Efficacy of non-ablative vaginal erbium laser for rUTI prevention in postmenopausal women

To evaluate the effect of vaginal erbium laser (VEL) for recurrent urinary tract infection (rUTI) prevention in postmenopausal women (PMW). 80 PMW with past histories of rUTI were recruited and randomized into local estrogen therapy (LET) or VEL group. The LET group was prescribed 12 weeks of vaginal estrogen, while treatment in the VEL group consisted of three VEL sessions at a 30-day interval. Primary outcomes were the number of UTI episodes and the percentage of cured and improved participants. Vaginal pH, lactobacillus flora, and vaginal health index score (VHIS) were assessed as secondary outcomes. The actual number of cumulative UTI episodes in VEL and LET were significantly lower than predictive numbers. No significant difference was found in the percentages of cured and improved participants between the two groups. Persistent improvement of vaginal health was observed in VEL. Only 54.8% of participants in LET still maintained vaginal lactobacillus predominance at the follow-up endpoint compared with 93.3% in VEL (p = 0.002). Consistently and significantly lower vaginal pH and higher VHIS scores were observed in VEL compared to LET at the same time-points. In comparison to vaginal estrogen, VEL showed a non-inferior and more sustained effect for rUTI prevention in PMW.