Low dose intravaginal estriol and pelvic floor rehabilitation in post-menopausal stress urinary incontinence

Authors and affiliations:                                                                                                                                               
Giovanni Giovanditti1; Pietro Saldutto1; Daniele Castellani1; Vikiela Galica1; Daniela Biferi1; Cristian Cicconetti1; Giuseppe Paradiso Galatioto1; Carlo Vicentini1.
1 Department of Health Science, University of L'Aquila, Teramo Hospital, Italy

Topic: Stress urinary incontinence.
Abstract                                                                                                                                 
Objective. Pelvic floor muscle training (PFMT) and electrical stimulation (ES) are conservative therapy of female stress urinary incontinence (SUI). The presence of estradiol receptors in the lower urinary tract advance the case for estradiol therapy in SUI. The aim of our study was to investigate the effects of the combination of pelvic floor rehabilitation and intravaginal estriol (IE) on SUI treatment in postmenopausal women.                                                                                     
Materials and Methods. Sixty-two women complaining SUI were randomized to PFMT, ES and biofeedback (Group 1) or the same treatment plus 1 mg IE (Group 2) for 6-months. Patients were evaluated with medical history, pelvic examination, urodynamics, 24-hour pad test. Urinary incontinence was evaluated using the International Consultation on Incontinence questionnaire on urinary incontinence short form and quality of life using the Incontinence Impact Questionnaire–Short Form.                                                                                                                                
Results. Two patients were lost at follow-up and one discontinued the study.   Mean urine leakage at the 24h-pad test dropped from 42,3±20,2 gr/die to 31,5±14,2 gr/die in group 1 and from 48,3±19,8 gr/die to 22,3±10,1 gr/die in group 2. Symptoms scores and incontinence status were statistically significant better in group 2 respect to group 1.                                               
Conclusion. IE added to PFMT, ES and BF is a safe and efficacious first-line therapy in postmenopausal women with SUI.
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