Predictors of the efficacy of CO2 laser therapy for female stress urinary incontinence

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Background: Predictors of the efficacy of a single-session of CO2 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 CO2 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 CO2 laser therapy. However, the subjective therapeutic effect may diminish within a median duration of 18 months.