The use of oestradiol therapy in postmenopausal women after TVT-O anti-incontinence surgery.
OBJECTIVE
To investigate whether patients who were treated with TVT-O procedure for urodynamic stress incontinence had a significant improvement in their urodynamic findings and their post-operative symptoms (frequency, urgency, nocturia) if they were treated post-operatively with vaginal oestradiol for 6 months compared to the non-treated group.


METHODS
Prospective randomised study. 190 patients were asked to participate in our study. Finally, a total of 92 patients in group 1 and 91 patients in group 2 completed the study. In group 1, which was the treatment group, patients having the TVT-O procedure for urodynamic stress incontinence were instructed to use post-operatively oestradiol tablets, 25 micrograms (Vagifem, Novo Nordisk) vaginally, once daily, nocte, for 2 weeks and then twice weekly for 6 months. The patients in group 2 (control group) had the TVT-O procedure only. All patients were reviewed in 2 months and again in 6 months time.


RESULTS
There was no statistically significant difference between the two groups concerning pre-operative and post-operative haemoglobin, operative time, hospital stay or return to work. The within group analysis did not show significant differences between pre-operative and post-operative urodynamic data in both groups. Patients treated with vaginal estradiol post-operatively showed a statistically significant reduction in relation to the symptoms of urgency and frequency but not in relation to nocturia and urge incontinence compared to the non-treated group. There is no difference in relation to the efficacy of TVT-O procedure between the groups at 6 months follow-up.


CONCLUSIONS
It appears that vaginal oestradiol treatment could be offered to postmenopausal patients after a TVT-O procedure having the symptoms of frequency and urgency provided they are aware of the lack of evidence regarding long term benefit.
Department of Urogynaecology and Pelvic Floor Disorders, University of Athens, Aretaieion Hospital, Athens, Greece. eurotas@panafonet.gr
A
A
Liapis
P
P
Bakas
C
C
Georgantopoulou
G
G
Creatsas
D000287:Administration, Topical; D000368:Aged; D004958:Estradiol / Q000627:therapeutic use*; D015914:Estrogen Replacement Therapy; D005260:Female; D006454:Hemoglobins; D006801:Humans; D008875:Middle Aged; D053158:Nocturia / Q000517:prevention & control*; D017698:Postmenopause; D011183:Postoperative Complications / Q000188:drug therapy*; D011446:Prospective Studies; D053825:Suburethral Slings / Q000009:adverse effects*; D014550:Urinary Incontinence, Stress / Q000601:surgery*; D053202:Urinary Incontinence, Urge / Q000517:prevention & control*; D014563:Urodynamics / Q000187:drug effects; D014621:Vagina
D006454:Hemoglobins; D004958:Estradiol