Introduction: Pelvic floor muscle training (PFMT) and electrical stimulation (ES) are conservative models of therapy for treating female stress urinary incontinence (SUI). The presence of estradiol receptors in the lower urinary tract advances the case for estradiol therapy in SUI. The aim of our study was to investigate the effects of the combination of pelvic floor rehabilitation and intravaginal estriol (IE) on SUI treatment in postmenopausal women. Material and Methods: Sixty-two women with SUI were randomized to PFMT, ES and biofeedback (Group 1) or the same treatment plus 1 mg IE (Group 2) for 6 months. Patients were evaluated with medical history, pelvic examination, urodynamics, 24-hour pad test. Urinary incontinence was evaluated using the International Consultation on Incontinence questionnaire on urinary incontinence short form and quality of life using the Incontinence Impact Questionnaire-Short Form. Results: Two patients were lost at follow-up and one discontinued the study. Mean urine leakage at the 24-hour pad test dropped from 42.3 ± 20.2 g/die to 31.5 ± 14.2 g/die in Group 1 and from 48.3 ± 19.8 g/die to 22.3 ± 10.1 g/die in Group 2. Symptoms scores and incontinence status were statistically significant better in Group 2 when compared to Group 1. Conclusion: IE added to PFMT, ES and BF is a safe and efficacious first-line therapy in postmenopausal women with SUI.

Keywords:
Pelvic floor dysfunction female, Urinary incontinence, Estriol, Pelvic floor muscle training, Postmenopause
1.
Botlero R, Urquhart DM, Davis SR, Bell RJ: Prevalence and incidence of urinary incontinence in women: review of the literature and investigation of methodological issues. Int J Urol 2008;15:230-234.
2.
Wu JM, Matthews CA, Conover MM, Pate V, Jonsson Funk M: Lifetime risk of stress urinary incontinence or pelvic organ prolapse surgery. Obstet Gynecol 2014;123:1201-1206.
3.
Lucas MG, Bosch RJ, Burkhard FC, Cruz F, et al: EAU guidelines on assessment and nonsurgical management of urinary incontinence. Eur Urol 2012;62:1130-1142.
4.
Berghmans LC, Hendriks HJ, De Bie RA, et al: Conservative treatment of urge urinary incontinence in women: a systematic review of randomized clinical trials. BJU Int 2000;85:254-263.
5.
Losif CS, Batra S, Ek A, Astedt B: Estrogen receptors in the human female lower urinary tract. Am J Obstet Gynecol 1981;141:817-820.
6.
Cody JD, Jacobs ML, Richardson K, et al: Oestrogen therapy for urinary incontinence in post-menopausal women. Cochrane Database Syst Rev 2012;10:CD001405.
7.
Fantl JA, Cardozo L, McClish DK: Estrogen therapy in the management of urinary incontinence in postmenopausal women: a meta-analysis. First report of the hormones and urogenital therapy committee. Obstet Gynecol 1994;83:12-18.
8.
Bump RC, Mattiasson A, Bø K, et al: The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol 1996;175:10-17.
9.
Schäfer W, Abrams P, Liao L, Mattiasson A, et al: Good urodynamic practices: uroflowmetry, filling cystometry, and pressure-flow studies. Neurourol Urodyn 2002;21:261-274.
10.
O'Sullivan R, Karantanis E, Stevermuer TL, et al: Definition of mild, moderate and severe incontinence on the 24-hour pad test. BJOG 2004;111:859-862.
11.
Cetinel B, Demirkesen O, Onal B, Erdal S, Gezer M: Is it possible to predict urodynamic stress urinary incontinence in women with minimal diagnostic evaluation? Urol Int 2014;93:444-448.
12.
Avery K, Donovan J, Peters TJ, Shaw C, Gotoh M, Abrams P: ICIQ: a brief and robust measure for evaluating the symptoms and impact of urinary incontinence. Neurourol Urodyn 2004;23:322-330.
