CO2 laser seem to be novel alternative therapies for female patients with mild or moderate SUI. Sixth month seems to be the effective duration for a single laser treatment and repeated treatments can maintain the long-term beneficial effect to 24 months.

Laser therapy seems to be effective for female patients with mild or moderate SUI and repeat treatment can possibly maintain a long-term effect. However, further high quality studies should be conducted to confirm the effectiveness and safety of laser therapy and to investigate the best laser type and suitable patient group for this therapy.