Reviews - Incontinence & Urodynamics

Does minimally invasive approach using vaginal laser therapy improve outcomes and remain safe for female with stress urinary incontinence? A systematic review and meta-analysis of randomized controlled trials

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Published: 24 December 2025
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Introduction & Objectives: Stress urinary incontinence (SUI) frequently affects women and can negatively impact their physical health, emotional state, and social life. In recent years, growing interest in less invasive treatment options has prompted the development of vaginal laser therapy (VLT) as a potential alternative for patients who have not responded to conventional treatments before considering more invasive procedures. However, the clinical effectiveness of VLT remains controversial across studies. This review aims to assess the effectiveness and safety of VLT in managing SUI.
Materials & Methods: A comprehensive search of the literature was carried out in PubMed, ScienceDirect, and Scopus databases using appropriate keywords. The methodological quality of the selected studies was evaluated with the Revised Cochrane Risk of Bias tool (RoB 2). Data were analysed through meta-analysis using Review Manager version 5.4. The protocol of this systematic review was registered in PROSPERO (CRD420251164307).
Results: A total of seven studies involving 584 participants were analysed. The results demonstrated that VLT significantly improved ICIQ-UI SF [MD = -1.54 (-2.15 – (-0.93), p<0.00001], PISQ-12 [MD = 1.22 (0.47-1.96), p=0.001], and FSFI [MD = 1.62 (0.41-2.82), p=0.009] compared with the sham laser group. Across most studies, only minor adverse events related to the VLT intervention were reported.
Conclusions: Our study demonstrated that VLT led to a statistically significant improvement in ICIQ-UI SF, PISQ-12, and FSFI scores among patients undergoing the procedure. Additional research is needed to directly compare VLT with other therapeutic options, including urethral bulking agents and non-invasive approaches for SUI.

