CO laser therapy for management of stress urinary incontinence in women: a systematic review and meta-analysis.

Background: Carbon dioxide (CO) laser therapy is an emerging treatment for women with stress urinary incontinence (SUI).

Objectives: To examine the efficacy of CO laser therapy for management of SUI-related symptoms in women.

Design: A systematic review and meta-analysis of randomized controlled trials and cohort studies.

Data Sources And Methods: Four databases were screened until January 2023. All efficacy continuous endpoints were assessed subtraction of the posttreatment from pretreatment values. The data were summarized as mean difference (MD) with 95% confidence interval (CI) using the random-effects model.

Results: A total of 15 studies with 700 patients were analyzed. CO laser therapy significantly decreased the 1-h pad weights at 3 months [ = 5 studies, MD = -3.656 g, 95% CI (-5.198, -2.113),  < 0.001], 6 months [ = 6 studies, MD = -6.583 g, 95% CI (-11.158, -2.008),  = 0.005], and 12 months [ = 6 studies, MD = -3.726 g, 95% CI (-6.347, -1.106),  = 0.005]. Moreover, CO laser therapy significantly decreased the International Consultation of Incontinence Questionnaire-Urinary Incontinence Short Form Scores at 3 months [ = 10 studies, MD = -4.805, 95% CI (-5.985, -3.626),  < 0.001] and 12-months [ = 6 studies, MD = -3.726, 95% CI (-6.347, -1.106),  = 0.005]. Additionally, CO laser therapy significantly decreased the Pelvic Floor Impact Questionnaire scores at 6 months [ = 2 studies, MD = -11.268, 95% CI (-18.671, -3.865),  = 0.002] and 12 months [ = 2 studies, MD = -10.624, 95% CI (-18.145, -3.103),  = 0.006]. Besides, CO laser therapy significantly decreased the Urogenital Distress Inventory-6 scores at 3 months [ = 2 studies, MD = -21.997, 95% CI (-32.294, -11.699),  < 0.001], but not at 6 months [ = 3 studies, MD = -3.034, 95% CI (-7.357, 1.259),  = 0.169]. Lastly, CO laser therapy significantly increased the Vaginal Health Index Score at 6 months [ = 2 studies, MD = 2.826, 95% CI (0.013, 5.638),  = 0.047] and 12 months [MD = 1.553, 95% CI (0.173, 2.934),  = 0.027].

Conclusion: CO laser therapy improved the SUI-related symptoms in women. To obtain solid conclusions, future studies should be well-designed with standardized settings, consistent therapeutic protocols, and long-term follow-up periods.