The role of estrogens in female lower urinary tract dysfunction
The role of estrogens in female lower urinary tract dysfunction
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DOI：
10.1016/s0090-4295(03)00676-9
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发表时间：
2003-10-01
期刊：
影响因子：
2.1
通讯作者：
Cardozo, LD
中科院分区：
文献类型：
--
作者：
Robinson, D;Cardozo, LD
成年后，泌尿生殖道和下尿路对雌激素和黄体酮的影响非常敏感。流行病学研究表明，雌激素缺乏与绝经后出现的下尿路症状有关。尽管雌激素替代疗法在绝经后尿失禁(UI)治疗中的作用仍然存在争议，但它在女性泌尿生殖器萎缩的治疗中的应用现在已经得到了很好的证实。本文综述了激素治疗对泌尿生殖系统影响的最新证据，特别强调绝经后尿路感染和复发性下尿路感染的治疗。单用雌激素治疗对尿动力应激性尿失禁的治疗效果甚微，尽管与α-肾上腺素能激动剂联合使用，可能会改善尿漏。雌激素治疗对于尿急、尿频和尿失禁等刺激性症状可能是有益的，尽管这种效果可能是由于泌尿生殖系统萎缩的逆转而不是对下尿路的直接作用。雌激素替代疗法在治疗女性反复下尿路感染中的作用仍有待确定，尽管现在有一些证据表明，阴道给药可能是有效的。低剂量、经阴道给药的雌激素在治疗绝经后妇女的泌尿生殖器萎缩方面有一定作用，而且似乎与全身制剂一样有效。(C)2003年爱思唯尔公司。
The urogenital tract and lower urinary tract are sensitive to the effects of estrogen and progesterone throughout adult life. Epidemiologic studies have implicated estrogen deficiency in the etiology of lower urinary tract symptoms that occur after menopause. Although the role of estrogen replacement therapy in the management of postmenopausal urinary incontinence (UI) remains controversial, its use in the treatment of women with urogenital atrophy is now well established. This review summarizes recent evidence of the urogenital effects of hormone therapy, particularly emphasizing management of postmenopausal UI and recurrent lower urinary tract infections. Estrogen therapy alone has little effect in the management of urodynamic stress UI, although in combination with an alpha-adrenergic agonist, it may improve urinary leakage. Estrogen therapy may be of benefit for the irritative symptoms of urinary urgency, frequency, and urge UI, although this effect may result from reversal of urogenital atrophy rather than a direct action on the lower urinary tract. The role of estrogen replacement therapy in the treatment of women with recurrent lower urinary tract infections remains to be determined, although there is now some evidence that vaginal administration may be efficacious. Low-dose, vaginally administered estrogens have a role in the treatment of urogenital atrophy in postmenopausal women and appear to be as effective as systemic preparations. (C) 2003 Elsevier Inc.