title: Clinical effects of preoperative oestradiol treatment before vaginal repair operation. A double-blind, randomized trial.
abstract: The objective of the study was to assess the effects of low-dose vaginal treatment with oestradiol before vaginal operation. In a double-blind randomized study including 43 postmenopausal women scheduled for vaginal repair operation for genital descensus, it was found that 7 patients suffered from concomitant urinary stress incontinence. Vagifem (25 micrograms oestradiol) or placebo was administered as vaginal pessaries daily, 3 weeks prior to surgery and the clinical effects evaluated. One month postoperatively the prevalence of bacteriuria (> 100,000 CFU/ml urine) was significantly lower when using oestradiol than in the placebo group. At follow-up 3 years later 40 women (93%) answered the questionnaires. None received hormone replacement therapy. Nineteen percent in the preoperative oestradiol group and 11% in the preoperative placebo group had had more than two episodes of cystitis treated with antibiotics. This difference is not statistically significant (p > 0.05). Recurrent cystitis was not correlated to bacteriuria postoperatively. Seventy-nine percent of the women with genital prolapse but only 29% of the women with concomitant urinary stress incontinence were cured (p < 0.05). Neither preoperative oestradiol treatment nor body weight had any influence on relapse. Preoperative low-dose vaginal oestradiol treatment may reduce the incidence of bacteriuria in the immediate postoperative period but no long-lasting effects on recurrent cystitis or relapse were seen. Longer-lasting hormone replacement therapy may be necessary to achieve lasting effects.
authors.affiliation: Department of Obstetrics and Gynaecology, University of Copenhagen, Gentofte County Hospital, Hellerup, Denmark.
authors.forename: A L
authors.initials: AL
authors.lastname: Mikkelsen
authors.forename: C
authors.initials: C
authors.lastname: Felding
authors.forename: H V
authors.initials: HV
authors.lastname: Clausen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001437:Bacteriuria / Q000453:epidemiology / Q000517:prevention & control; D003556:Cystitis / Q000453:epidemiology / Q000517:prevention & control; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D004958:Estradiol / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D008875:Middle Aged; D010570:Pessaries; D011184:Postoperative Period; D011292:Premedication; D015995:Prevalence; D011795:Surveys and Questionnaires; D014550:Urinary Incontinence, Stress / Q000209:etiology; D014596:Uterine Prolapse / Q000150:complications / Q000188:drug therapy / Q000601:surgery*; D014621:Vagina / Q000187:drug effects / Q000601:surgery*
chemical_list: D004958:Estradiol