Vaginal Lawsuit Petition
Vaginal Lawsuit : Oestrogen receptors have been demonstrated in the squamous epithelium of both the proximal and distal urethra.24 Oestrogen has been shown to improve the maturation index of urethral squamous epitheLium.25It has been suggested that oestrogen increases urethral closure pressure and improves pressure transmission to the proximal urethra, both of which promote continence. Epidemiological studies have implicated oestrogen deficiency in the aetiology of lower urinary tract symptoms. Seventy percent of women relate the onset of urinary incontinence to their final menstrual period.2 Lower urinary tract symptoms have been shown to be common in postmenopausal women attending a menopause clinic, with 20% complaining of severe urgency and almost 50% complaining of stress incontinence.
There is, however, conflicting evidence regarding the role of oestrogen withdrawal at the time of the menopause. Some studies have shown a peak incidence in perimenopausal women36‘37 whilst other evidence suggests that many women develop incontinence at least 10 years prior to the cessation of menstruation, with significantly more premenopausal women than postmenopausal women being affected.
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Urinary tract infection is also a common cause of urinary symptoms in women of all ages. This is a particular problem in the elderly with a reported incidence of 20% in the community and over 50% in institutionalized patients.39‘40 Pathophysiological changes, such as impairment of bladder emptying, poor perineal hygiene and both faecal and urinary incontinence, may partly account for the high prevalence observed. In addition, as previously described, changes in the vaginal flora due to oestrogen depletion lead to colonization with Gramnegative bacilli, which, as well as causing local irritative symptoms, also act as uropathogens. These microbiological changes may be reversed with oestrogen replacement following the menopause, offering a rationale for treatment and prophylaxis.
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Oestrogen preparations have been used for many years in the treatment of urinary incontinence,41‘42 although their precise role remains controversial. Many of the studies performed have been uncontrolled observational series examining the use of a wide range of different preparations, doses and routes of administration. The inconsistent use of progestogens to provide endometrial protection is a further confounding factor making interpretation of the results difficult.
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