From the Guidelines
Perineal laser ablation does not have sufficient evidence to support its use in alleviating bladder symptoms, and its effectiveness is not well-established in the context of bladder health. The provided evidence does not directly address the use of perineal laser ablation for bladder symptoms, and the available studies focus on its application in prostate cancer treatment 1. In the context of bladder health, behavioral treatments such as bladder training, delayed voiding, and pelvic floor muscle training have been shown to be effective in reducing symptoms and improving quality of life 1.
Key Considerations
- The American Urological Association (AUA) and the Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (SUFU) guideline on overactive bladder recommends behavioral treatments as a first-line approach for managing bladder symptoms 1.
- There is limited evidence to support the use of perineal laser ablation for bladder symptoms, and its potential benefits and risks are not well-established in this context.
- Patients with bladder symptoms should consult with a urogynecologist or pelvic floor specialist to determine the most appropriate treatment approach for their specific condition.
Treatment Options
- Behavioral treatments such as bladder training, delayed voiding, and pelvic floor muscle training are recommended as a first-line approach for managing bladder symptoms 1.
- Other treatment options, such as weight loss and fluid management, may also be beneficial in reducing bladder symptoms 1.
- Perineal laser ablation may be considered for other indications, such as prostate cancer treatment, but its use in bladder health is not well-established 1.
From the Research
Perineal Laser Ablation and Bladder Symptoms
- The effectiveness of perineal laser ablation in alleviating bladder symptoms is a topic of ongoing research, with various studies investigating its potential benefits 2, 3, 4, 5.
- A study published in 2020 found that vaginal erbium laser (VEL) treatment can be effective in improving symptoms of stress urinary incontinence (SUI), overactive bladder syndrome, and mixed incontinence (MUI) 2.
- Another study published in 2022 reported that Pixel CO2 laser treatment significantly improved SUI symptoms in women, with an efficacy rate of 80% 3.
- A systematic review published in 2021 found that lasers, including Er:YAG and Fractional CO2 lasers, showed modest reductions in mild SUI cases, with benefits lasting up to 13-16 months, but the overall quality of the studies was poor 4.
- A retrospective cohort study published in 2024 found that combination therapy with vaginal and urethral Er:YAG laser (VEL+UEL) was effective and safe in treating overactive bladder with urinary incontinence (OAB-wet), with significant improvements in OAB symptoms, voided volume, frequency, nocturia, and vaginal health 5.
Mechanisms of Action and Safety
- The mechanisms of action of lasers in treating bladder symptoms are not fully understood, but they are thought to involve the stimulation of collagen production, improvement of tissue strength, and enhancement of urethral closure 2, 3.
- The safety of perineal laser ablation has been reported to be good, with minimal adverse events and no long-term side effects 3, 4, 5.
- However, more research is needed to fully understand the safety and efficacy of perineal laser ablation in treating bladder symptoms, as well as its potential long-term effects and cost-effectiveness 2, 4, 5.
Clinical Applications and Future Directions
- Perineal laser ablation may be a promising treatment option for women with bladder symptoms, particularly those with SUI, OAB, and MUI 2, 3, 5.
- Further studies are needed to investigate the optimal laser settings and protocols, as well as the potential benefits and risks of combination therapy with other treatments 4, 5.
- The development of new laser technologies and techniques may also improve the efficacy and safety of perineal laser ablation in treating bladder symptoms 2, 3.