Estrogen replacement propitiates significantly
incontinence improvement and of most of the mentioned symptoms, even though the action
mechanism is not completely known.
In our casuistic, in the Urogynecological and Vaginal Surgery of the Department of
Gynecology of UNIFESP-EPM Sector, the estroprogestogen therapeutic in women with stress
urinary incontinence without uterine prolapse and with first or second degree cystocele,
propitiates a significant clinical improvement, with diminishing of the urinary loss
episodes and residual urine, as well as a significant raise of bladder capacity, of
urethral closure pressure and the medium urinary flow(24).
We have evaluated hormonal replacement effects upon the responsible elements of urinary
continence. In this manner we analized the different therapeutic schemes, through
experimental studies and clinical tests, with different drugs and ways of administration.
We observed that the symptoms and effects resulting from estrogenic deficiency are
reverted with relative ease. It is obvious that the answer is quickest when the potency of
the drug is larger. We prefer systemic hormone therapy for several reasons, from which we
stress that the using of topic preparations for long periods of time, end up by bothering
the patients, and to depend on the product, it may produce a prolongued and continuous
estrogenic stimulus, increasing the risk of endometrium carcinoma, without the patient or
the doctor knowing it; topic vaginal therapy does not produce the beneficial effects in
other organs and tissues.
We must emphasize the criterion for estrogenic replacement, as well as the need of a
rigorous accompaniment so an unforeseen event does nor occur.
To end this, we must point out that we adopted as a routine to begin the therapeutic of
patients with stress urinary incontinence, with hormonal replacement, when the symptoms
began or became pronounced with the advent of menopause. At the moment we give preference
to the continuous estroprogestogen scheme with conjugated equine estrogen associated to