Journal of Menopausal Medicine

The Korean Society of Menopause (대한폐경학회)
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Changes of Urinary Tract after Menopause and Effectiveness of Menopausal Hormone Replacement Therapy

폐경 후 요로계 변화와 폐경호르몬치료 효과

  • Kim, Jun Mo (Department of Urology, Soonchunhyang University Bucheon Hospital) ;
  • Kim, Tae Hee (Department of Obstetrics and Gynecology, Soonchunhyang University Bucheon Hospital)
  • 김준모 (순천향대학교 부천병원 비뇨기과) ;
  • 김태희 (순천향대학교 부천병원 산부인과)
  • Published : 2011.12.31
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Abstract

Because sex hormones influence the lower urinary tract, menopause can cause several urinary diseases including overactive bladder, stress urinary incontinence and recurrent urinary tract infection. However, the results of many clinical studies have indicated that menopausal hormone replacement therapy is not effective for the treatment of previous diseases, especially via the oral route. Although estrogen vaginal cream or pessary is an effective treatment for overactive bladders and can prevent recurrent urinary tract infection, its beneficial effects only last for the duration of the treatment. If patients with previous mentioned urologic disease have other local symptoms and conditions, such as atrophic vaginitis and dyspareunia, local estrogen replacement therapy will be helpful in relieving the local symptoms. However, the potential for breast cancer or return of withdrawal of bleeding, patient's age, adverse effect of systemic administration, estrogen-progesterone combination therapy, and effectiveness among other treatment modalities must be considered before a treatment decision can be made. In this article, we will review the current issues on the relationship among urinary tract and sex hormone and menopause, and the effectiveness of menopausal hormone replacement therapy for the treatment of overactive bladders, stress urinary tract incontinence and recurrent urinary tract infection.

폐경 후 여성호르몬 감소에 따른 요로기능의 변화로 과민성 방광, 복압성 요실금, 재발성 요로감염과 같은 질환의 발생률이 높아지게 된다. 본 연구는 여성호르몬이 하부요로기능에 미치는 영향 및 폐경 후 요로기능의 변화와 함께 여러 형태의 폐경호르몬요법에 따른 과민성 방광, 복압성 요실금, 재발성의 치료 또는 예방효과에 대해서 보고자 한다.

