Predictors of Clinical Response to CO2 Laser Therapy for Mild-to-Moderate Stress Urinary Incontinence: results from two-centre study.

Paweł Rzymski; Katarzyna Tomczyk

Authors

Paweł Rzymski Poznan University of Medical Sciences , Zlotowska Plastic Surgery Clinic, Poznan, Poland
Katarzyna Tomczyk Poznan University of Medical Sciences , Institut Milbrand, Poznan, Poland

Keywords:

stress urinary incontinence, CO₂ laser, urethral mobility, predictors, urogynecology

Abstract

Background:
Stress urinary incontinence (SUI) is a common urogynecological condition with a substantial impact on quality of life. Fractional CO₂ laser therapy has emerged as a minimally invasive treatment for mild-to-moderate SUI; however, data on predictors of treatment response remain limited. This study aimed to assess clinical, questionnaire-based, and ultrasound parameters associated with outcomes following CO₂ laser therapy.

Methods:
This prospective two-centre study included 31 women aged 33–66 years with grade 1–2 SUI. Participants completed validated questionnaires, including the Urogenital Distress Inventory (UDI-6), the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12), and visual analogue scales (VAS) for urogynecological symptoms. Pelvic floor ultrasound evaluated urethral length, resting position, and mobility during voluntary contraction and Valsalva. All patients underwent three sessions of fractional CO₂ vaginal laser therapy at 28–30-day intervals. Statistical analysis was performed using SigmaPlot 11.0, with p < 0.05 considered significant.

Results:
CO₂ laser therapy resulted in significant improvement in VAS-assessed symptoms, including vaginal atrophy, dryness, itching, dyspareunia, and SUI severity. Total UDI-6 scores decreased significantly after treatment. Ultrasound assessment showed a significant reduction in urethral descent during Valsalva. Baseline urethral mobility during voluntary contraction emerged as a potential predictor of therapeutic response. Improvement in sexual function was observed but did not reach statistical significance.

Conclusions:
Fractional CO₂ laser therapy appears to be an effective minimally invasive option for women with mild-to-moderate SUI and vulvovaginal atrophy. Pretreatment urethral functional parameters may help identify patients most likely to benefit. Further large-scale randomized studies are needed to confirm these findings.

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