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1. Lane GI, Barboglio-Romo P, Crescenze I, et al. Vaginal lasers for treating stress urinary incontinence in women. Cochrane Database Syst Rev 2020; 2020:CD013643.
2. Cobley J, Wyndaele M, Hashim H. Pathophysiology of urinary incontinence. Surg - Oxf Int Ed 2023; 41:265-271.
3. Gafni-Kane A, Zhou Y, Botros SM. Predictive modeling and threshold scores for care seeking among women with urinary incontinence: the short forms of the pelvic floor distress inventory and urogenital distress inventory. Neurourol Urodyn 2016;35: 949-954.
4. Gandhi J, Chen A, Dagur G, et al. Genitourinary syndrome of menopause: an overview of clinical manifestations, pathophysiology, etiology, evaluation, and management. Am J Obstet Gynecol 2016;215:704-711.
5. Kołodyn´ska G, Zalewski M, Rozek-Piechura K. Urinary incontinencein postmenopausal women - causes, symptoms, treatment. Przeglad Menopauzalny Menopause Rev 2019; 18:46-50.
6. Sikora M, Gamper M, Zivanovic I, et al. Current treatment of stress urinary incontinence by bulking agents and laser therapy - An update. J Clin Med 2024;13:1377.
7. Shin H, Lee Y, Lim S, et al. A new approach to treatment of stress urinary incontinence using non-ablative transurethral laser. Sci Rep 2025; 15:5706.
8. Ruffolo AF, Braga A, Torella M, et al. Vaginal laser therapy for female stress urinary incontinence: new solutions for a well-known issue-A concise review. Med Kaunas Lith 2022; 58:512.
9. Imamura M, Hudson J, Wallace SA, et al. Surgical interventions for women with stress urinary incontinence: systematic review and network meta-analysis of randomised controlled trials. BMJ 2019;365: l1842.
10. Kuhlmann PK, Dallas K, Masterson J, et al. Risk factors for intraoperative bladder perforation at the time of midurethral sling placement. Urology 2021; 148:100-105.
11. Zwierzchowska A, Tomasik P, Horosz E, et al. Sonography as a diagnostic tool in midurethral sling complications: a narrative review. J Clin Med 2024; 13:2336.
12. Reisenauer C, Hartlieb S, Schoenfisch B, et al. Vaginal therapy of mild and moderate stress urinary incontinence using Er:YAG laser: a real treatment option. Arch Gynecol Obstet 2019; 300:1645-1650.
13. Tadir Y, Gaspar A, Lev-Sagie A, et al. Light and energy based therapeutics for genitourinary syndrome of menopause: Consensus and controversies. Lasers Surg Med 2017; 49:137-159.
14. Kaufman MR, Ackerman AL, Amin KA, et al. The AUA/SUFU/AUGS guideline on genitourinary syndrome of menopause. J Urol 2025; 214:242-250.
15. Shobeiri SA, Kerkhof MH, Minassian VA, et al. IUGA committee opinion: laser-based vaginal devices for treatment of stress urinary incontinence, genitourinary syndrome of menopause, and vaginal laxity. Int Urogynecology J 2019; 30:371-376.
16. Kobashi KC, Vasavada S, Bloschichak A, et al. Updates to surgical treatment of female stress urinary incontinence (SUI): AUA/SUFU guideline (2023). J Urol 2023; 209:1091-1098.
17. Nambiar AK, Bosch R, Cruz F, et al. EAU guidelines on assessment and nonsurgical management of urinary incontinence. Eur Urol 2018; 73:596-609.
18. Preti M, Vieira-Baptista P, Digesu GA, et al. The clinical role of LASER for vulvar and vaginal treatments in gynecology and female urology: An ICS/ISSVD best practice consensus document. Neurourol Urodyn 2019; 38:1009-1023.
19. Gambacciani M, Cervigni M, Gaspar A, et al. Safety of vaginal erbium laser: A review of 113,000 patients treated in the past 8 years. Climacteric J Int Menopause Soc 2020;23:S28-S32.
20. O’Reilly BA, Viereck V, Phillips C, et al. Vaginal erbium laser treatment for stress urinary incontinence: A multicenter randomized sham-controlled clinical trial. Int J Gynaecol Obstet Off Organ Int Fed Gynaecol Obstet 2024; 164:1184-1194.
21. Cañadas Molina A, Sanz Baro R. The first major complication due to laser treatment for stress urinary incontinence: a short report. Climacteric J Int Menopause Soc 2021; 24:206-209.
22. Long C-Y, Lee JP-N, Loo Z-X, et al. The clinical effects of pixel CO2 laser on bladder neck and stress urinary incontinence. J Clin Med 2022; 11:4971.
23. Blaganje M, Šćepanović D, Žgur L, et al. Non-ablative Er:YAG laser therapy effect on stress urinary incontinence related to quality of life and sexual function: A randomized controlled trial. Eur J Obstet Gynecol Reprod Biol 2018; 224:153-158.
24. Seki AS, Bianchi-Ferraro AMHM, Fonseca ESM, et al. CO2 Laser and radiofrequency compared to a sham control group in treatment of stress urinary incontinence (LARF study arm 3). A randomized controlled trial. Int Urogynecol J 2022; 33:3535-3542.
25. Alexander JW, Karjalainen P, Ow LL, et al. CO2 surgical laser for treatment of stress urinary incontinence in women: a randomized controlled trial. Am J Obstet Gynecol 2022; 227:473.e1-473.e12.
26. Temtanakitpaisan T, Chongsomchai C, Buppasiri P. Fractional CO2 laser treatment for women with stress predominant urinary incontinence: a randomized controlled trial. Int Urogynecol J 2023; 34:2827-2832.
27. Yim LW, Wan OYK, Wong D, et al. Vaginal laser treatment on stress urinary incontinence: a randomized controlled trial. Int Urogynecol J. 2025;36:2217-27.
28. Sigurdardóttir HB, Kirschner B, Obel J, et al. Vaginal CO2 laser treatment for urinary stress incontinence: A randomized controlled trial. Maturitas 2025; 199:108658.
