Can a laser treat bladder leakage?

Laser therapies are used in medicine for many different conditions.  Urologists use lasers to break up kidney stones and get them out of the body.  Ear, nose and throat surgeons use lasers to treat tumors.  LASIK eye surgery is one of the most common laser procedures but you may have not realized that it was done with a laser. Reality shows like “Real Housewives of…” frequently discuss cosmetic laser procedures for wrinkles and skin tightening.  Right now, there is also a lot of media attention on vaginal laser procedures like vaginal rejuvenation.  These vaginal lasers are used to treat different problems.  But can a laser treat bladder leakage?

The “techie” part

Let’s start by talking about lasers in general.  LASER is an acronym that stands for “light amplification by stimulated emission of radiation.”    Lasers are pretty techie, so bear with me here.  In a laser, a specific medium is activated and emits a wavelength of high energy light.  There are different types of lasers. Each laser type is named after the medium that is activated.  In gynecology, the common lasers are CO2 (carbon dioxide) and Er:YAG.  Each medium releases a different wavelength of light.  This means that if you have different types of laser procedures, you’ll notice that the light may be different colors like green, blue-green, or red.  This is all important because each type of laser acts a little differently on the body.

When the light from the laser is focused on the body, it interacts with the cells by a process called photolysis.  “Photo” means light and “lysis” means destroying the cell.  So, the laser causes targeted cell injury.  A controlled injury of the skin encourages collagen production and results in skin tightening.  Different types of lasers target different layers of the skin. Consequently, it is very important that the right laser is used in the right way in the vagina or there can be burns.

What we know about vaginal lasering and incontinence

A lack of support to the urethra, the tube allows urine to exit the bladder freqeuntly causes stress urinary incontinence.  Resupporting the urethra or tightening the tissue underneath the urethra (essentially the vagina) helps with bladder leakage.  A laser tightens this tissue but will that this type of laser treat bladder leakage in a permanent way?

There is not much research to help answer this question.  Laser treatments currently fall into the “promising” category, at least for the short term.  Here is what we can say about laser treatment for bladder leaking:

• CO2 and Er:YAG may improve bladder leakage symptoms over 3-36 months
• There is no data that radiofrequency helps urinary incontinence
• We do not know if laser treatment works better than or is as effective as pelvic floor exercises or surgery
• Laser treatments have a favorable safety profile

The bottom line

So, lasers may treat bladder leakage and they are generally safe (as long as the person doing the laser is well trained and using the correct laser in the correct way).  The treatment is usually spendy and laser treatments are generally out of pocket and not covered by insurance. 

There are still a lot of questions about laser therapy for leaking.  We need to do trials comparing laser therapy to other treatments.  This means that I can’t tell you how well it works compared to other types of treatments and when you should pick a laser treatment over another type of treatment. 

We also don’t know who is the best candidate for laser therapy.  For example, does it work the best on women with more mild symptoms?  Or maybe for younger women?  We also don’t know how often the treatment might need to be repeated and how long it might last. 

So, it is safe but expensive and it likely works in some women.  We have a lot more work to do so I can tell my patients who benefits from laser, how long they benefit, and how it compares to other therapies.

Interested in reacing more details? Here is a consensus statement on vaginal energy-based devices (laser and radio-frequency) from the American Urogynecologic Society.

_{Alshiek JA et al. Vaginal based energy devices-AUGS Clinical Consensus Statement. Female Pelv Med &Reconstruct Surgery;26(5):287-98}.