Combined intraurethral and intravaginal er: YAG laser (UEL plus VEL) therapy vs. intraurethral (UEL) alone treatment for stress urinary incontinence? A multicenter retrospective cohort study, real world data from the VELA centers

Abstract

This study aimed to compare the efficacy of the combined intraurethral and intravaginal (UEL + VEL) non-ablative Erbium (Er): YAG laser with UEL alone in improving the symptoms of stress urinary incontinence (SUI) and/or stress-dominant mixed urinary incontinence (MUI) in women.This retrospective, multicenter cohort study included 228 women with SUI and/or MUI, with 161 women in the UEL + VEL group and 67 in the UEL group. The primary outcome was the change International Consultation on Incontinence Questionnaire - Urinary Incontinence Short Form (ICIQ-UI SF) scores at baseline and at 3, 6, and 12 months.Demographic characteristics, including age, body mass index (BMI), and menopausal duration, were similar between the groups, with the exception of parity, which was significantly higher in the UEL group (2.49 +/- 1.15 vs. 2.01 +/- 1.15, p = 0.025). Baseline ICIQ-UI SF scores were significantly higher in the UEL + VEL group (12.08 +/- 4.17 vs. 10.35 +/- 4.95, p = 0.008). Over time, the UEL + VEL group showed a steeper and more substantial decline in symptom scores, eventually converging with the UEL group at 12 months. The UEL group, starting with lower baseline scores, showed a more moderate decline. This suggests that UEL + VEL might be more effective in reducing symptoms over time. Within-subjects test indicated that parity significantly influenced symptom improvement over time (p < 0.001, F = 13.843), and between-subjects test at 12 months showed that treatment type (p = 0.036, F = 4.479), parity (p = 0.002, F = 10.029), and their interaction (p = 0.022, F = 5.333). were significant predictors of outcome.Both UEL and combined UEL + VEL applications significantly improved UI symptoms up to 12 months. However, UEL + VEL was more effective overall. Parity was a significant factor influencing the treatment outcome, suggesting that increasing parity may be a prognostic factor in laser therapy for UI.