13.
Uebersax JS, Wyman JF, Shumaker SA, McClish DK, Fantl JA: Short forms to assess life quality and symptom distress for urinary incontinence in women: the incontinence impact questionnaire and the urogenital distress inventory. Continence program for women research group. Neurourol Urodyn 1995;14:131-139.
14.
Losif CS, Bekassy Z: Prevalence of genito-urinary symptoms in the late menopause. Acta Obstet Gynecol Scand 1984;63:257-260.
15.
Grady D, Brown JS, Vittinghoff E, et al: Postmenopausal hormones and incontinence: the heart and estrogen/progestin replacement study. Obstet Gynecol 2001;97:116-120.
16.
Grodstein F, Lifford K, Resnick NM, et al: Postmenopausal hormone therapy and risk of developing urinary incontinence. Obstet Gynecol 2004;103:254-260.
17.
Hendrix SL, Cochrane BB, Nygaard IE, et al: Effects of estrogen with and without progestin on urinary incontinence. JAMA 2005;293:935-948.
18.
Keane DP, Sims TJ, Abrams P, et al: Analysis of collagen status in premenopausal nulliparous women with genuine stress incontinence. Br J Obstet Gynecol 1997;104:994-998.
19.
Edwall L, Carlström K, Jonasson AF: Endocrine status and markers of collagen synthesis and degradation in serum and urogenital tissue from women with and without stress urinary incontinence. Neurourol Urodyn 2007;26:410-415.
20.
Falconer C, Blomgren B, Johansson O, et al: Different organization of collagen fibrils in stress-incontinent women of fertile age. Acta Obstet Gynecol Scand 1998;77:87-94.
21.
Dessole S, Rubattu G, Ambrosini G, Gallo O, Capobianco G, Cherchi PL, Marci R, Cosmi E: Efficacy of low-dose intravaginal estriol on urogenital aging in postmenopausal women. Menopause 2004;11:49-56.
22.
Heimer GM, Englund DE: Effects of vaginally-administered oestriol on post-menopausal urogenital disorders: a cytohormonal study. Maturitas 1992;14:171-179.
23.
Kegel AH: Physiologic therapy for urinary stress incontinence. J Am Med Assoc 1951;146:915-917.
24.
Robinson D, Cardozo L: Estrogens and the lower urinary tract. Neurourol Urodyn 2011;30:754-757.
25.
Lose G, Englev E: Estradiol-releasing vaginal ring versus oestriol vaginal pessaries in the treatment of bothersome lower urinary tract symptoms. BJOG 2000;107:1029-1034.
26.
Beisland HO, Fossberg E, Moer A, Sander S: Urethral sphincteric insufficiency in postmenopausal females: treatment with phenylpropanolamine and estriol separately and in combination. A urodynamic and clinical evaluation. Urol Int 1984;39:211-216.
27.
Iosif CS: Effects of protracted administration of estriol on the lower genito urinary tract in postmenopausal women. Arch Gynecol Obstet 1992;251:115-120.
28.
Bhatia NN, Bergman A, Karram MM: Effects of estrogen on urethral function in women with urinary incontinence. Am J Obstet Gynecol 1989;160:176-181.
29.
Hilton P, Stanton SL: The use of intravaginal oestrogen cream in genuine stress incontinence. Br J Obstet Gynaecol 1983;90:940-944.
30.
Capobianco G, Donolo E, Borghero G, Dessole F, Cherchi PL, Dessole S: Effects of intravaginal estriol and pelvic floor rehabilitation on urogenital aging in postmenopausal women. Arch Gynecol Obstet 2012;285:397-403.
31.
Tarcan T, Mangir N, Sahan A, Tanidir Y, Sulukaya M, İlker Y: Safety and efficacy of retropubic or transobturator midurethral slings in a randomized cohort of Turkish women. Urol Int 2014;93:449-453.
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2015
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