Which type of urinary incontinence has been studied with vaginal laser treatment ?
Vaginal laser treatment has mainly been studied for stress urinary incontinence.
This form of incontinence causes leakage when abdominal pressure increases, for example when coughing or sneezing, laughing, running or jumping, during certain sporting activities or when carrying a load.
The mechanism notably involves insufficient support of the urethra and pelvic floor.
Leakage triggered by exertion therefore does not have the same mechanism as leakage preceded by an urgent need to urinate. This distinction is essential before treatment is considered.
How might vaginal laser treatment act on stress urinary incontinence ?
Vaginal laser treatment does not directly strengthen the perineal muscles or treat the bladder.
Energy is delivered to the vaginal wall tissues. The mechanisms studied include changes in collagen and the properties of tissues around the vagina and urethra.
The aim is to improve tissue support in the urethral region rather than induce a muscle contraction.
Laser treatment and pelvic floor rehabilitation therefore do not act on the same structure : laser treatment targets vaginal tissues, while rehabilitation mainly targets pelvic floor muscle function.
Is vaginal laser treatment effective for minor stress leakage ?
Some studies show reduced symptoms in women with mild stress urinary incontinence, but results remain insufficient to guarantee effectiveness.
Early studies were often favourable, but many had no placebo group and followed patients for a limited period.
Controlled trials subsequently produced more nuanced results. In a randomised trial comparing an Erbium laser with sham treatment, symptom improvement was observed, but only 21 % of treated women reported being continent compared with 4 % in the placebo group.
European recommendations particularly highlight the small number of good-quality controlled trials, the heterogeneity of lasers and settings used and the lack of long-term evidence.
Laser treatment may therefore improve leakage in some patients, but it is not possible to predict with certainty which women will respond to treatment.
Does vaginal laser treatment treat urgency incontinence ?
Vaginal laser treatment is not a recommended treatment for urgency incontinence or an overactive bladder.
In this case, leakage is preceded by a sudden urge that is difficult to control. The woman may need to urinate frequently or wake several times at night to urinate.
The problem mainly concerns bladder function and does not correspond to the mechanism of stress incontinence.
Studies of laser treatment for an overactive bladder show only minimal short-term improvement, with low-quality evidence.
Leakage occurring before reaching the toilet must therefore not be confused with leakage caused by exertion, such as coughing, sneezing or physical activity.
Does vaginal laser treatment treat mixed urinary incontinence ?
Mixed incontinence combines stress leakage and leakage associated with an urgent need to urinate.
In this situation, the predominant component and the discomfort caused by each must be determined.
Treating vaginal tissues alone does not necessarily improve the component associated with an overactive bladder.
Mixed incontinence therefore requires broader assessment than uncomplicated stress incontinence.
Can laser treatment replace pelvic floor rehabilitation ?
No. Pelvic floor muscle rehabilitation remains the first-line treatment for stress urinary incontinence.
European Association of Urology recommendations advocate supervised, intensive pelvic floor muscle training for at least three months in women with stress or mixed incontinence.
Rehabilitation improves the strength, endurance and control of muscles involved in supporting the urethra and pelvic organs.
Laser treatment should therefore not be presented as an equivalent substitute for pelvic floor rehabilitation.
Can laser treatment treat significant urinary incontinence ?
Laser treatment is not appropriate for significant or complex stress urinary incontinence.
Heavy or very frequent leakage, recurrent incontinence after a procedure or associated prolapse require appropriate urological or gynaecological assessment.
Depending on the situation, other conservative or surgical treatments may be offered.
The more significant or complex the incontinence, the less appropriate it is to offer laser treatment without a precise prior assessment.
How can you know which treatment is appropriate for your urinary leakage ?
The type of incontinence must first be identified : stress, urgency or a combination of both.
The timing of leakage already provides essential information. Leakage during coughing or sport suggests stress incontinence. Leakage preceded by a sudden urge is more suggestive of urgency.
The frequency and volume of leakage, its impact and pelvic floor condition must then be assessed, with particular investigation for prolapse when suggestive signs are present.
In Geneva, this assessment determines whether perineal, urological or gynaecological management is necessary.
Vaginal laser treatment has mainly been studied for mild forms of stress urinary incontinence, but current evidence does not allow it to be considered a standard treatment. The priority is therefore to identify the type and severity of incontinence precisely before choosing treatment.
Article written by Dr Valeria Romano
Dr Valeria Romano supports each patient with a comprehensive approach to the aesthetics of the face, body and intimate areas, and to skin and hair quality. Every treatment is based on a personalised medical assessment.
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