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Is There Enough Evidence to Justify the Use of Laser and Other Thermal Therapies in Female Lower Urinary Tract Dysfunction? Report From the ICI-RS 2019

Dudley Robinson 1, Richard Flint 1 2, Nikolaus Veit-Rubin 3, George Araklitis 1, Linda Cardozo 1 2

DOI: 10.1002/nau.24298

Abstract
Aims: There is increasing evidence to suggest that thermomodulation may have a role in the management of women with lower urinary tract dysfunction (LUTD) and there has been widespread adoption of laser and radiofrequency (RF) therapies within clinical practice. However, in many areas of LUTD, the data are still limited and there remains a need for further evaluation of the safety and efficacy of thermal therapy. The aim of this study proposal is to report the findings of the International Consultation on Incontinence Research Society to clarify our current knowledge regarding the evidence for thermal therapy in LUTD and to set research priorities for the future.

Methods: Literature review based on the search terms: «laser,» «radiofrequency,» «genitourinary syndrome of the menopause» or «urogenital atrophy,» «stress urinary incontinence (SUI),» «pelvic organ prolapse,» «OAB» or «overactive bladder,» and «urinary tract infection.»

Results: The current available evidence, though of low or very low quality, appears promising for the use of laser therapy in the management of genitourinary syndrome of the menopause, there are some data to suggest a possible role in SUI although very little evidence for urogenital prolapse. At present, the evidence supporting the use of laser in OAB and recurrent urinary tract infection is limited or lacking, while the available evidence for RF in the management of all forms of LUTD is much less robust.

Conclusions: Laser and RF are being introduced clinically as a minimally invasive, low-risk interventions for women with LUTD although at present, the evidence supporting usage is limited. Consequently, there is an urgent need to demonstrate the safety and efficacy with prospective long-term studies including sham studies and comparative studies with current standard therapy.