Urinary incontinence can have many etiologies. diVa vaginal laser is a fantastic alternative to painful and costly incontinence surgeries, but there are limitations. Prominent anterior vaginal wall defect/cystocele (a weakening of the anterior vaginal wall, allowing the bladder to drop "down" into the vaginal cavity (posteriorly, when speaking anatomically) is an example of where surgical management would be indicated. Severe stress incontinence (laugh, run, jump, sneeze) where even minimal increase in pressure or position leads to uncontrollable leakage is probably another situation where surgical expertise would be indicated. Mild to moderate stress incontinence, especially coupled with risk factors such as vaginal childbirth, multiple children or large birthweights, as well as menopause status, are very good candidates for diVa vaginal laser therapy. By deep penetrative therapy with the powerful erbium laser allowing for the most significant collagen stimulation, neovascularization, and growth of new epithelial cells, bladder improvements with vaginal rejuvenation have never been more robust. Typical response is seen within 2-4 weeks of first procedure, and build from there.