Periurethral Vessels Research Articles

The Emerging Concept of Hormonal Impact on Wound Healing in Feminizing and Masculinizing Genital Surgery

We attempt, within this review, to discuss the effects of hormones for their known impact on the wound healing cascade. Hormone receptors mediate a cellular response; changes in their expression, whether physiologic or pathologic, affect growth and development, and have effects on wound healing. Attempts to measure their distribution have been quite variable in their effectiveness not only between but within a given tissue. Other factors contribute to this variability. These include age, gender, and tissue histology (urinary mucosae, periurethral vessels, muscular layer, and connective tissue). Gene expression and autonomic nervous system receptors have been noted to change in relation to variance in hormonal status. Reduced levels of estrogens and androgen are associated with dramatic alterations in genital tissue structure, including the nerve network, as well as the response to physiological modulators. Estrogen and androgen deficiency is associated with reduced expression of sex steroid receptors. Cutaneous, vascular, and mucosal tissue of the genitalia, may be more sensitive than other tissues to the effects of a variety of hormones with differential effects for mucosal versus cutaneous epithelium, and for male and female derived tissue. We might also imagine that chromosomal variations exhibited in disorders of sexual development could modify the hormonal environment and the response to hormones during wound healing.

Should hormone replacement therapy be used in postmenopausal women for voiding dysfunction?

Should hormone replacement therapy be used in postmenopausal women for voiding dysfunction?

P14.01: Effects of systemic and local estrogen therapy on periurethral vessels in postmenopausal incontinent women using Doppler velocimetry analysis

P14.01: Effects of systemic and local estrogen therapy on periurethral vessels in postmenopausal incontinent women using Doppler velocimetry analysis

Estrogen therapy influence on periurethral vessels in postmenopausal incontinent women using Dopplervelocimetry analysis

Lack of estrogen affects the urinary tract mainly by diminishing vascular, muscular and epithelial trophism, resulting in negative effects on continence in postmenopausal women. Therefore, the use of estrogens in these patients may revert these alterations and lead to an expressive improvement of the urinary symptoms. Objective Study the effect of topical estrogen therapy (conjugated equine estrogens, estriol or promestriene) in periurethral vessels detected by Dopplervelocimetric analysis using, as parameters: the number of vessels, resistance and pulsatility indexes, as well as the minimum diastolic value. Methods Forty-one postmenopausal women with stress urinary incontinence were randomized into three groups according to different types of topical estrogen received during 3 months. Group 1 received conjugated equine estrogens, group 2 received estriol and group 3 received promestriene. Periurethral Dopplervelocimetry analysis was done before estrogen administration and during treatment in all groups. Results We observed an increase in the number of the periurethral vessels in group 1 and group 2, being higher in group 1 than in group 2. The pulsatility index remained unchanged in all three groups. The resistance index at the periurethral vessels reduced only at the conjugated estrogen group (group 1). In this same group we noticed an increase in the mean minimal diastolic value, meaning a better periurethral vascularization. Conclusion Topical conjugated equine estrogens and estriol were effective in increasing the number of periurethral vessels in postmenopausal women with urinary stress incontinence, with the conjugated equine estrogens being the most effective intervention studied.

Effect of Laparoscopic Hysterectomy on the Vascularization of the Lower Urinary Tract

Introduction: The aim of this prospective study was to evaluate the changes in the vascularization of the lower urinary tract following laparoscopic hysterectomy (LH). Methods: Seventy women undergoing LH not under the indication of a uterine myoma were included. All subjects underwent urinalysis, pelvic examination, and introital color Doppler ultrasonography and completed a urinary questionnaire before and 6 months after LH. One-hour pad tests and urodynamic studies were performed in clinically incontinent women pre- and postoperatively. Results: Evaluation of the Doppler velocimetric parameters of bladder neck and periurethral vessels before and after LH, including number of vessels, pulsatility index, systolic peak, and minimum diastole, revealed no statistically significant differences (p > 0.05). In addition, the prevalence of stress urinary incontinence (SUI) decreased significantly from 37.1% (n = 26) preoperatively to 17.1% (n = 12) postoperatively (p < 0.01). A total of 19 patients reported no further SUI following LH. Their urinary leakages on the pad tests had all <10 g before surgery. When we analyzed the data of the women reporting no further SUI (n = 19) and de novo SUI (n = 5) following LH, the changes in the pulsatility index also showed no significant difference from the pre-LH values (p > 0.05). Conclusions: The results of our study suggest that LH has little impact on the blood flow of bladder neck and urethra. Although some women experienced relief of the symptoms of mild or de novo SUI after LH, this being unrelated to changes in the vascularization of the lower urinary tract.

