Background Laser therapy is now being proposed for the treatment of pelvic organ prolapse (POP) and urinary incontinence (UI). Objectives To systematically review the available literature on laser therapy for POP and UI. Search strategy PubMed, Web Of Science and Embase were searched for relevant articles, using a three‐concept (POP, UI, laser therapy) search engine composed as (concept 1 OR concept 2) AND concept 3. Selection criteria Only full‐text clinical studies in English. Data collection and analysis Data on patient characteristics, laser setting, treatment outcome and adverse events were independently collected by two researchers. There was a lack of methodological uniformity so meta‐analysis was not possible and the results are presented narratively. Main results Thirty‐one studies recruiting 1530 adult women met the inclusion criteria. All studies showed significant improvement either on UI, POP or both; however the heterogeneity of laser settings, application and outcome measures was huge. Only one study was a randomised controlled trial, two studies were controlled cohort studies. All three were on UI and used standardised validated tools. The risk of bias in the randomised controlled trial was low on all seven domains; the controlled studies had a serious risk of bias. No major adverse events were reported, mild pain and burning sensation were the most commonly described adverse events. Conclusions All studies on vaginal and/or urethral laser application for POP and UI report improvement, but the quality of studies needs to be improved. Tweetable abstract There is weak evidence that laser therapy is effective for urinary incontinence and pelvic organ prolapse #LASER#UI#POP.

For the time being, routine indwelling catheterisation of the bladder for caesarean section remains recommended Sir, Li and Wen's systematic review doesn't show evidence of no effect, but only that there is no evidence of the effect of the placement of an indwelling catheter for caesarean section. 1As stated by the authors, the review lacks power to demonstrate any difference in important clinical outcomes between the catheterised versus the non-catheterised group. Urinary tract infection is a common but clinically less important outcome compared with possible serious perioperative complications, such as postpartum haemorrhage.Besides the methodological limitations of this review (recognised by the authors), the lack of data from clinically important outcomes undermines the rash conclusion that the routine use of indwelling urinary catheters for caesarean delivery patients is not necessary, and is even harmful. The non-randomised controlled trial included mentions that 6.7% of cases of postpartum uterine atony lead to haemorrhage! 2 As stated by the authors, only 0.1% of obstetricians do not use urethral catheterisation, and obstetricians should continue to use (brief) catheterisation until there is evidence that catheterisation doesn't improve important outcomes, even at the cost of more urinary tract infections. There is evidence that catheterisation for no longer than 12 hours doesn't significantly increase the rate of urinary tract infections. As caesarean section is a frequently used intervention worldwide, even small differences for clinically important outcomes are worthy of study by methodologically sound randomised controlled trials, investigating the correct, important clinical questions. j For the time being, routine indwelling catheterisation of the bladder for caesarean section remains recommended Authors' ReplySir, We wish to thank Page et al. 1 for their comments on our paper.2 As they stated, serious perioperative complications such as postpartum haemorrhage are more critical than urinary tract infection (UTI). However, the main disadvantage of catheterisation is that it increases the risk of UTI. Catheterisation of the bladder for caesarean section is to prevent bladder injury, intraoperative difficulties and postoperative urinary retention. So the primary outcomes of our paper were UTI, postpartum urinary retention, intraoperative difficulties and operative complications. Our study found that not using an indwelling urinary catheter in caesarean section was associated with less UTI and no increase in either urinary retention or intraoperative difficulties, based on current available evidence.As for one included non-randomised controlled trial that mentioned 6.7% uncatheterised cases of postpartum uterine atony leading to haemorrhage, 3 we failed to confirm whether the non-catheterised group could cause more postpartum haemorrhage because no information 886