https://doi.org/10.4081/aiua.2026.14671
Effectiveness of CO2 micro-ablative vaginal laser therapy in the treatment of recurrent cystitis
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Published: 6 March 2026
Background: Cystitis is the most common clinical manifestation of urinary tract infection (UTI) in women.
Aim: The current study intends to assess the effectiveness of CO2 micro-ablative vaginal laser therapy in the treatment of recurrent cystitis RC.
Methods: A total of 75 women were divided into 2 Groups: Group 1 included 34 women (22 were menopausal women and 12 were non-menopausal women) with bacterial cystitis who were positive to urine culture analysis. The Group 2 included 41 women (34 were menopausal women and 7 were nonmenopausal women) with interstitial cystitis who were negative for urine culture analysis. Patients received three treatment sessions with a dual-wavelength (10600 nm/1540 nm) laser system. A visual analog scale (VAS) evaluation, ranging from 0 to 10, was administered to assess baseline and post-laser treatment urinary symptoms associated with cystitis. Concerning IUS (stress urinary incontinence) and Urgency score measurements, a VAS ranging from 0 to 5 was used. The O'Leary-Sant Interstitial Cystitis Symptom Index (ICSI) was used as treatment outcome measures.
Results: In both groups, a significant reduction in the average number of cystitis episodes after treatment was observed and the VAS scale showed a significant reduction in pre- and post-treatment symptoms. VAS results for patients’ satisfaction and expectations showed positive outcomes revealing that more than 90% of patients were satisfied following the treatment.
Conclusions: CO2 vaginal laser may represent an advantageous therapeutic approach to treating recurrent cystitis.
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1. Stamm WE, Norrby SR. Urinary tract infections: disease panorama and challenges, J. Infect. Dis. 2001; 183:S1-S4. DOI: https://doi.org/10.1086/318850
2. Foxman B. Urinary tract infection syndromes: Occurrence, recurrence, bacteriology, risk factors, and disease burden. Infect. Dis. Clin. 2014; 28:1-13. DOI: https://doi.org/10.1016/j.idc.2013.09.003
3. Naber KG, Tirán-Saucedo J, Wagenlehner FME, RECAP group. Psychosocial burden of recurrent uncomplicated urinary tract infections. GMS Infect Dis. 2022; 10:Doc01.
4. McQuiston HJ, Dinesen MR, Nielsen ABS, et al. Different recommendations for empiric first-choice antibiotic treatment of uncomplicated urinary tract infections in Europe. Scand J Prim Health Care. 2013;31:235-40. DOI: https://doi.org/10.3109/02813432.2013.844410
5. Anger J, Lee U, Ackerman AL, et al. Recurrent uncomplicated urinary tract infections in women: AUA/CUA/SUFU Guideline. J Urol 2019;202:282-9. DOI: https://doi.org/10.1097/JU.0000000000000296
6. Kodner CM, Gupton, E.K.T. Recurrent urinary tract infections in women: diagnosis and management. Am Fam Physician. 2010; 82:638-43.
7. Bitcoin C, Anderson K, Cox A. Treatment of interstitial. cystitis/bladder pain syndrome: a contemporary review. EMJ 2020:91-99.
8. De Merwe V, Nordling J, Bouchelouche P, et al. diagnostic criteria, classification, and nomenclature for painful bladder syndrome/interstitial cystitis: An ESSIC proposal. Joop P. Eur Urol. 2008:53; 60-7. DOI: https://doi.org/10.1016/j.eururo.2007.09.019
9. Homma Y, Akiyama Y, Hwan KJ, et al. Definition change and update of clinical guidelines for interstitial cystitis and bladder pain syndrome. Low Urin Tract Symptoms. 2024; 16:e12532. DOI: https://doi.org/10.1111/luts.12532
10. Jung C, Brubaker L. The etiology and management of recurrent urinary tract infections in postmenopausal women. Climacteric 2019;22:242-249. DOI: https://doi.org/10.1080/13697137.2018.1551871
11. Beerepoot M, Geerlings, S. Non-antibiotic prophylaxis for urinary tract infections. Pathogens 2016; 5:36. DOI: https://doi.org/10.3390/pathogens5020036
12. Pabich WL, Fihn SD, Stamm WE, et al. Prevalence and determinants of vaginal flora alterations in postmenopausal women. J. Infect. Dis. 2003; 188:1054-1058. DOI: https://doi.org/10.1086/378203
13. Muhleisen AL, Herbst-Kralovetz MM. Menopause and the vaginal microbiome. Maturitas 2016; 91:42-50. DOI: https://doi.org/10.1016/j.maturitas.2016.05.015
14. Stapleton AE. The vaginal microbiota and urinary tract infection. Microbiol. Spectr. 2016; 4:37. DOI: https://doi.org/10.1128/microbiolspec.UTI-0025-2016
15. Sekito T, Wada K, Ishii A, et al. Etiology of recurrent cystitis in postmenopausal women based on vaginal microbiota and the role of Lactobacillus vaginal suppository. Front Microbiol. 2023; 14:1187479. DOI: https://doi.org/10.3389/fmicb.2023.1187479
16. Armelle J. Cystites récidivantes: Des moyens de prévention non médicamenteux. Progrès Urol. 2017; 27:823-830. DOI: https://doi.org/10.1016/j.purol.2017.09.006
17. Yoshimura N, Uno T, Sasaki M, et al. The O'Leary-Sant Interstitial Cystitis Symptom Index is a clinically useful indicator of treatment outcome in patients with interstitial cystitis/bladder pain syndrome with Hunner lesions: A post hoc analysis of the Japanese phase III trial of KRP-116D, 50% dimethyl sulfoxide solution. Int J Urol. 2022; 29:289- DOI: https://doi.org/10.1111/iju.14765
296.