Hormonal influence on periurethral vessels in postmenopausal incontinent women using Doppler velocimetry analysis

The lack of estrogen affects the urinary tract mainly by diminishing vascular, muscular and epithelial trophism, resulting in negative effects on continence in postmenopausal women. Objective Study the effect of hormone therapy (estrogen and progesterone) in periurethral vessels detected by Doppler velocimetric analysis using, as parameters, the number of vessels, resistance and pulsatility indexes, as well as the minimum diastolic value. Methods Thirty-eight postmenopausal women with stress urinary incontinence were randomized into two groups. The first consisted of women receiving 3 months of estrogen therapy previous to 3 months of continuous estrogen and progesterone combined therapy. The second comprised of women receiving 3 months of continuous estrogen and progesterone therapy. Periurethral Doppler velocimetric analysis was done before hormone administration and during treatment in both groups. Results We observed a statistically significant increased number of periurethral vessels during treatment in both groups. There was an increase in value of the mean minimum diastolic value during estrogen and progesterone therapy in Group 2. The resistance indexes diminished in both groups. However, they were not statistically significant. Conclusion Hormonal therapy of short duration (3–6 months) had a positive effect on the urethral continence mechanism increasing the number of periurethral vessels either with estrogen alone or combined therapy (estrogen and progesterone).

Efeitos das isoflavonas sobre o assoalho pélvico e a vascularização peri-uretral de mulheres na pós-menopausa

PURPOSE: to evaluate muscular strength of the pelvic floor and the periurethral vessels of postmenopausal women before and after six months of soybean extract treatment. METHODS: the study was conducted on 30 postmenopausal women before and after six consecutive months of soyabean extract (100 mg/day) administration. Urinary loss and muscular strength of the pelvic floor were investigated through digital perineometer and functional evaluation. Digital color Doppler in the periurethral region was used to count the number of vessels. For statistical analysis, the paired Student t test was applied to compare the results before and after the treatment. RESULTS: twenty women reported urinary incontinence before the treatment period. The amelioration of this symptom was observed in 15 (75%) women after the treatment. Vaginal pressure (muscular strength of the pelvic floor) was 12.95±1.73 and 15.86±1.86 Sauers, before and after the treatment, respectively (p<0.001). Twenty-two women (73.3%) presented an increase in the pressure at the end of this study. In relation to the function evaluation, 18 (60%) had improvement in muscular strength and 12 women did not present any change. On ultrasonography (Doppler), the number of vessels was 2.20±0.15 blood vessels/field in the beginning of this study and 3.46±0.25 blood vessels/field at the end of the treatment (p<0.001). An increase in the number of periurethral vessels was detected in 21 women (70%). CONCLUSION: it is important to emphasize that these are preliminary results. A double blind randomized and placebo-controlled clinical trial with a high number of participants is necessary. However, the treatment with concentrated soybean extract (100 mg per day) for six consecutive months may determine an improvement in pelvic floor muscular strength and an increase in the number of periurethral vessels in postmenopausal women.

Three‐dimensional power Doppler measurement of perfusion of the periurethral tissue in incontinent women – a preliminary report

This study was designed to test the hypothesis that decreased periurethral vascularization and blood flow might lead to urinary incontinence. Three-dimensional color histogram may better quantify the vasculature than traditional two-dimensional Doppler ultrasound imaging. Between June 2002 and July 2003, 57 patients were invited to undergo three-dimensional power color Doppler study of the periurethral vessels before surgery. In group 1, 29 women with stress urinary incontinence underwent tension-free vaginal tape procedures and in group 2, 28 continent women underwent other procedures for treatment of benign gynecologic disease and without urological problems. We used 3 indices of color histogram to quantify the vascularization and blood flow within a tissue block from the bladder neck to the urethral meatus and the periurethral area within 5 mm of the urothelium borders. The values of 3 indices of histogram, vascularization index, flow index and vascularization-flow index, were analyzed. Judging from the values of vascularization index, flow index and vascularization-flow index generated in our study, significantly decreased periurethral vasculature was found in women with stress urinary incontinence and women in the postmenopausal status as compared with women in the continent group and those in the premenopausal status, respectively (p<0.05). Three-dimensional histogram measurement revealed less periurethral vessels and flow in women suffering from stress urinary incontinence, a finding that might play a role in the pathogenesis of stress urinary incontinence.

A randomized comparative study of the effects of oral and topical estrogen therapy on the lower urinary tract of hysterectomized postmenopausal women

To compare the effects of oral and vaginal estrogen therapy (ET) on the lower urinary tract in postmenopausal women with prior hysterectomy. Randomized, prospective study. Tertiary teaching hospital. Fifty-seven hysterectomized, postmenopausal women. Patients were randomized to receive either oral (0.625 mg of conjugated equine E per tablet; n = 27) or topical (0.625 mg conjugated equine E per 1 g vaginal cream; n = 30) E, administered once daily. All subjects had E2 measurements, urinalysis, pelvic examination, introital color Doppler ultrasonographies, and personal interviews with the Bristol Female Lower Urinary Tract Symptoms Questionnaires before and 3 months after ET. A higher serum level of E2 was noted in the oral group compared with the topical group after ET. The post-ET pulsatility index of periurethral vessels and bladder neck revealed statistically significant decreases in both groups. The incidences of urinary frequency and nocturia were significantly decreased after 3 months of ET in both groups. Changes in the incidence of other symptoms, including stress incontinence and urge incontinence, were not statistically significant. However, subjective improvement of stress incontinence was found in 72.7% of the oral group and 60% of the topical group. The results suggest that ET alone, by an oral or vaginal route, could increase the blood flow around the bladder neck and mid-urethra and relieve the symptoms of overactive bladder and stress incontinence in postmenopausal women with prior hysterectomy. In addition, vaginal preparations are as effective as systemic therapy at the lower serum level of E2.

