ABSTRACT
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.
Subject(s)
Estrogens/deficiency , Urinary Tract/metabolism , Urothelium/physiology , Aging/physiology , Animals , Atrophy , Collagen/analysis , Collagen/drug effects , Cyclooxygenase 1/genetics , Estrogen Replacement Therapy , Estrogens/physiology , Estrogens/therapeutic use , Extracellular Matrix/metabolism , Female , Gene Expression , Glycosaminoglycans/metabolism , Humans , Hyaluronic Acid/metabolism , Microcirculation/drug effects , Muscle, Smooth/drug effects , Neovascularization, Physiologic/drug effects , Pelvic Floor/blood supply , RNA, Messenger/metabolism , Receptors, Muscarinic/drug effects , Receptors, Muscarinic/physiology , Selective Estrogen Receptor Modulators/therapeutic use , Urinary Incontinence/drug therapy , Urinary Incontinence/physiopathology , Urinary Tract/blood supply , Urothelium/drug effects , Uterine Prolapse/physiopathology , Vagina/metabolism , Vagina/pathology , Vascular Endothelial Growth Factor A/drug effects , Vascular Endothelial Growth Factor A/genetics , Vascular Endothelial Growth Factor A/metabolism , beta 2-Microglobulin/geneticsABSTRACT
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.
Subject(s)
Estradiol/analogs & derivatives , Estriol/administration & dosage , Estrogens, Conjugated (USP)/administration & dosage , Urethra/blood supply , Urinary Incontinence, Stress/drug therapy , Administration, Intravaginal , Aged , Estradiol/administration & dosage , Estrogen Replacement Therapy/methods , Female , Humans , Laser-Doppler Flowmetry/methods , Middle Aged , Postmenopause , Statistics, Nonparametric , Ultrasonography , Urethra/diagnostic imaging , Urethra/drug effects , Urinary Incontinence, Stress/diagnostic imagingABSTRACT
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).