Predictors of the efficacy of CO 2 laser therapy for female stress urinary incontinence.

Background: Predictors of the efficacy of a single-session of CO 2 laser therapy for female stress urinary incontinence are important for pretreatment consultation. Thus, the objective of this study was to evaluate these predictors.

Methods: All consecutive women who underwent vaginal CO 2 laser therapy for stress urinary incontinence were prospectively enrolled.

Results: The median duration of subjective improvement (defined as ≥1 on the global response assessment) was 18.3 months (95% confidence interval (CI): 12.1 to 18.3 months, n = 75). Multivariable analysis revealed that low voided volume (dL, hazard ratio [HR] = 0.707; area under the curve [AUC] = 0.66, cutoff value of voided volume ≤4.0 dL), high postvoid residual volume (dL, HR = 2.714; AUC = 0.60, cutoff value of postvoid residual volume ≥1.0 dL), and low functional profile length (HR = 0.956; AUC = 0.58, cutoff value of functional profile length ≤2.8 cm) were predictors of subjective failure. A logit(p) = 1.0 - 0.5 x (voided volume) + 0.9 x (postvoid residual volume) can be used to predict failure (HR = 1.775; AUC = 0.71, cutoff value of logit(p) ≥0.0).Pad weights decreased at 3 and 6-month follow-up visits. At 6 months, 8 women (21%) were cured (<1 g pad weight), and 16 women (42%) showed improvement (>50% decrease in pad weight).Overactive bladder symptoms improved at 3 and 6 months. However, there was no change in female sexual function from baseline.

Conclusion: A low voided volume and high postvoid residual volume can be used to predict subjective failure after one session of transvaginal CO 2 laser therapy. However, the subjective therapeutic effect may diminish within a median duration of 18 months.