Placement of the vaginal 17β-estradiol tablets in the inner or outer one third of the vagina affects the preferential delivery of 17β-estradiol toward the uterus or periurethral areas, thereby modifying efficacy and endometrial safety

Objective: The purpose of this study was to investigate whether the effects of 17β-estradiol tablets that are designed for the treatment of postmenopausal urovaginal atrophy are influenced by the site of placement into the vagina. Study Design: In this controlled crossover trial, 10 postmenopausal women received a single 17β-estradiol tablet in the outer or inner one third of the vagina. Before and 3 hours after treatment, the pulsatility index, resistance index, and blood flow were evaluated in the uterine and periurethral vessels by Doppler examination. Parallel 17β-estradiol serum evaluations were performed. Results: Comparable and significant increases in 17β-estradiol were observed. After inner administration, the pulsatility index and resistance index of both uterine arteries decreased; uterine artery blood flow increased significantly (P <.0001) but decreased in periurethral vessels (P <.02). After outer administration, the uterine artery pulsatility index, resistance index, and blood flow did not change, and the periurethral blood flow significantly increased (P <.0001). Conclusion: For optimizing the efficacy while minimizing the risk of endometrial hyperplasia, 17β-estradiol tablets must be placed in the outer one third of the vagina. (Am J Obstet Gynecol 2003;189:55-8.)

Effects of ovariectomy and hormone replacement on collagen and blood vessels of the urethral submucosa of rats.

Collagen and blood vessels of the urethral submucosa of ovariectomized rats were studied following 28 daily subcutaneous injections of 17-beta estradiol (n=6, group 1), medroxy-progesterone acetate (n=6, group 2), both drugs (n=6, group 3) or vehicle (n= 6, control) and after sham surgery without castration or injection (n=6). Investigations included the immunohistochemistry of estrogen and progesterone receptors and collagen fibres, Western blot analysis of collagen types I and III and counting periurethral vessels by light microscopy. Our results showed positive immunostaining with estrogen, progesterone and collagen types I and III in all samples. Collagen type I and III levels were lower in the controls than in the sham group. The other groups showed increases (2>3>1) over the controls with a relatively higher increase in type III. The type I/III collagen ratio progressively decreased (control>1>2>3) below sham levels. The mean vessel count was significantly lower in control than in sham animals (P<0.00001). However, only estrogen treatment significantly increased the vessel number compared to controls (P=0.04). Our results indicate that estrogen and progesterone, alone or in combination, have an effect on collagen types I and III, and that estrogen has an effect on blood vessels of the urethral submucosa in female rats.

Power Doppler of the urethra in continent or incontinent, pre- and postmenopausal women.

Urethral pressure should exceed bladder pressure, both at rest and on stress, for urinary continence to occur. A decrease in urethral pressure is a major factor explaining the pathogenesis of urinary incontinence. A number of elements, such as smooth and striated periurethral muscles, and connective, vascular and elastic tissues, contribute to urethral pressure. The periurethral vessels are influenced by hormonal changes during the menstrual cycle, during pregnancy and postmenopause. We studied the periurethral vessels in 97 women, 57 of whom were incontinent and 40 continent, using power color Doppler velocimetry. The number of periurethral vessels, systolic peak, minimum diastolic values, pulsatility and resistance indexes, as well as systolic-diastolic ratio, were assessed. Statistically significant differences were found between incontinent women in the premenopausal period and those in the postmenopausal period, regarding the number of periurethral vessels, systolic peak, minimum diastolic values, pulsatility and resistance indexes.

Power doppler velocimetry of peri-urethral vessels in incontinent post menopausal women during hormonal replacement with oestrogen and progesterone or only with oestrogen

Power doppler velocimetry of peri-urethral vessels in incontinent post menopausal women during hormonal replacement with oestrogen and progesterone or only with oestrogen

Dopplervelocimetry Parameters in the Periurethral Vessels in Postmenopausal Women and During Estrogen Replacement

Dopplervelocimetry Parameters in the Periurethral Vessels in Postmenopausal Women and During Estrogen Replacement

P-90. Power Color Doppler Velocimetric Parameters of the Peri-Urethral Vessels in Continent or Urinary Stress Incontinent Fertile and Postmenopausal Women

Baracat, B. C. MD, PhD; Bella, Z. I. K.; Girao, M. J.B.C.; Sartori, M. F.G.; Bella, V. Di Jr.; Lederman, H. L.; de Lima, G. Rodrigues MD, PhD