Keywords

References

  1. Robinson D, Cardozo L. Estrogens and the lower urinary tract. Neurourol Urodyn 2011; 30: 754-7. https://doi.org/10.1002/nau.21106
  2. Iosif CS, Batra S, Ek A, Astedt B. Estrogen receptors in the human female lower uninary tract. Am J Obstet Gynecol 1981; 141: 817-20. https://doi.org/10.1016/0002-9378(81)90710-9
  3. Batra SC, Iosif CS. Progesterone receptors in the female lower urinary tract. J Urol 1987; 138: 1301-4. https://doi.org/10.1016/S0022-5347(17)43588-9
  4. Van Geelen JM, Doesburg WH, Thomas CM, Martin CB Jr. Urodynamic studies in the normal menstrual cycle: the relationship between hormonal changes during the menstrual cycle and the urethral pressure profile. Am J Obstet Gynecol 1981; 141: 384-92. https://doi.org/10.1016/0002-9378(81)90599-8
  5. Hextall A, Bidmead J, Cardozo L, Hooper R. The impact of the menstrual cycle on urinary symptoms and the results of urodynamic investigation. BJOG 2001; 108: 1193-6.
  6. Rechberger T, Skorupski P. The controversies regarding the role of estrogens in urogynecology. Folia Histochem Cytobiol 2007; 45 Suppl 1: S17-21.
  7. Samsioe G. Urogenital aging--a hidden problem. Am J Obstet Gynecol 1998; 178: S245-9. https://doi.org/10.1016/S0002-9378(98)70555-1
  8. Hextall A, Cardozo L. The role of estrogen supplementation in lower urinary tract dysfunction. Int Urogynecol J Pelvic Floor Dysfunct 2001; 12: 258-61. https://doi.org/10.1007/s001920170049
  9. Stamey TA, Timothy MM. Studies of introital colonization in women with recurrent urinary infections. I. The role of vaginal pH. J Urol 1975; 114: 261-3.
  10. Molander U, Milsom I, Ekelund P, Mellstrom D, Eriksson O. Effect of oral oestriol on vaginal flora and cytology and urogenital symptoms in the post-menopause. Maturitas 1990; 12: 113-20. https://doi.org/10.1016/0378-5122(90)90089-O
  11. Milsom I, Arvidsson L, Ekelund P, Molander U, Eriksson O. Factors influencing vaginal cytology, pH and bacterial flora in elderly women. Acta Obstet Gynecol Scand 1993; 72: 286-91. https://doi.org/10.3109/00016349309068039
  12. Lee YS, Lee KS, Jung JH, Han DH, Oh SJ, Seo JT, et al. Prevalence of overactive bladder, urinary incontinence, and lower urinary tract symptoms: results of Korean EPIC study. World J Urol 2011; 29: 185-90. https://doi.org/10.1007/s00345-009-0490-1
  13. Iosif CS, Bekassy Z. Prevalence of genito-urinary symptoms in the late menopause. Acta Obstet Gynecol Scand 1984; 63: 257-60. https://doi.org/10.3109/00016348409155509
  14. Brown JS, Vittinghoff E, Kanaya AM, Agarwal SK, Hulley S, Foxman B. Urinary tract infections in postmenopausal women: effect of hormone therapy and risk factors. Obstet Gynecol 2001; 98: 1045-52. https://doi.org/10.1016/S0029-7844(01)01630-1
  15. Foxman B, Barlow R, D'Arcy H, Gillespie B, Sobel JD. Urinary tract infection: self-reported incidence and associated costs. Ann Epidemiol 2000; 10: 509-15. https://doi.org/10.1016/S1047-2797(00)00072-7
  16. Harrington RD, Hooton TM. Urinary tract infection risk factors and gender. J Gend Specif Med 2000; 3: 27-34.
  17. Hooton TM, Scholes D, Hughes JP, Winter C, Roberts PL, Stapleton AE, et al. A prospective study of risk factors for symptomatic urinary tract infection in young women. N Engl J Med 1996; 335: 468-74. https://doi.org/10.1056/NEJM199608153350703
  18. Falconer C, Ekman G, Malmstrom A, Ulmsten U. Decreased collagen synthesis in stress-incontinent women. Obstet Gynecol 1994; 84: 583-6.
  19. Jackson S, Shepherd A, Brookes S, Abrams P. The effect of oestrogen supplementation on post-menopausal urinary stress incontinence: a double-blind placebo-controlled trial. Br J Obstet Gynaecol 1999; 106: 711-8. https://doi.org/10.1111/j.1471-0528.1999.tb08372.x
  20. Rechberger T, Postawski K, Jakowicki JA, Gunja-Smith Z, Woessner JF Jr. Role of fascial collagen in stress urinary incontinence. Am J Obstet Gynecol 1998; 179: 1511-4. https://doi.org/10.1016/S0002-9378(98)70017-1
  21. Jackson S, James M, Abrams P. The effect of oestradiol on vaginal collagen metabolism in postmenopausal women with genuine stress incontinence. BJOG 2002; 109: 339-44. https://doi.org/10.1111/j.1471-0528.2002.01052.x
