Vaginal estrogen therapy and overactive bladder symptoms in postmenopausal patients after a tension-free vaginal tape procedure: a randomized clinical trial.
OBJECTIVE
To evaluate whether the frequency of overactive bladder (OAB) symptoms increases in menopause patients after a tension-free vaginal tape (TVT) procedure, and to determine if topical estrogen therapy can help prevent these symptoms.


METHODS
After undergoing a preoperative assessment, enrolled patients were randomly allocated to receive TVT plus postoperative vaginal estrogen therapy (ET group) or TVT without adjunctive medical treatment (No ET group). The pre- and postoperative assessments included: acquisition of a urogynecologic history with standardized questions regarding urinary function (including a 10-grade visual analogue scale score), urogynecologic clinical examination, and urodynamic assessment. Follow-up assessments were performed at 1, 3, and 6 months after surgery.


RESULTS
Fifty-six of 59 patients were evaluable; 28 received topic vaginal estrogen after surgery (ET group) and 28 did not receive adjunctive medical treatment (No ET group). The overall OAB syndrome rate in menopause patients (No ET group) was 7% (2 of 28 patients) at baseline and 32% (9 of 28 patients) 6 months after surgery (P = 0.04). At the 6-month follow-up assessment, the incidence of urinary urgency was 4% (1 of 28 patients) and 29% (8 of 28 patients) in the ET and No ET groups, respectively (P = 0.01). Differences in frequency and nocturia were not statistically significant. Analysis of the visual analogue scale scores revealed that at the 6-month follow-up assessment, urgency significantly improved in the ET group compared with the No ET group (0.23 +/- 1.0 vs 2.30 +/- 3.7, respectively; P = 0.02).


CONCLUSIONS
The TVT procedure seems to increase the frequency of OAB syndrome in menopause patients. Vaginal estriol therapy significantly reduces symptoms of urinary urgency, has a high rate of patient satisfaction, and can be used to treat postmenopausal women for at least 6 months after a TVT procedure.
Zullo
Marzio Angelo
MA
Department of Obstetrics and Gynecology, Campus Bio-Medico University of Rome, Rome, Italy. m.zullo@unicampus.it
Plotti
Francesco
F
Calcagno
Marco
M
Palaia
Innocenza
I
Muzii
Ludovico
L
Manci
Natalina
N
Angioli
Roberto
R
Panici
Pierluigi Benedetti
PB
D000282:Administration, Intravaginal; D003131:Combined Modality Therapy; D004334:Drug Administration Schedule; D004964:Estriol / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008875:Middle Aged; D017698:Postmenopause; D011182:Postoperative Care; D011446:Prospective Studies; D013526:Surgical Mesh; D014550:Urinary Incontinence, Stress / Q000628:therapy*; D014563:Urodynamics; D013520:Urologic Surgical Procedures
D004964:Estriol