Platelet-Rich Plasma and Er: YAG Laser Therapy for Female Stress Urinary Incontinence: A Systematic Review: Platelet-Rich Plasma and Er: YAG Laser Therapy for Female Stress Urinary Incontinence: A Systematic Review

Misbah Ur Rahman; Waqas Ahmad; Sana Idrees; Wajeeha Nadeem; Rabia Khan; Zarmeena Liaqat

doi:10.54393/pjhs.v7i4.3839

Authors

Misbah Ur Rahman Department of Urology, Institute of Kidney Diseases, Hayatabad Medical Complex, Peshawar, Pakistan
Waqas Ahmad Department of Urology, Institute of Kidney Diseases, Hayatabad Medical Complex, Peshawar, Pakistan
Sana Idrees Department of Gynaecology and Obstetrics, Abwa Medical College, Faisalabad, Pakistan
Wajeeha Nadeem Department of Gynaecology and Obstetrics, Amina Innayat Medical College, Lahore, Pakistan
Rabia Khan Department of Gynaecology and Obstetrics, Usman Memorial Hospital, Karachi, Pakistan
Zarmeena Liaqat Department of Gynaecology and Obstetrics, Saidu Group of Teaching Hospital, Swat, Pakistan

DOI:

https://doi.org/10.54393/pjhs.v7i4.3839

Keywords:

Stress Urinary Incontinence, Platelet-Rich Plasma, Er: YAG Laser, Vaginal Laser, Pelvic Floor Dysfunction, Minimally Invasive Therapy

Abstract

Female stress urinary incontinence (SUI) is a prevalent condition that negatively affects quality of life. Although surgery is effective, concerns related to morbidity and patient reluctance have increased interest in minimally invasive treatment options. Objectives: To systematically evaluate clinical evidence on the effectiveness and safety of platelet-rich plasma (PRP) injections and non-ablative Er: YAG vaginal laser therapy in women with stress urinary incontinence. Methods: This systematic review followed PRISMA 2020 guidelines. PubMed/MEDLINE, Scopus, and the Cochrane Library were searched for studies published between January 2018 and March 2025. Randomized controlled trials and prospective interventional cohort studies involving adult women with SUI were included. Data were extracted on validated symptom scores, objective outcomes, adverse events, and treatment effects. Risk of bias was assessed using Cochrane RoB-2 and NIH tools. Due to heterogeneity, results were synthesized narratively. Results: Ten studies (six randomized trials and four cohort studies) were included. Both PRP and Er: YAG laser therapy demonstrated improvement in symptom severity using validated patient-reported and objective measures. Sham-controlled trials generally favored active treatment, while combined PRP and pelvic floor muscle training showed greater benefit. Most randomized trials had some risk of bias, and cohort studies were of fair quality. Conclusions: PRP injections and Er: YAG vaginal laser therapy are promising minimally invasive options for selected women with mild to moderate SUI, though further high-quality trials are needed to confirm long-term effectiveness.

Author Biographies

Wajeeha Nadeem, Department of Gynaecology and Obstetrics, Amina Innayat Medical College, Lahore, Pakistan

Rabia Khan, Department of Gynaecology and Obstetrics, Usman Memorial Hospital, Karachi, Pakistan

Zarmeena Liaqat, Department of Gynaecology and Obstetrics, Saidu Group of Teaching Hospital, Swat, Pakistan

References

Behnia-Willison F, Nguyen TT, Norbury AJ, Mohamadi B, Salvatore S, Lam A. Promising Impact of Platelet Rich Plasma and Carbon Dioxide Laser for Stress Urinary Incontinence. European Journal of Obstetrics and Gynecology and Reproductive Biology: X. 2020 Jan; 5: 100099. doi: 10.1016/j.eurox.2019.100099. DOI: https://doi.org/10.1016/j.eurox.2019.100099

Long CY, Lin KL, Shen CR, Ker CR, Liu YY, Loo ZX et al. A Pilot Study: Effectiveness of Local Injection of Autologous Platelet-Rich Plasma in Treating Women with Stress Urinary Incontinence. Scientific Reports. 2021 Jan; 11(1): 1584. doi: 10.1038/s41598-020-80598-2. DOI: https://doi.org/10.1038/s41598-020-80598-2