  22. Fleischmann N, Christ G, Sclafani T, Melman A. The effect of ovariectomy and long-term estrogen replacement on bladder structure and function in the rat. J Urol 2002; 168: 1265-8. https://doi.org/10.1016/S0022-5347(05)64637-X
  23. Robinson D, Rainer RO, Washburn SA, Clarkson TB. Effects of estrogen and progestin replacement on the urogenital tract of the ovariectomized cynomolgus monkey. Neurourol Urodyn 1996; 15: 215-21. https://doi.org/10.1002/(SICI)1520-6777(1996)15:3<215::AID-NAU6>3.0.CO;2-I
  24. 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: 12-8.
  25. Wilson PD, Faragher B, Butler B, Bu'Lock D, Robinson EL, Brown AD. Treatment with oral piperazine oestrone sulphate for genuine stress incontinence in postmenopausal women. Br J Obstet Gynaecol 1987; 94: 568-74. https://doi.org/10.1111/j.1471-0528.1987.tb03152.x
  26. Moehrer B, Hextall A, Jackson S. Oestrogens for urinary incontinence in women. Cochrane Database Syst Rev 2003; 2: CD001405.
  27. Sultana CJ, Walters MD. Estrogen and urinary incontinence in women. Maturitas 1994; 20: 129-38. https://doi.org/10.1016/0378-5122(94)90008-6
  28. Ishiko O, Hirai K, Sumi T, Tatsuta I, Ogita S. Hormone replacement therapy plus pelvic floor muscle exercise for postmenopausal stress incontinence. A randomized, controlled trial. J Reprod Med 2001; 46: 213-20.
  29. Cardozo L, Lose G, McClish D, Versi E, de Koning Gans H. A systematic review of estrogens for recurrent urinary tract infections: third report of the hormones and urogenital therapy (HUT) committee. Int Urogynecol J Pelvic Floor Dysfunct 2001; 12: 15-20. https://doi.org/10.1007/s001920170088
  30. Bhatia NN, Bergman A, Karram MM. Effects of estrogen on urethral function in women with urinary incontinence. Am J Obstet Gynecol 1989; 160: 176-81. https://doi.org/10.1016/0002-9378(89)90114-2
  31. Simunic V, Banovic I, Ciglar S, Jeren L, Pavicic Baldani D, Sprem M. Local estrogen treatment in patients with urogenital symptoms. Int J Gynaecol Obstet 2003; 82: 187-97. https://doi.org/10.1016/S0020-7292(03)00200-5
  32. Serati M, Salvatore S, Uccella S, Cardozo L, Bolis P. Is there a synergistic effect of topical oestrogens when administered with antimuscarinics in the treatment of symptomatic detrusor overactivity? Eur Urol 2009; 55: 713-9. https://doi.org/10.1016/j.eururo.2008.06.051
  33. Ewies AA, Alfhaily F. Topical vaginal estrogen therapy in managing postmenopausal urinary symptoms: a reality or a gimmick? Climacteric 2010; 13: 405-18. https://doi.org/10.3109/13697137.2010.500748
  34. Fu X, Rezapour M, Wu X, Li L, Sjogren C, Ulmsten U. Expression of estrogen receptor-alpha and -beta in anterior vaginal walls of genuine stress incontinent women. Int Urogynecol J Pelvic Floor Dysfunct 2003; 14: 276-81. https://doi.org/10.1007/s00192-003-1042-7
  35. Cody JD, Richardson K, Moehrer B, Hextall A, Glazener CM. Oestrogen therapy for urinary incontinence in post-menopausal women. Cochrane Database Syst Rev 2009; 4: CD001405.
  36. Raz R, Stamm WE. A controlled trial of intravaginal estriol in postmenopausal women with recurrent urinary tract infections. N Engl J Med 1993; 329: 753-6. https://doi.org/10.1056/NEJM199309093291102
  37. Eriksen B. A randomized, open, parallel-group study on the preventive effect of an estradiol-releasing vaginal ring (Estring) on recurrent urinary tract infections in postmenopausal women. Am J Obstet Gynecol 1999; 180: 1072-9. https://doi.org/10.1016/S0002-9378(99)70597-1
  38. Raz R, Colodner R, Rohana Y, Battino S, Rottensterich E, Wasser I, et al. Effectiveness of estriol-containing vaginal pessaries and nitrofurantoin macrocrystal therapy in the prevention of recurrent urinary tract infection in postmenopausal women. Clin Infect Dis 2003; 36: 1362-8. https://doi.org/10.1086/374341
  39. Xu R, Wu Y, Hu Y. Prevention and treatment of recurrent urinary system infection with estrogen cream in postmenopausal women. Zhonghua Fu Chan Ke Za Zhi 2001; 36: 531-3.
  40. Cardozo L, Benness C, Abbott D. Low dose oestrogen prophylaxis for recurrent urinary tract infections in elderly women. Br J Obstet Gynaecol 1998; 105: 403-7. https://doi.org/10.1111/j.1471-0528.1998.tb10124.x

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