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

Abstract

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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