Introduction 15 Antimuscarinic (anticholinergic) drugs and beta-3 agonists (e.g., mirabegron) are the most frequently used drugs for UUI. For anticholinergics, dry mouth is the most common side effect (reported in nearly one-third of patients), though constipation, blurred vision, fatigue, and, particularly in the elderly, cognitive dysfunction may occur. Although modern anticholinergics have more selective and longer-lasting binding to muscarinic receptors compared to older anticholinergics, side effects remain common.20 Mirabegron, on the other hand, may increase blood pressure and is therefore contraindicated in patients with severe uncontrolled hypertension.21 Antimuscarinics and mirabegron 50mg have similar efficacy and are significantly better than placebo, however overall efficacy is rather low (56%, depending on the outcome measure used).21 Combination treatment of solifenacin 5 mg plus mirabegron 25 or 50 mg has been shown to be more efficacious than monotherapy and may therefore be an effective treatment option in patients who respond inadequately to first-line pharmacological treatment, potentially reducing the number of patients moving on to more invasive treatment options.21 This creates a clinical need for non-surgical alternatives for treating prolapse and (S)UI. The use of vaginal laser therapy to treat urogynaecological conditions seems appealing, as if proven effective, this could be an alternative minimally invasive treatment to add to the current portfolio of non-surgical treatments. Lasers have been widely used in areas other than gynecology, mainly in the field of medical aesthetics and dermatology. The two main types of laser used for tissue remodeling, are categorized depending on the medium used to generate the laser energy: CO2 laser and Erbium Yag laser. Current evidence suggests that lasers can cause shrinkage of collagen with subsequent remodeling of the connective tissue of the dermis. As a result, clinicians and companies started to explore whether the tissue remodeling properties seen with laser therapy to the dermis may also be adopted as non-surgical treatment to the vaginal epithelium and subepithelial fascia for gynaecological conditions caused by damaged connective tissues, including genitourinary syndrome of menopause (GSM), urinary incontinence and prolapse.22 However, the current lack of robust data on its efficacy and safety and the typically high cost of laser therapy have hindered its implementation in clinical practice. Fig 5. Vaginal laser therapy. Drawings made by Myrthe Boymans.
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