Clinical and urethral epithelium response to the estrogen therapy in postmenopausal genuine stress incontinence

The present work had studied the response of the urethral epithelium in postmenopausal women, suffered from genuine stress incontinence to local estrogen therapy and the role of such response in the mechanism of continence. A total of 27 women in postmenopausal age referred to the gynacologist with lower urinary tract symptoms including incontinence were examined and clinically evaluated to segregate cases with genuine stress incontinence. They all had [the stress after bladder filling test] to enhance the clinical identification and quantification of urine incontinence. Sixteen women were diagnosed to have postmenopausal genuine stress incontinence ranging in its degree between mild, moderate and severe degree [5, 8, 3 women respectively]. All women were treated with 2g daily of estrogen vaginal cream for 4 weeks. Urethral smears from the midurethra were taken before and after treatment for cytological subjectively and objectively by 62.5% of cases. The cytologic changes seen in the urethral smear reflected a positive maturation index of the transitional epithelium that correlated well with the clinical response to estrogen treatment [P 0.05]. Women who did not improve clinically with treatment had no significant change in urethral cytology. The results of the present study suggested that the improvement of postmenopausal genuine stress incontinence after estrogen administration is achieved by affecting the urethral softness factor. Which in return might have increased the urethral resistance and the improved the urethral closure