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Estrogen for the prevention of recurrent urinary tract infections in postmenopausal women: a meta-analysis of randomized controlled trials

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Abstract

Introduction and hypothesis

Recurrent urinary tract infections (rUTIs) are commonly encountered in postmenopausal women. Optimal non-antimicrobial prophylaxis for rUTIs is an important health issue. The aim of this study was to evaluate the use of estrogen in the prevention of rUTIs versus placebo.

Methods

Eligible studies published up to December 2019 were retrieved through searches of MEDLINE, Embase, and Cochrane Central Register of Controlled Trials and Database of Systematic Reviews. We included randomized controlled trials of estrogen therapies versus placebo regarding the outcomes of preventing rUTIs. Changes in vaginal pH and estrogen-associated adverse events were also analyzed.

Results

Eight studies including 4702 patients (2367 who received estrogen and 2335 who received placebo) were identified. Five studies including 1936 patients evaluated the use of vaginal estrogen, which resulted in a significant reduction in rUTIs (relative risk, 0.42; 95% CI, 0.30–0.59). Three studies including 2766 patients evaluated the outcomes of oral estrogen in the prevention of UTIs and showed no significant difference in the number of rUTIs compared to treatment with placebo (relative risk, 1.11; 95% CI, 0.92–1.35). Two studies reviewed changes in vaginal pH and showed a lower pH (mean difference, −1.81; 95% CI, −3.10−−0.52) after vaginal estrogen therapy. Adverse events associated with vaginal estrogen were reported, including vaginal discomfort, irritation, burning, and itching. There was no significance increase in the vaginal estrogen group (relative risk, 3.06; 95% CI, 0.79–11.90).

Conclusions

Compared with placebo, vaginal estrogen treatment could reduce the number of rUTIs and lower the vaginal pH in postmenopausal women.

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Abbreviations

UTI:

urinary tract infection

rUTI:

recurrent UTI

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Authors and Affiliations

  1. Department of Medicine, Mackay Medical College, New Taipei, Taiwan

    Ying-Yu Chen, Tsung-Hsien Su & Hui-Hsuan Lau

  2. Department of Obstetrics and Gynecology, Mackay Memorial Hospital, 92 Sec. 2 Chung-San North Road, Taipei, 104, Taiwan

    Ying-Yu Chen, Tsung-Hsien Su & Hui-Hsuan Lau

  3. Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Mackay Medicine, Nursing and Management College, Mackay Medical College, Taipei, Taiwan

    Ying-Yu Chen, Tsung-Hsien Su & Hui-Hsuan Lau

  4. Department of Obstetrics and Gynecology, Hsin-Chu Mackay Memorial Hospital, Hsin-Chu, Taiwan

    Ying-Yu Chen, Tsung-Hsien Su & Hui-Hsuan Lau

Authors
  1. Ying-Yu Chen
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  2. Tsung-Hsien Su
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Contributions

Ying-Yu Chen: Protocol/project development, Data Collection and management, Data Analysis, Manuscript writing.

TH Su: Protocol/project development, Data collection and management.

HH Lau: Protocol/project development, Manuscript writing and editing.

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Correspondence to Hui-Hsuan Lau.

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Chen, YY., Su, TH. & Lau, HH. Estrogen for the prevention of recurrent urinary tract infections in postmenopausal women: a meta-analysis of randomized controlled trials. Int Urogynecol J 32, 17–25 (2021). https://doi.org/10.1007/s00192-020-04397-z

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  • DOI: https://doi.org/10.1007/s00192-020-04397-z

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