Fractional CO2 Laser Treatment for Female Stress Urinary Incontinence: A Prospective Study.

INTRODUCTION AND HYPOTHESIS: Stress urinary incontinence (SUI) is a prevalent condition that negatively affects women's quality of life. Fractional CO2 laser (FxCO2) therapy is an emerging energy-based treatment, but its long-term efficacy and optimal patient selection remain unclear. To evaluate the 12-month efficacy and safety of FxCO2 for female SUI and to explore the relationship between outcomes and baseline disease severity.

METHODS

In this prospective self-controlled study, 66 women with SUI received three sessions of FxCO2 therapy. Assessments were conducted at baseline and 1, 3, 6, and 12 months posttreatment, including the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), 1-h pad test, Urogenital Distress Inventory-6, Incontinence Impact Questionnaire-7, Patient Global Impression of Improvement, and pelvic floor muscle (PFM) strength evaluation.

RESULTS

ICIQ-UI SF scores, urine leakage, and pelvic floor muscle strength improved significantly at all follow-ups (p < 0.001). Mild cases maintained benefits, while moderate-to-severe cases showed reduced long-term effects. MCID analysis revealed that overall improvements did not meet clinical significance, except in severe cases, which showed MCID-level improvements in ICIQ-UI SF at 3 months and UDI-6 at 3 and 6 months, indicating clear clinical benefits for this group.

CONCLUSIONS

Fractional CO2 laser treatment alleviates symptoms and enhances pelvic floor function in women with SUI, with effectiveness linked to initial disease severity. Significant improvements were seen only in severe cases, while mild-to-moderate cases showed only statistical changes. Personalized management is advised, and combined therapy should be considered for moderate-to-severe cases to maximize benefits.