Clinical Effects of Preoperative Oestradiol Treatment before Vaginal Repair Operation

Abstract

The objective of the study was to assess the effects of low-dose vaginal treatment with oestradiol before vaginal operation. In a double-blind randomized study including 43 postmenopausal women scheduled for vaginal repair operation for genital descensus, it was found that 7 patients suffered from concomitant urinary stress incontinence. Vagifem® (25 µg oestradiol) or placebo was administered as vaginal pessaries daily, 3 weeks prior to surgery and the clinical effects evaluated. One month postoperatively the prevalence of bacteriuria ( > 100,000 CFU/ml urine) was significantly lower when using oestradiol than in the placebo group. At follow-up 3 years later 40 women (93%) answered the questionnaires. None received hormone replacement therapy. Nineteen percent in the preoperative oestradiol group and 11% in the preoperative placebo group had had more than two episodes of cystitis treated with antibiotics. This difference is not statistically significant (p > 0.05). Recurrent cystitis was not correlated to bacteriuria postoperatively. 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 oestradiol treatment may reduce the incidence of bacteriuria in the immediate postoperative period but no long-lasting effects on recurrent cystitis or relapse were seen. Longer-lasting hormone replacement therapy may be necessary to achieve lasting effects.

Urinary tract infections after pelvic floor gynecological surgery: prevalence and effect of antimicrobial prophylaxis. A systematic review

“…Estrogens are used to control the colonization of uropathogens by decreasing the vaginal pH and promoting the colonization of lactobacilli [27]. The potential role of preoperative hormone replacement therapy is also examined in some studies [28]. Although estradiol replacement in postmenopausal women may reduce the incidence of UTIs by modifying the vaginal flora [26] and by estrogen stimulation of the urethral epithelium, Mikkelsen et al showed that preoperative estradiol treatment before vaginal repair operation might reduce the incidence of bacteriuria in the immediate postoperative period but no long-lasting effects on recurrent cystitis were seen [28].…”

Fast track vaginal surgery

“…Several factors may influence morbidity, hospital stay and the speed of restitution after surgery (12,19,20). The surgical stress response, postoperative pain, immobilization and semi-starvation cause a catabolic state and organ distress, i.e.…”

Randomised controlled trial to investigate the effectiveness of local oestrogen treatment in postmenopausal women undergoing pelvic organ prolapse surgery (LOTUS): a pilot study to assess feasibility of a large multicentre trial

“…Among women planning to undergo surgical repair for prolapse, three studies have reported on preoperative vaginal oestrogen by various methods, compared with placebo or no treatment, with a total of 111 participants. [10][11][12] Follow-up varied from 12 weeks to 3 years of postoperative surveillance. No vaginal oestrogen was given following surgery.…”