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.
Liapis
A
A
Department of Urogynaecology and Pelvic Floor Disorders, University of Athens, Aretaieion Hospital, Athens, Greece. eurotas@panafonet.gr
Bakas
P
P
Georgantopoulou
C
C
Creatsas
G
G
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