29. Lee P, Perruzza D, Edell H, et al. Double-blind randomized controlled trial of Er: YAG vaginal laser to treat female stress urinary incontinence. Am J Obstet Gynecol 2025; 232:541.e1-541.e12.
30. Sterne JAC, Savović J, Page MJ, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ 2019; 366: l4898.
31. Hafidh B, Baradwan S, Latifah HM, et al. CO2 laser therapy for management of stress urinary incontinence in women: a systematic review and meta-analysis. Ther Adv Urol 2023;15:17562872231210216.
32. Wang Y, Wang C, Song F, et al. Safety and efficacy of vaginal laser therapy for stress urinary incontinence: a meta-analysis. Ann Palliat Med 2021; 10:2736-2746.
33. Kuszka A, Gamper M, Walser C, et al. Erbium:YAG laser treatment of female stress urinary incontinence: midterm data. Int Urogynecology J 2020; 31:1859-1866.
34. González Isaza P, Jaguszewska K, Cardona JL, et al. Long-term effect of thermoablative fractional CO2 laser treatment as a novel approach to urinary incontinence management in women with genitourinary syndrome of menopause. Int Urogynecology J 2018;29:211-215.
35. Lapii GA, Yakovleva AY, Neimark AI. Structural reorganization of the vaginal mucosa in stress urinary incontinence under conditions of Er:YAG laser treatment. Bull Exp Biol Med 2017;162:510-514.
36. Salvatore S, Leone Roberti Maggiore U, Athanasiou S, et al. Histological study on the effects of microablative fractional CO2 laser on atrophic vaginal tissue: an ex vivo study. Menopause NYN 2015;22: 845-849.
37. Lin K-L, Chou S-H, Long C-Y. Effect of Er:YAG laser for women with stress urinary incontinence. BioMed Res Int 2019;2019:7915813.
38. Franić D, Fistonić I. Laser therapy in the treatment of female urinary incontinence and genitourinary syndrome of menopause: an update. BioMed Res Int 2019; 2019:1576359.
39. Gambacciani M, Levancini M, Russo E, et al. Long-term effects of vaginal erbium laser in the treatment of genitourinary syndrome of menopause. Climacteric J Int Menopause Soc 2018; 21:148-152.
40. Gaspar A, Maestri S, Silva J, et al. Intraurethral Erbium:YAG laser for the management of urinary symptoms of genitourinary syndrome of menopause: A pilot study. Lasers Surg Med 2018; 50:802-807.
41. Balk E, Adam G, Kimmel H. Nonsurgical treatments for urinary incontinence in women: a systematic review update. Rockville, Agency for Healthcare Research and Quality (US). Available from: https://www.ncbi.nlm.nih.gov/books/NBK534625/
42. Ranjbar A, Mehrnoush V, Darsareh F, et al. Vaginal laser therapy for stress urinary incontinence: a systematic review of prospective randomized clinical trials. J Menopausal Med 2022;28:103-111.
43. Kamińska A, Skorupska K, Kubik-Komar A, et al. Reliability of the Polish pelvic organ prolapse/urinary incontinence sexual questionnaire (PISQ-12) and assessment of sexual function before and after pelvic organ prolapse reconstructive surgery - A prospective study. J Clin Med 2021;10:4167.
44. Li-Yun-Fong RJ, Larouche M, Hyakutake M, et al. Is pelvic floor dysfunction an independent threat to sexual function? A cross-sectional study in women with pelvic floor dysfunction. J Sex Med 2017; 14:226-237.
45. Zhuo Z, Wang C, Yu H, et al. The relationship between pelvic floor function and sexual function in perimenopausal women. Sex Med 2021; 9:100441.
46. Jasim S, Khalil Al-Rawi R. Efficacy and safety of vaginal CO2 Laser treatment in female stress urinary incontinence. Med J Babylon 2018; 15:251.
47. Lauterbach R, Aharoni S, Justman N, et al. The efficacy and safety of a single maintenance laser treatment for stress urinary incontinence: a double-blinded randomized controlled trial. Int Urogynecol J 2022; 33:3499-3504.
48. Kim SR, Moon YJ, Kim SK, et al. Changes in sexual function and comparison of questionnaires following surgery for pelvic organ prolapse. Yonsei Med J 2014; 55:170-177.
49. Ma Y, Liao Y, Lai Y, et al. 16 - Evaluating changes in sexual function and urinary symptoms after fractional CO2 vaginal laser and physical therapy in women with stress urinary incontinence. Continence 2025;15:101940.
50. Arunkalaivanan A, Kaur H, Onuma O. Laser therapy as a treatment modality for genitourinary syndrome of menopause: a critical appraisal of evidence. Int Urogynecol J 2017; 28:681-685.
51. Lanzafame RJ, de la Torre S, Leibaschoff GH. The rationale for photobiomodulation therapy of vaginal tissue for treatment of genitourinary syndrome of menopause: an analysis of its mechanism of action, and current clinical outcomes. Photobiomodulation Photomed Laser Surg 2019; 37:395-407.
52. Tien Y-W, Hsiao S-M, Lee C-N, et al. Effects of laser procedure for female urodynamic stress incontinence on pad weight, urodynamics, and sexual function. Int Urogynecology J 2017; 28:469-476.
53. Clayton AH, Valladares Juarez EM. Female sexual dysfunction. Psychiatr Clin North Am 2017; 40:267-284.

How to Cite



Does minimally invasive approach using vaginal laser therapy improve outcomes and remain safe for female with stress urinary incontinence? A systematic review and meta-analysis of randomized controlled trials. (2025). Archivio Italiano Di Urologia E Andrologia, 97(4). https://doi.org/10.4081/aiua.2025.14644