Athanasiou S, Kalantzis C, Zacharakis D, Kathopoulis N, Pontikaki A, Grigoriadis T. The Use of Platelet-Rich Plasma as a Novel Nonsurgical Treatment of the Female Stress Urinary Incontinence: A Prospective Pilot Study. Urogynecology. 2021 Nov; 27(11): e668-72. doi: 10.1097/SPV.0000000000001100. DOI: https://doi.org/10.1097/SPV.0000000000001100

Juhász ML, Korta DZ, Mesinkovska NA. Vaginal Rejuvenation: A Retrospective Review of Lasers and Radiofrequency Devices. Dermatologic Surgery. 2021 Apr; 47(4): 489-94. doi: 10.1097/DSS.0000000000002845. DOI: https://doi.org/10.1097/DSS.0000000000002845

Bujnak A, Crowder CA, Krychman ML. Energy-based Devices for Functional Vaginal Problems: Issues and Answers. Current Sexual Health Reports. 2021 Mar; 13(1): 1-3. doi: 10.1007/s11930-021-00302-x. DOI: https://doi.org/10.1007/s11930-021-00302-x

Filippini M, Angioli R, Luvero D, Sammarini M, De Felice G, Latella S et al. The Utility of CO2 Laser Treatment of Pelvic Symptoms in Women with Previous Perineal Trauma during Delivery. Journal of Personalized Medicine. 2023 Dec; 14(1): 60. doi: 10.3390/jpm14010060. DOI: https://doi.org/10.3390/jpm14010060

Lee P, Perruzza D, Edell H, Jarvi S, Kim K, Sultana R et al. Double-blind Randomized Controlled Trial of Er: YAG Vaginal Laser to Treat Female Stress Urinary Incontinence. American Journal of Obstetrics and Gynecology. 2025 Jun; 232(6): 541-e1. doi: 10.1016/j.ajog.2024.11.021. DOI: https://doi.org/10.1016/j.ajog.2024.11.021

Chiang CH and Kuo HC. The Efficacy and Mid-Term Durability of Urethral Sphincter Injections of Platelet-Rich Plasma in Treatment of Female Stress Urinary Incontinence. Frontiers in Pharmacology. 2022 Feb; 13: 847520. doi: 10.3389/fphar.2022.847520. DOI: https://doi.org/10.3389/fphar.2022.847520

Reisenauer C, Hartlieb S, Schoenfisch B, Brucker SY, Neis F. Vaginal Therapy of Mild and Moderate Stress Urinary Incontinence Using Er: YAG Laser: A Real Treatment Option. Archives of Gynecology and Obstetrics. 2019 Dec; 300(6): 1645-50. doi: 10.1007/s00404-019-05334-2. DOI: https://doi.org/10.1007/s00404-019-05334-2

Setyaningrum T, Listiawan MY, Santoso B, Prakoeswa CR, Widjiati W, Tjokroprawiro BA. Experimental Analysis of Vaginal Laxity in Rats Treated with a Combination of Er: YAG Fractional Lasers and AMSC-MP. Journal of Lasers in Medical Sciences. 2023 Jan; 14: e2. doi: 10.34172/jlms.2023.02. DOI: https://doi.org/10.34172/jlms.2023.02

Cañadas Molina A, Sanz Baro R. The First Major Complication Due to Laser Treatment for Stress Urinary Incontinence: A Short Report. Climacteric. 2021 Mar; 24(2): 206-9. doi: 10.1080/13697137.2020.1816958. DOI: https://doi.org/10.1080/13697137.2020.1816958

Zhang G, Song Y, Zhuang T, Zhao Y, Pan Z, Pan Z. Clinical Application and Research Progress of Platelet-Rich Plasma. Hematology. 2025 Dec; 30(1): 2549159. doi: 10.1080/16078454.2025.2549159. DOI: https://doi.org/10.1080/16078454.2025.2549159

Blaganje M, Šćepanović D, Žgur L, Verdenik I, Pajk F, Lukanović A. Non-ablative Er: YAG Laser Therapy Effect on Stress Urinary Incontinence Related to Quality of Life and Sexual Function: A Randomized Controlled Trial. European Journal of Obstetrics and Gynecology and Reproductive Biology. 2018 May; 224: 153-8. doi: 10.1016/j.ejogrb.2018.03.038. DOI: https://doi.org/10.1016/j.ejogrb.2018.03.038

