Systematic Review Examines Vaginal Laser and Radiofrequency for Stress Urinary Incontinence

Key Takeaways

• A systematic review and meta-analysis of 10 randomized sham-controlled trials found that energy-based devices produced a small but statistically significant improvement in stress urinary incontinence symptoms versus sham treatment.
• The most consistent signal was seen with non-ablative Er:YAG laser, while CO2 laser results were mixed and radiofrequency data were too limited for firm conclusions.
• The authors emphasized that benefits appeared modest and short term, with longer-term, standardized trials still needed.

In a systematic review and meta-analysis published in International Urogynecology Journal, investigators reported that energy-based devices may offer modest short-term symptom improvement for women with stress urinary incontinence compared with sham treatment.

David Lukanović, Geetika Shah, Miha Matjašič, and Christian Phillips evaluated randomized controlled trials of vaginal laser and radiofrequency therapies in women with stress urinary incontinence, focusing on sham-controlled studies with at least 1 month of follow-up. The primary endpoint was change in International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form scores.

The analysis included 10 randomized trials representing 11 datasets and approximately 850 women. Using a random-effects model with Knapp-Hartung adjustment, the pooled analysis showed a mean difference of -1.08 points (95% CI, -2.08 to -0.08) favoring energy-based devices over sham. However, the prediction interval ranged from -3.63 to 1.48, suggesting that treatment effect could vary substantially across settings and that no benefit remains plausible in some populations. Heterogeneity was moderate (I2 = 53%).

In subgroup analyses, non-ablative Er:YAG laser demonstrated the most consistent effect, with a mean difference of -1.42 points (95% CI, -2.55 to -0.28) and lower heterogeneity (I2 = 29%). Findings for CO2 laser were inconsistent, and evidence for radiofrequency was insufficient for firm conclusions. Reported adverse events were mild and transient.

“EBDs may improve SUI symptoms compared with sham, with the most consistent benefit observed for non-ablative Er:YAG laser,” the authors wrote. “However, effects are modest and short-term. High-quality RCTs with standardized protocols and long-term follow-up are needed.”