Postmenopausal disorders with special reference to urinary incontinence : An epidemiological, experimental and clinical study

Abstract: A cross-sectional study of the whole female population of ages 61, 71 and 81 years in a defined part of Sweden was undertaken to investigate the prevalence and severity of postmenopausal symptoms, especially lower genital tract disorders, and to relate their symptoms to reported oestrogen replacement therapy (ERT) (studies I and II). A new substance for endoscopic treatment of urinary incontinence, dextranomers in hyaluronan, (DiHA), was monitored experimentally in terms of tissue reaction, volume changes, DNA changes (study III), and possible migration of particles to distant organs (study IV). Subsequently a clinical study on a group of stress-incontinent women was undertaken to investigate the safety of DiHA,elaborate the technique of its use and assess its efficacy in treatment (study V).The questionnaire sent out was answered by 84%, 87% and 62% of the women in respective age-groups. The use of ERT was reported to be 34%, 25% and 16%. The most prevalent disorder was urinary incontinence, reported by more than half of the women. Very few had undergone surgery for this disorder. ERT had beenoffered but gave little relief. Non-invasive endoscopic treatment for urinary incontinence has tentative advantages in being a simple day-care procedure, having few complications in the short term, and being easily accepted by the patients. DiHA, used in these experimental studies (studies III and IV) was well tolerated by tissues, had no significant side-effects, caused no malignant transformation, tissue necrosis, calcification or significant eosinophilia, and no distant migration occurred (study IV). In the clinical study on 20 stress-incontinent women (study V) the treatment was readily accepted and few side-effects were noted. Cure or improvement from the treatment was experienced by 85% of the women.Urinary incontinence is a major not fully acknowledged problem for elderly women. Simple treatment modalities are needed. Endoscopic treatment appears to be a promising alternative.