Objective: To study the efficacy of fractional carbon dioxide (CO2) laser for treatment of stress urinary incontinence (SUI) grade I.
Material and Method: A prospective single arm clinical trial was conducted from December 2015 to February 2016 at Thammasat University hospital, a tertiary care center in Thailand. Women with SUI grade I were recruited and treated with fractional CO2 laser for 3 episodes, 4-week interval. Pre and post-treatment SUI symptoms, bladder neck descent (BND) and the Q-tip test were compared. The study hypothesis was that fractional CO2 laser could improve the anatomical changes of the vaginal wall under the bladder neck and help strengthen the bladder neck support.
Results: Fifty women of mean age 55.4 years with SUI grade I were recruited. The frequency of SUI grade I and nocturia decreased significantly after laser treatments. The average of pre-treatment BND was 12.03+7.3 mm and after treatment the average BND was decreased to 8.6+3.7 mm with statistical significance. The Q-tip test was also significantly decreased. No women had serious complications from the treatment.
Conclusion: Fractional CO2 laser was well tolerated. It seems to improve the anatomical function of the bladder neck which may help improve the bladder neck support and mild stress incontinence. However, further well controlled study need to be done to decrease the confounding factors and biases.

Keywords: Stress urinary incontinence, Fractional CO2 laser, Lower urinary tract symptoms