Journal
FEMALE PELVIC MEDICINE AND RECONSTRUCTIVE SURGERY
Volume 27, Issue 2, Pages 112-117Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/SPV.0000000000000749
Keywords
conjugated vaginal estrogen; estradiol ring; recurrent urinary tract infection; urinary tract infection; vaginal estrogen
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The study demonstrated that commonly prescribed forms of vaginal estrogen with contemporary dosing schedules can prevent urinary tract infections in postmenopausal women with an active diagnosis of recurrent UTI. Subjects treated with vaginal estrogen had fewer UTIs within 6 months compared to those who received placebo.
Objectives We aimed to compare the efficacy of 2 commonly used contemporary vaginal estrogen administrations versus placebo for the prevention of urinary tract infection (UTI) in postmenopausal women with a clinical diagnosis of recurrent UTI (rUTI). Methods This was an investigator-initiated, multicenter, single-blind, randomized, placebo-controlled trial of vaginal estrogen (delivered via ring or cream) compared with placebo. Postmenopausal women with documented rUTI were randomized to receive either vaginal estrogen (via ring or cream) or placebo cream in a 1:1:1 fashion. The primary outcome was occurrence of UTI at 6 months. After 6 months, open-label use of ring or active cream was offered to all participants for an additional 6 months. Because of slower than expected recruitment, sample size calculations and block randomization schema were revised to combine estrogen groups (ring or cream) for statistical comparisons to placebo cream in a 1:1 fashion. Results Thirty-five women were randomized with 9 dropouts (1 ring, 2 cream, and 6 placebo) prior to the 6 months. Intention-to-treat analysis (assuming dropouts as failures) revealed fewer women treated with vaginal estrogen had a UTI within 6 months versus placebo (11/18 vs 16/17, respectively; P = 0.041). Per-protocol analysis revealed fewer subjects treated with vaginal estrogen had a UTI at 6 months (8/15 vs 10/11, respectively; P = 0.036). Conclusions Commonly prescribed forms of vaginal estrogen with contemporary dosing schedules prevent UTIs in postmenopausal women with an active diagnosis of rUTI.
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