Chapter 3.2 48 Altogether, it seems fair to conclude that, on the short term, vaginal laser therapy improves SUI symptoms to a similar extent as PFMT. Therefore it may be another conservative treatment option for mild to moderate SUI. Both treatments may have a considerable placebo effect, and in our population, do not seem to be very effective on the long term. The latter observation, together with the typically higher cost associated with laser, questions its place in the portfolio of conservative treatment options for SUI. In the context of our health care system, unlike PFMT, vaginal laser treatment is not covered by medical insurance. Our observations further attenuate safety concerns on vaginal laser therapy. Side effects were only minor in nature, and self-limiting. One has to keep in mind that also PFMT is associated with minor side effects, including discomfort, soreness, pain and bleeding.79 Given the inconsistency of study results in terms of treatment effect, a rigorous meta-analysis of available studies using individual patient data would be welcomed. Nevertheless this may still not be conclusive, given the treatment methods and outcome measurement methods in available studies are not standardised. From a research viewpoint, it would be desirable to identify an optimal treatment protocol and ideal target population, which obviously conflicts with the clinical reality of facing individual patients, with their own needs, expectations and treatment response. This obviously also applies to PFMT, which in practice also lacks standardisation. From a clinical viewpoint, further trials should asses laser therapy alongside or even in combination with other conservative treatments, or lifestyle changes, because there is still a clinical need for effective conservative therapies. If shown effective, the potential impact of population characteristics including age, BMI, severity of SUI and hormonal status may identify the ideal target population. In parallel a healtheconomic analysis should then be done, to determine a justified price health insurance or patients may want to pay. On the other hand, from a pathophysiology viewpoint, performing additional placebo controlled studies may be interesting, as the last word on the efficacy of laser, and the working mechanism, has not been said.
RkJQdWJsaXNoZXIy MTk4NDMw