This article is based on a panel discussion at the Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (SUFU) 2025 Winter Meeting celebrating the 75th anniversary of the National Institute of Diabetes and Digestive and Kidney Diseases. For additional articles related to the SUFU conference, see the May 2025 issue of AUANews.

Stress urinary incontinence (SUI) is characterized by the involuntary loss of urine with physical exertion, coughing, or exercise. SUI is the most common type of urinary incontinence with a prevalence of over 40% in females who actively participate in physical activities.¹ Its impact on overall quality of life can be devastating. Women with SUI may avoid physical activities for fear of urine leakage; this may lead to a sedentary lifestyle in these women, which increases the risk of diseases such as type 2 diabetes and heart disease.²

The 2025 SUFU Annual Meeting included a panel discussion of the current status of options available to be performed in the clinic. Dr Jeremy Ockrim, urological surgeon in Female and Reconstructive Surgery at the University College London Hospital, moderated the panel, introducing the speakers and posing questions about the different therapies. Dr Sandip Vasavada, professor of urology at Cleveland Clinic Glickman Urological Institute, discussed the electromagnetic chair. He concluded that the electromagnetic chair may improve symptoms of overactive bladder and stress incontinence in some females, but the type and mode of delivery of electrical stimulation (ES) remain variable and long-term studies are lacking.³ Dr Michelle Van Kuiken, assistant professor of urology at University of California, San Francisco, then spoke about the role of continence pessaries. Overall, continence pessaries are a suitable option for many patients as they can treat both pelvic organ prolapse and incontinence simultaneously at low costs. Unfortunately, they do have to be removed during sexual relations and long-term studies are again lacking. The role of ES for SUI was then analyzed by Dr Arthur Mourtzinos, associate professor of urology at Lahey Health Medical Center, Burlington, Massachusetts. There are 3 main type of ES: vaginal ES, surface ES, and electro-acupuncture. A Cochrane review revealed ES was more effective than sham or no active treatment, but it appeared to provide only a short-term reduction in urine leakage.⁴ Overall, the quality of evidence was too low to provide reliable results.

Dr Giulia Ippolito, assistant professor of urology at the University of Michigan, discussed the role of vaginal lasers for the treatment of SUI. In 2018, the Food and Drug Administration issued a warning that it “had not cleared or approved any energy-based medical device for vaginal ‘rejuvenation’ or vaginal cosmetic procedures, or for the treatment of vaginal symptoms related to menopause, urinary incontinence, or sexual function.” Laser treatment is typically delivered by a physician in an outpatient setting over several sessions.⁵ It involves introducing a laser probe device into the vagina to deliver the laser energy based on each manufacturer’s protocol.⁵ People undergo 2 to 3 treatments at intervals between 2 and 8 weeks.⁵ The data available are very uncertain on the impact of vaginal lasers on clinically relevant outcomes. Dr Van Kuiken also discussed the impact of urethral bulking agents for the treatment of SUI. Ideal candidates for these procedures are those with mild to moderate SUI, women still childbearing, and elderly patients, who may not be good surgical candidates. Patients typically return to normal activities immediately; however, they may require further injections in the future. Long-term subjective continence rates range from 21% to 44% at 96 months while reinjection rates range upward of 80%.⁶

A number of novel devices and procedures exist for the treatment of SUI in females. The data presented during the panel suggest that these treatments may improve short-term quality of life and reduction in urine leakage. Aside from urethral bulking agents, however, long-term studies are lacking. In addition, we cannot draw any conclusions on the safety of ES and vaginal lasers. Moreover, the difference in efficacy and safety between the different treatments remains uncertain because of an insufficient number of studies.