CO2 laser therapy for management of stress urinary incontinence in women: a systematic review and meta-analysis

Background

Carbon dioxide (CO2) laser therapy is an emerging treatment for women with stress urinary incontinence (SUI).

Objectives

To examine the efficacy of CO2 laser therapy for management of SUI-related symptoms in women.

Design

A systematic review and meta-analysis of randomized controlled trials and cohort studies.

Data sources and methods

Four databases were screened until January 2023. All efficacy continuous endpoints were assessed via subtraction of the posttreatment from pretreatment values. The data were summarized as mean difference (MD) with 95% confidence interval (CI) using the random-effects model.

Results

A total of 15 studies with 700 patients were analyzed. CO2 laser therapy significantly decreased the 1-h pad weights at 3 months [n = 5 studies, MD = -3.656 g, 95% CI (-5.198, -2.113), p < 0.001], 6 months [n = 6 studies, MD = -6.583 g, 95% CI (-11.158, -2.008), p = 0.005], and 12 months [n = 6 studies, MD = -3.726 g, 95% CI (-6.347, -1.106), p = 0.005]. Moreover, CO2 laser therapy significantly decreased the International Consultation of Incontinence Questionnaire-Urinary Incontinence Short Form Scores at 3 months [n = 10 studies, MD = -4.805, 95% CI (-5.985, -3.626), p < 0.001] and 12-months [n = 6 studies, MD = -3.726, 95% CI (-6.347, -1.106), p = 0.005]. Additionally, CO2 laser therapy significantly decreased the Pelvic Floor Impact Questionnaire scores at 6 months [n = 2 studies, MD = -11.268, 95% CI (-18.671, -3.865), p = 0.002] and 12 months [n = 2 studies, MD = -10.624, 95% CI (-18.145, -3.103), p = 0.006]. Besides, CO2 laser therapy significantly decreased the Urogenital Distress Inventory-6 scores at 3 months [n = 2 studies, MD = -21.997, 95% CI (-32.294, -11.699), p < 0.001], but not at 6 months [n = 3 studies, MD = -3.034, 95% CI (-7.357, 1.259), p = 0.169]. Lastly, CO2 laser therapy significantly increased the Vaginal Health Index Score at 6 months [n = 2 studies, MD = 2.826, 95% CI (0.013, 5.638), p = 0.047] and 12 months [MD = 1.553, 95% CI (0.173, 2.934), p = 0.027].

Conclusion

CO2 laser therapy improved the SUI-related symptoms in women. To obtain solid conclusions, future studies should be well-designed with standardized settings, consistent therapeutic protocols, and long-term follow-up periods.

Prophylactic tranexamic acid during myomectomy: A systematic review and meta-analysis of randomized controlled trials

OBJECTIVE

To conduct a systematic review and meta-analysis of randomized controlled trials on the clinical efficacy and safety of prophylactic tranexamic acid (TXA) versus control (normal saline/no treatment) during myomectomy.

METHODS

Six databases were screened from inception until 21-February-2022. The eligible studies were assessed for risk of bias. The outcomes were summarized as mean difference (MD) and risk ratio (RR) with 95% confidence intervals (CI) in a random-effects model.

RESULTS

Seven studies, comprising eight arms and 571 patients (TXA = 304 patients, control = 267 patients) were analyzed. The included studies had an overall low risk of bias. The mean intraoperative blood loss (MD = -224.34 ml, 95% CI [-303.06, -145.61], p < 0.001), mean postoperative blood loss, and mean total blood loss were significantly reduced in favor of the prophylactic TXA group. Additionally, the mean postoperative hemoglobin (MD = 0.4 mg/dl, 95% CI [0.11, 0.68], p = 0.006) and mean postoperative hematocrit levels were significantly higher in favor of the prophylactic TXA group. While the mean hospital stay was significantly reduced in favor of the prophylactic TXA group (MD = -0.39 d, 95% [-0.74, -0.04], p = 0.03), there was no significant difference between both groups regarding the mean operation time and rate of blood transfusion. None of the participants in both groups developed any incidence of thromboembolic events. The rate of nausea was significantly higher in disfavor of the prophylactic TXA group (RR = 2.68, 95% CI [1.11, 6.43], p = 0.03).

CONCLUSION

Among patients undergoing myomectomy, prophylactic TXA was largely safe and linked to substantial reductions in perioperative blood loss and related morbidities.

Vasopressin to Control Blood Loss during Hysterectomy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

OBJECTIVE

Minimizing intraoperative blood loss during hysterectomy is crucial to lessen associated perioperative morbidity. The aim of this investigation is to conduct a systematic review and meta-analysis of all randomized controlled trials (RCTs) that compared vasopressin versus normal saline in controlling intraoperative blood loss during hysterectomy.

DATA SOURCES

We screened 5 major databases (PubMed, Scopus, Web of Science, Embase, and the Cochrane Central Register of Controlled Trials) from inception till July 18, 2021. We used the following query search in all databases: (vasopressin OR arginine vasopressin OR argipressin OR antidiuretic hormone) AND (hysterectomy) AND (saline OR placebo OR control OR no treatment) AND (randomized OR randomised OR randomly). There was no language restriction during database screening.

METHODS OF STUDY SELECTION

We considered all studies that met the following evidence-based criteria: (1) patients: individuals undergoing hysterectomy for any indication, (2) intervention: vasopressin, (3) comparator: normal saline, placebo, or no treatment, (4) outcomes: reliable extraction of any of our endpoints, and (5) study design: RCTs. We assessed risk of bias of included studies and pooled endpoints as mean difference (MD) or risk ratio (RR) with 95% confidence interval (CI). We performed statistical analysis using the Review Manager software, version 5.4.0.

TABULATION, INTEGRATION, AND RESULTS

Seven RCTs with an overall low risk of bias met the inclusion criteria. This meta-analysis included a total of 455 patients; 232 and 223 patients were allocated to vasopressin and control group, respectively. The majority of RCTs were vaginal hysterectomy (n = 5), few abdominal hysterectomy, (n = 2) and no laparoscopic hysterectomy. The mean estimated intraoperative blood loss was significantly lower in favor of the vasopressin group compared with the control group (n = 6 RCTs, MD = -119.85 mL, 95% CI [-177.55, -62.14], p <.001). However, there was no significant difference between both groups regarding mean operating time, mean change in postoperative hemoglobin, mean hospital stay, rate of febrile morbidity, rate of pelvic infection, rate of perioperative blood transfusion, and rate of perioperative complications.

CONCLUSION

Compared with normal saline, vasopressin significantly reduced the estimated blood loss during hysterectomy but did not change any clinically significant outcomes. In addition, vasopressin was safe and did not correlate with an increase in the rates of febrile morbidity or pelvic infection.