To evaluate the efficacy and safety of new erbium laser therapy for the treatment of male stress urinary incontinence

Male patients with stress urinary incontinence caused by radical prostatectomy, transurethral prostate resection and radiotherapy were included in this pilot study. Treatment consists of intraurethral laser irradiation of the external urethral sphincter. ErYAG 2940 nm laser was used in its thermal only Smooth mode delivering in average 120 J of non-ablative energy in multiple irradiation passes. 4 treatment sessions with one month interval were scheduled for all patients. Before the laser irradiation local anesthesia (lidocaine cream) was applied into patient urethra. Treatment efficacy was evaluated with the reduction of number of pads and with patient’s subjective assessment of the improvement. Measurements of efficacy as well as the observation of the adverse effects and the discomfort during the treatment were performed at every visit.

10 male patients suffering of SUI, average age 70.2 years (range 57-82) with an average use of 3.4 pads/day (range 1-6) were included in this study, done in a single medical center in Malaga, Spain in period June - October 2017. All patients but one improved already after the first session. Average number of pads per day was reduced from 3.4 before the treatment to 1.7, 1.5 and 1.4 at 2, 3 and 4 months follow-ups. 6 patients remained with only 1 pad/day and 2 patients were without pads at 4 months after the beginning of the therapy. All patients tolerated the treatment well and there were no adverse effects observed. Most of the patients (9/10) assessed their improvement as significant and were very satisfied with the treatment and the results.

A new treatment of intrinsic sphincter deficiency in female using non-ablative ErYAG laser was recently proposed and the first clinical results (1) were promising showing excellent improvement and practically no adverse effects. The proposed mechanism of action was the improvement of mucosal component of the urethral sphincter caused by controlled laser produced tissue hyperthermia. We believed that the improvements achieved in our patients were based on the same principle as described for female urethral sphincter.

New non-ablative erbium laser therapy had shown good results in treatment of male stress urinary incontinence and seems to be a promising minimally invasive alternative to existing therapies. Larger series and longer follow ups are needed to allow us to draw the firm conclusions

A. Gaspar, H. Brandi, Non-ablative erbium YAG laser for the treatment of type III stress urinary incontinence (intrinsic sphincter deficiency), Journal of Laser in Medical Science, 2017, Apr;32(3):685-691 (2017)