18. Omi T, Numano K. The role of the CO2 laser and fractional CO2 laser in dermatology. Laser Ther. 2014; 23:49-60. DOI: https://doi.org/10.5978/islsm.14-RE-01
19. Samuels JB, Garcia MA. Treatment to external labia and vaginal canal with CO2 laser for symptoms of vulvovaginal atrophy in postmenopausal women. Aesthetic Surg. J. 2019; 39: 83-93. DOI: https://doi.org/10.1093/asj/sjy087
20. Behnia-Willison F, Sarraf S, Miller J, et al. Safety and long-term efficacy of fractional CO2 laser treatment in women suffering from genitourinary syndrome of menopause. Eur J Obstet Gynecol Reprod Biol. 2017; 213:39-44. DOI: https://doi.org/10.1016/j.ejogrb.2017.03.036
21. Gambacciani M, Torelli MG, Martella L, et al. Rationale and design for the vaginal erbium laser academy study (Velas): An international multicenter observational study on genitourinary syndrome of menopause and stress urinary incontinence. Climacteric. 2015;18:43-48. DOI: https://doi.org/10.3109/13697137.2015.1071608
22. Bizjak-Ogrinc U, Sencar S, Vizintin Z. 3 years follow-up of pelvic organ prolapses treated with Er: YAG laser. Lasers Surg. Med. 2017;49:63.
23. Bizjak-Ogrinc U, Sentra S. Non-surgical minimally invasive Er: YAG Laser treatment for higher grade cystocele. Proceedings 38th Annual IUGA Meeting, Dublin; 2013.
24. Stefano S, Stavros A, Massimo C. The use of pulsed CO2 lasers for the treatment of vulvovaginal atrophy. Curr Opin Obstet Gynecol. 2015; 27:504-508. DOI: https://doi.org/10.1097/GCO.0000000000000230
25. Qi Y, Mo K, Wang A, He Y. Different effects of CO2 laser and estrogen treatment on vaginal mucosa microbiota and function in genitourinary syndrome of menopause patients. J Obstet Gynaecol Res. 2024;50:671-681. DOI: https://doi.org/10.1111/jog.15876
26. De Vicente GJM, Guzmán CT. Uso de la tecnología láser en urología funcional y uroginecología. Arch Esp Urol. 2020; 73:709-723.
27. Klap J, Campagne-Loiseau S, Berrogain N, et al. Vaginal LASER therapy for genito-urinary disorders: A systematic review and statement from the Committee for Female Urology and Pelviperineology of the French Association of Urology. Prog. Urol. 2021; 31:634-650.
28. Luvero D. The Efficacy of CO2 Vaginal laser in the treatment of recurrent,post-coital and interstitial cystitis: a multicentric prospective study. J Clin Med. 2024;13:3550. DOI: https://doi.org/10.3390/jcm13123550
29. Zerbinati N, Serati M, Origoni M, et al. Microscopic and ultrastructural modifications of postmenopausal atrophic vaginal mucosa after fractional carbon dioxide laser treatment. Lasers Med Sci 2015;30:429-36. DOI: https://doi.org/10.1007/s10103-014-1677-2
30. Cui M, Honore P, Zhong C, et al. TRPV1 receptors in the CNS play a key role in broad-spectrum analgesia of TRPV1 antagonists. The Journal of Neuroscience. 2006; 26:9385-9393. DOI: https://doi.org/10.1523/JNEUROSCI.1246-06.2006
31. Joseph RJ, et al. Finding a balance in the vaginal microbiome: how do we treat and prevent the occurrence of bacterial vaginosis? Antibiotics 2021; 10:719. DOI: https://doi.org/10.3390/antibiotics10060719
32. Zhou X, Bent SJ, Schneider MG, et al. Characterization of vaginal microbial communities in adult healthy women using cultivation-independent methods. Microbiology (Reading) 2004; 150:2565-2573. DOI: https://doi.org/10.1099/mic.0.26905-0
33. Auriemma RS, Scairati R, Del Vecchio G, et al. The vaginal microbiome: a long urogenital colonization throughout woman life. Front Cell Infect Microbiol 2021;11:686167. DOI: https://doi.org/10.3389/fcimb.2021.686167
34. Song CH, Kim YH, Naskar M, et al. Lactobacillus crispatus limits bladder uropathogenic E. coli. infection by triggering a host type I interferon response. Proc Natl Acad Sci USA 2022;119:e2117904119. DOI: https://doi.org/10.1073/pnas.2117904119
35. Biehl LM, Farowski F, Hilpert C, Nowag, et al. Longitudinal variability in the urinary microbiota of healthy premenopausal women and the relation to neighboring microbial communities: A pilot study. PLoS One. 2022; 17:e0262095. DOI: https://doi.org/10.1371/journal.pone.0262095
36. Gilbert NM, O'Brien VP, Lewis AL. Transient microbiota exposures activate dormant Escherichia coli infection in the bladder and drive severe outcomes of recurrent disease. PLoS Pathog. 2017;13:e1006238. DOI: https://doi.org/10.1371/journal.ppat.1006238
CRediT authorship contribution
Maurizio Filippini, Jessica Sozzi, conceptualization, methodology, software, validation, formal analysis, investigation, resources, data curation, visualization, writing – review and editing, project administration. Maurizio Filippini, writing – original draft preparation, funding acquisition.
Data Availability Statement
The data that support the findings of this study are available from the corresponding author upon reasonable request.
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