2 The condition, current treatments and procedure
2.1 Stress urinary incontinence is the involuntary leakage of urine during exercise or certain movements, such as coughing, sneezing and laughing. In women, it is most commonly associated with previous pregnancy, with or without recognised obstetric trauma. Previous urogynaecological surgery may also result in stress urinary incontinence.
2.2 NICE's guideline on urinary incontinence and pelvic organ prolapse makes recommendations for the management of urinary incontinence in women, accompanied by a patient decision aid to promote shared decision making. Conventional treatment is conservative and includes lifestyle changes, such as weight loss and pelvic floor muscle training. Surgical options are only offered if conservative measures do not help.
2.3 Transvaginal laser therapy for stress urinary incontinence is done as an outpatient procedure and can be done without anaesthetic. A laser-probe device is inserted into the vagina to apply laser energy to the vaginal wall. The laser causes a controlled thermal injury, which is claimed to promote tissue remodelling and the production of new collagen. Treatment typically consists of 3 sessions at 4 to 6 weeks apart. The aim is to improve the support to the bladder and reduce the symptoms of stress urinary incontinence.
2.4 There are different types of lasers used for this procedure, including CO2 and erbium-doped yttrium aluminium garnet (Er:YAG) lasers. The type of laser and the energy level used have different tissue penetration and can cause different types of thermal injury.