RESUMEN
The decline in sex hormone levels that accompanies the menopause has substantial effects on the tissues of the urogenital system, leading to atrophic changes. These changes can have negative effects on sexual and urinary function. The authors evaluate the repercussion of hypoestrogenism and sexual steroids on some elements of the pelvic floor and lower urinary tract. They summarize their research work and review significant published papers. They emphasize the changes in urinary mucosae, periurethral vessels, muscular layer, connective tissue, gene expression, autonomic nervous system receptors, as well as the main clinical aspects involved.
Asunto(s)
Estrógenos/deficiencia , Sistema Urinario/metabolismo , Urotelio/fisiología , Envejecimiento/fisiología , Animales , Atrofia , Colágeno/análisis , Colágeno/efectos de los fármacos , Ciclooxigenasa 1/genética , Terapia de Reemplazo de Estrógeno , Estrógenos/fisiología , Estrógenos/uso terapéutico , Matriz Extracelular/metabolismo , Femenino , Expresión Génica , Glicosaminoglicanos/metabolismo , Humanos , Ácido Hialurónico/metabolismo , Microcirculación/efectos de los fármacos , Músculo Liso/efectos de los fármacos , Neovascularización Fisiológica/efectos de los fármacos , Diafragma Pélvico/irrigación sanguínea , ARN Mensajero/metabolismo , Receptores Muscarínicos/efectos de los fármacos , Receptores Muscarínicos/fisiología , Moduladores Selectivos de los Receptores de Estrógeno/uso terapéutico , Incontinencia Urinaria/tratamiento farmacológico , Incontinencia Urinaria/fisiopatología , Sistema Urinario/irrigación sanguínea , Urotelio/efectos de los fármacos , Prolapso Uterino/fisiopatología , Vagina/metabolismo , Vagina/patología , Factor A de Crecimiento Endotelial Vascular/efectos de los fármacos , Factor A de Crecimiento Endotelial Vascular/genética , Factor A de Crecimiento Endotelial Vascular/metabolismo , Microglobulina beta-2/genéticaRESUMEN
UNLABELLED: Lack of estrogen affects the urinary tract mainly by diminishing vascular, muscular and epithelial trophism, resulting in negative effects on continence in postmenopausal women. Therefore, the use of estrogens in these patients may revert these alterations and lead to an expressive improvement of the urinary symptoms. OBJECTIVE: Study the effect of topical estrogen therapy (conjugated equine estrogens, estriol or promestriene) in periurethral vessels detected by Dopplervelocimetric analysis using, as parameters: the number of vessels, resistance and pulsatility indexes, as well as the minimum diastolic value. METHODS: Forty-one postmenopausal women with stress urinary incontinence were randomized into three groups according to different types of topical estrogen received during 3 months. Group 1 received conjugated equine estrogens, group 2 received estriol and group 3 received promestriene. Periurethral Dopplervelocimetry analysis was done before estrogen administration and during treatment in all groups. RESULTS: We observed an increase in the number of the periurethral vessels in group 1 and group 2, being higher in group 1 than in group 2. The pulsatility index remained unchanged in all three groups. The resistance index at the periurethral vessels reduced only at the conjugated estrogen group (group 1). In this same group we noticed an increase in the mean minimal diastolic value, meaning a better periurethral vascularization. CONCLUSION: Topical conjugated equine estrogens and estriol were effective in increasing the number of periurethral vessels in postmenopausal women with urinary stress incontinence, with the conjugated equine estrogens being the most effective intervention studied.
Asunto(s)
Estradiol/análogos & derivados , Estriol/administración & dosificación , Estrógenos Conjugados (USP)/administración & dosificación , Uretra/irrigación sanguínea , Incontinencia Urinaria de Esfuerzo/tratamiento farmacológico , Administración Intravaginal , Anciano , Estradiol/administración & dosificación , Terapia de Reemplazo de Estrógeno/métodos , Femenino , Humanos , Flujometría por Láser-Doppler/métodos , Persona de Mediana Edad , Posmenopausia , Estadísticas no Paramétricas , Ultrasonografía , Uretra/diagnóstico por imagen , Uretra/efectos de los fármacos , Incontinencia Urinaria de Esfuerzo/diagnóstico por imagenRESUMEN
UNLABELLED: The lack of estrogen affects the urinary tract mainly by diminishing vascular, muscular and epithelial trophism, resulting in negative effects on continence in postmenopausal women. OBJECTIVE: Study the effect of hormone therapy (estrogen and progesterone) in periurethral vessels detected by Doppler velocimetric analysis using, as parameters, the number of vessels, resistance and pulsatility indexes, as well as the minimum diastolic value. METHODS: Thirty-eight postmenopausal women with stress urinary incontinence were randomized into two groups. The first consisted of women receiving 3 months of estrogen therapy previous to 3 months of continuous estrogen and progesterone combined therapy. The second comprised of women receiving 3 months of continuous estrogen and progesterone therapy. Periurethral Doppler velocimetric analysis was done before hormone administration and during treatment in both groups. RESULTS: We observed a statistically significant increased number of periurethral vessels during treatment in both groups. There was an increase in value of the mean minimum diastolic value during estrogen and progesterone therapy in Group 2. The resistance indexes diminished in both groups. However, they were not statistically significant. CONCLUSION: Hormonal therapy of short duration (3-6 months) had a positive effect on the urethral continence mechanism increasing the number of periurethral vessels either with estrogen alone or combined therapy (estrogen and progesterone).