Oestrogens for Preventing Recurrent Urinary Tract Infection in Postmenopausal Women

摘要

BACKGROUND: Recurrent urinary tract infection (RUT1) is defined as three episodes of urinary tract infection (UTI) in the previous 12 months or two episodes in the last six months. The main factors associated with RUTI in postmenopausal women are vesical prolapse, cystocoele, post-voidal residue, and urinary incontinence, all associated with a decrease in estrogen. The use of estrogens to prevent RUTI has been proposed.OBJECTIVES: To estimate the efficacy and safety of oral or vaginal estrogens for preventing RUTI in postmenopausal women.SEARCH STRATEGY: We searched the Cochrane Renal Group's specialized register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (from 1950), EMBASE (from 1980), and reference lists of articles without language restriction. Date of last search: February |2007.SELECTION CRITERIA: Randomized controlled trials (RCTs) in which postmenopausal women (more than 12 months since last menstrual period) diagnosed with RUTI received any type of estrogen (oral, vaginal) versus placebo or any other intervention were included.DATA COLLECTION AND ANALYSIS: Authors extracted data and assessed quality. Statistical analyses were performed using the random effects model, and the results were expressed as relative risk (RR) for dichotomous outcomes or mean difference (WMD) for continuous data with 95% confidence intervals (CIs).MAIN RESULTS: Nine studies (3,345 women) were included. Oral estrogens did not reduce UTI compared to placebo (4 studies, 2,798 women: RR 1.08, 95% Cl 0.88 to 1.33). Vaginal estrogens versus placebo reduced the number of women with UTIs in two small studies using different application methods. The RR for one was 0.25 (95% Cl 0.13 to 0.50) and 0.64 (95% Cl 0.47 to 0.86) in the second. Two studies compared oral antibiotics versus vaginal estrogens (cream , pessaries ). There was very significant heterogeneity and the results could not be pooled. Vaginal cream reduced the proportion of UTIs compared to antibiotics in one study and in the second study antibiotics were superior to vaginal pessaries. Adverse events for vaginal estrogens were breast tenderness, vaginal bleeding or spotting, nonphysiologic discharge, vaginal irritation, burning, and itching.AUTHORS' CONCLUSION: Based on only two studies comparing vaginal estrogens to placebo, vaginal estrogens reduced the number of UTIs in postmenopausal women with RUTI; however, this varied according to the type of estrogen used and the treatment duration