Wang X, Zhang Z, Meng L, Xu S, Zheng J, Wang H et al. Efficacy and Safety of Non-Ablative Er: YAG Laser for Mild to Moderate Stress Urinary Incontinence: A Prospective, Multicenter, Randomized, Sham-Controlled Clinical Trial. Lasers in Medical Science. 2025 Apr; 40(1): 195. doi: 10.1007/s10103-025-04400-3. DOI: https://doi.org/10.1007/s10103-025-04400-3

O'Reilly BA, Viereck V, Phillips C, Toozs‐Hobson P, Kuhn A, Athanasiou S et al. Vaginal Erbium Laser Treatment for Stress Urinary Incontinence: A Multicenter Randomized Sham‐Controlled Clinical Trial. International Journal of Gynecology and Obstetrics. 2024 Mar; 164(3): 1184-94. doi: 10.1002/ijgo.15222. DOI: https://doi.org/10.1002/ijgo.15222

Saraluck A, Chinthakanan O, Kijmanawat A, Aimjirakul K, Wattanayingcharoenchai R, Manonai J. Autologous Platelet Rich Plasma (A‐PRP) Combined with Pelvic Floor Muscle Training for the Treatment of Female Stress Urinary Incontinence (SUI): A Randomized Control Clinical Trial. Neurourology and Urodynamics. 2024 Feb; 43(2): 342-53. doi: 10.1002/nau.25365. DOI: https://doi.org/10.1002/nau.25365

Grigoriadis T, Kalantzis C, Zacharakis D, Kathopoulis N, Prodromidou A, Xadzilia S et al. Platelet-rich Plasma for the Treatment of Stress Urinary Incontinence—A Randomized Trial. Urogynecology. 2024 Jan; 30(1): 42-9. doi: 10.1097/SPV.0000000000001378. DOI: https://doi.org/10.1097/SPV.0000000000001378

Gaspar A, Koron N, Silva J, Brandi H. Vaginal Erbium Laser for Treatment of Stress Urinary Incontinence: Optimization of Treatment Regimen for a Sustained Long-Term Effect. Lasers in Medical Science. 2022 Jun; 37(4): 2157-64. doi: 10.1007/s10103-021-03474-z. DOI: https://doi.org/10.1007/s10103-021-03474-z

Kuszka A, Gamper M, Walser C, Kociszewski J, Viereck V. Erbium: YAG Laser Treatment of Female Stress Urinary Incontinence: Midterm Data. International Urogynecology Journal. 2020 Sep; 31(9): 1859-66. doi: 10.1007/s00192-019-04148-9. DOI: https://doi.org/10.1007/s00192-019-04148-9

Lia M, Pilát P, Weydandt L, Baessler K, Kempe T, Aktas B. The Effect of Vaginal Er: YAG Laser Therapy on Pelvic Floor Symptoms in Women with Stress Urinary Incontinence: A Single‐Center Cohort Study. Lasers in Surgery and Medicine. 2025 Mar; 57(3): 265-75. doi: 10.1002/lsm.70001. DOI: https://doi.org/10.1002/lsm.70001

Sigurdardóttir HB, Kirschner B, Obel J, Aziz M, Stenz CB, Schroll JB. Vaginal CO2 Laser Treatment for Urinary Stress Incontinence: A Randomized Controlled Trial. Maturitas. 2025 Jul: 108658. doi: 10.1016/j.maturitas.2025.108658. DOI: https://doi.org/10.1016/j.maturitas.2025.108658

Phillips C, Shah G, Gamper M, Kuszka A, Chandrakumaran K, Viereck V. Vaginal Erbium Laser for the Treatment of Mild‐to‐Moderate Stress Urinary Incontinence: A Multicentre Randomized Sham–Controlled Trial. An International Journal of Obstetrics and Gynaecology. 2025 Nov. doi: 10.1111/1471-0528.70080. DOI: https://doi.org/10.22541/au.174685361.17801667/v1

Alexander JW, Karjalainen P, Ow LL, Kulkarni M, Lee JK, Karjalainen T et al. CO2 Surgical Laser for Treatment of Stress Urinary Incontinence in Women: A Randomized Controlled Trial. American Journal of Obstetrics and Gynecology. 2022 Sep; 227(3): 473-e1. doi: 10.1016/j.ajog.2022.05.054. DOI: https://doi.org/10.1016/j.ajog.2022.05.054

Yim LW, Wan OY, Wong D, Tam MS, Lee YT, Lee KW et al. Vaginal Laser Treatment on Stress Urinary Incontinence: A Randomized Controlled Trial. International Urogynecology Journal. 2025 May: 1-1.

