Effect of Combined Treatment with Phenylpropanolamine and Estriol, Compared with Estriol Treatment Alone, in Postmenopausal Women with Stress Urinary IncontinenceAhlström K.a · Sandahl B.b · Sjöberg B.c · Ulmsten U.d · Stormby N.e · Lindskog M.f
Departments of Obstetrics and Gynecology,aKristianstad Hospital, bMalmö General Hospital, cSödersjukhuset Stockholm, and dUppsala University Hospital, Sweden; eDepartment of Pathologic Research, Medscand AB, Malmö, Sweden; fDepartment of Clinical Research, Pharmacia LEO Therapeutics AB, Helsingborg, Sweden
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Twenty-nine postmenopausal women with slight to severe stress urinary incontinence and estrogen deficiency symptoms in the urogenital tract were treated with estriol, p.o. 4 mg once daily, and either phenylpropanolamine (PPA), p.o. 50 mg twice daily, or placebo for periods of 6 weeks according to a randomized double-blind crossover schedule. At urodynamic recordings the maximum urethral closure pressure increased by 22% with combined treatment (p < 0.001) and an additional effect of PPA to estriol was shown (p = 0.022). The pressure transmission ratio increased, by about 15%, with both treatments (p < 0.07). The number of leakage episodes was reduced by 28 % with combined treatment (p = 0.007), but not with estriol alone (p = 0.08). Both combined treatment and estriol alone reduced significantly (p < 0.01) the urinary incontinence complaints. Twelve women (43%) preferred combined treatment, while 7 (25%) preferred estriol alone. In women with initially slight to very severe urine loss, combined treatment reduced also (p = 0.02) the amount of urine loss, measured at a standardized physical stress test. Signs ofestrogen deficiency in vulva, vagina and urethra were reduced, 75%(p < 0.001)or 65% (p = 0.001) with estriol given in combination with PPA or alone. Maturation index of both urethral and vaginal epithelium displayed significant changes. It is concluded that the combined treatment, PPA + estriol, by affecting both the muscular and mucosal factor of the urethra, is more effective than estriol alone for treatment of female stress urinary incontinence in the postmenopausal ages.
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