CLINICAL EFFECTS OF PREOPERATIVE ESTRADIOL TREATMENT BEFORE VAGINAL REPAIR OPERATION

The objective of the study was to assess the effects of low-dose vagin al treatment with oestradiol before vaginal operation. In a double-bli nd randomized study including 43 postmenopausal women scheduled for va ginal repair operation for genital descensus, it was found that 7 pati ents suffered from concomitant urinary stress incontinence. Vagifem(R) (25 mu g oestradiol) or placebo was administered as vaginal pessaries daily, 3 weeks prior to surgery and the clinical effects evaluated. O ne month postoperatively the prevalence of bacteriuria (> 100,000 CFU/ ml urine) was significantly lower when using oestradiol than in the pl acebo group. At follow-up 3 years later 40 women (93%) answered the qu estionnaires. None received hormone replacement therapy. Nineteen perc ent in the preoperative oestradiol group and 11% in the preoperative p lacebo group had had more than two episodes of cystitis treated with a ntibiotics. This difference is not statistically significant (p > 0.05 ). Recurrent cystitis was not correlated to bacteriuria postoperativel y. Seventy-nine percent of the women with genital prolapse but only 29 % of the women with concomitant urinary stress incontinence were cured (p < 0.05). Neither preoperative oestradiol treatment nor body weight had any influence on relapse. Preoperative low-dose vaginal oestradio l treatment may reduce the incidence of bacteriuria in the immediate p ostoperative period but no long-lasting effects on recurrent cystitis or relapse were seen. Longer-lasting hormone replacement therapy may b e necessary to achieve lasting effects.