Long CY, Wu PC, Chen HS, Lin KL, Loo Z, Liu Y et al. Changes in Sexual Function and Vaginal Topography Using Transperineal Ultrasound After Vaginal Laser Treatment for Women with Stress Urinary Incontinence. Scientific Reports. 2022 Mar; 12(1): 3435. doi: 10.1038/s41598-022-06601-0. DOI: https://doi.org/10.1038/s41598-022-06601-0

Gao L, Wang Y, Wen W, Duan Y, Li Z, Dang E et al. Fractional Carbon Dioxide Vaginal Laser Treatment of Stress Urinary Incontinence: Remodeling of Vaginal Tissues and Improving Pelvic Floor Structures. Lasers in Surgery and Medicine. 2023 Mar; 55(3): 268-77. doi: 10.1002/lsm.23641. DOI: https://doi.org/10.1002/lsm.23641

Ashton L, Nakatsuka H, Johnson CM, Kenne K, Kreder KJ, Kruse R et al. A Single Injection of Platelet-Rich Plasma Injection for the Treatment of Stress Urinary Incontinence in Females: A Randomized Placebo-Controlled Trial. Urology. 2024 Nov; 193: 63-8. doi: 10.1016/j.urology.2024.06.047. DOI: https://doi.org/10.1016/j.urology.2024.06.047

Hsiao SM, Wu WY, Lin HH. Predictors of the Efficacy of CO2 Laser Therapy for Female Stress Urinary Incontinence. Journal of the Chinese Medical Association. 2025 Feb; 88(2): 145-50. doi: 10.1097/JCMA.0000000000001193. DOI: https://doi.org/10.1097/JCMA.0000000000001193

Wu YR, Shen D, Zhang YQ, Cui ZY, Yang WZ. Efficacy Evaluation of Lattice Carbon Dioxide Laser Therapy in the Treatment of Postmenopausal Patients with Mild to Moderate Stress Urinary Incontinence. Pakistan Journal of Medical Sciences. 2021 Nov; 37(7): 1989. doi: 10.12669/pjms.37.7.4077. DOI: https://doi.org/10.12669/pjms.37.7.4077

Filippini M, Elmi S, Sozzi J, Pieri L, Fusco I, Zingoni T et al. Thermo-Ablative Fractional CO2 Lasers Combined with 1540 nm Wavelengths Is a Promising Treatment Option in Stress Urinary Incontinence. Medical Sciences. 2025 Mar; 13(1): 25. doi: 10.3390/medsci13010025. DOI: https://doi.org/10.3390/medsci13010025

Petca A, Fotă A, Petca RC, Rotar IC. Modern Conservative Management Strategies for Female Stress Urinary Incontinence: A Systematic Review. Journal of Clinical Medicine. 2025 May; 14(10): 3268. doi: 10.3390/jcm14103268. DOI: https://doi.org/10.3390/jcm14103268

Li PC and Ding DC. Exploring the Role of Laser Therapy for Stress Urinary Incontinence: A Literature Review. Lasers in Medical Science. 2025 Dec; 40(1): 1-3. doi: 10.1007/s10103-025-04385-z. DOI: https://doi.org/10.1007/s10103-025-04385-z

Sima RM, Pleș L, Bălălău OD, Amza M, Conea IM, Bunea TI et al. Surgical Techniques for Urinary Incontinence in Young Women—Narrative Review. Surgical Techniques Development. 2025 Aug; 14(3): 28. doi: 10.3390/std14030028. DOI: https://doi.org/10.3390/std14030028

Le C, Murgia RD, Noell C, Weiss M, Weiss R. Female Genitourinary Treatments in Aesthetics. Clinics in Dermatology. 2022 May; 40(3): 259-64. doi: 10.1016/j.clindermatol.2021.11.009. DOI: https://doi.org/10.1016/j.clindermatol.2021.11.009

Mohamed-Ahmed R, Taithongchai A, da Silva AS, Robinson D, Cardozo L. Treating and Managing Urinary Incontinence: Evolving and Potential Multicomponent Medical and Lifestyle Interventions. Research and Reports in Urology. 2023 Dec: 193-203. doi: 10.2147/RRU.S387205. DOI: https://doi.org/10.2147/RRU.S387205