A systematic review of estrogens for recurrent urinary tract infections: Third report of the Hormones and Urogenital Therapy (HUT) Committee

Our objective was to apply a meta-analysis to the available data to evaluat e the effect of estrogen supplementation in the prevention of recurrent uri nary tract infections in postmenopausal women. The literature review incorp orated articles based on a search of Excerpta Medica, Medline, Science Cita tion Index and a manual search of commonly read journals in the fields of u rology, gynecology, gerontology and primary healthcare, from January 1969 t o December 1998. The search was not limited to English-language publication s. Inclusion criteria were peer-reviewed articles containing original data with a primary outcome of symptomatic urinary tract infections and an estro gen-treated group. Articles were categorized into randomized controlled tri als, case-control studies and self-controlled series. Of the articles revie wed, five were randomized controlled trials, two were case-control studies and three were self-control series. Mete-analysis of data from 334 subjects revealed a significant benefit from estrogen over placebo (odds ratio = 2. 51, 95% confidence interval = 1.48-4.25). The most convincing results were obtained using the vaginal route of administration. A variety of different estrogen preparations have been employed in the few published reports, maki ng comparison of the data difficult. However, vaginal administration seems to be effective in the prevention of recurrent urinary tract infections in postmenopausal women.