Robinson Dudley, Toozs-Hobson Philip, Cardozo Linda
Department of Urogynaecology, Kings College Hospital, London, UK.
Menopause Int. 2013 Dec;19(4):155-62. doi: 10.1177/1754045313511398.
The female genital and lower urinary tracts share a common embryological origin, arising from the urogenital sinus and both are sensitive to the effects of the female sex steroid hormones throughout life. Estrogen is known to have an important role in the function of the lower urinary tract and estrogen and progesterone receptors have been demonstrated in the vagina, urethra, bladder and pelvic floor musculature. In addition estrogen deficiency occurring following the menopause is known to cause atrophic change and may be associated with lower urinary tract symptoms such as frequency, urgency, nocturia, urgency incontinence and recurrent infection. These may also co-exist with symptoms of urogenital atrophy such as dyspareunia, itching, vaginal burning and dryness. Epidemiological studies have implicated estrogen deficiency in the aetiology of lower urinary tract symptoms with 70% of women relating the onset of urinary incontinence to their final menstrual period. Whilst for many years systemic and vaginal estrogen therapy was felt to be beneficial in the treatment of lower urinary and genital tract symptoms this evidence has recently been challenged by large epidemiological studies investigating the use of systemic hormone replacement therapy as primary and secondary prevention of cardiovascular disease and osteoporosis. The aim of this paper is to examine the effect of the sex hormones, estrogen and progesterone, on the lower urinary tract and to review the current evidence regarding the role of systemic and vaginal estrogens in the management of lower urinary tract symptoms and urogenital atrophy.
女性生殖系统和下尿路有着共同的胚胎学起源，均源自泌尿生殖窦，并且在一生中都对女性性激素的作用敏感。已知雌激素在下尿路功能中发挥重要作用，且在阴道、尿道、膀胱及盆底肌肉组织中已证实存在雌激素和孕激素受体。此外，绝经后出现的雌激素缺乏会导致萎缩性改变，并可能与下尿路症状相关，如尿频、尿急、夜尿、急迫性尿失禁及反复感染。这些症状还可能与泌尿生殖萎缩的症状同时存在，如性交困难、瘙痒、阴道烧灼感及干燥。流行病学研究表明雌激素缺乏与下尿路症状的病因有关，70%的女性将尿失禁的发作与末次月经联系起来。尽管多年来全身及阴道雌激素治疗被认为对治疗下尿路和生殖道症状有益，但最近这一证据受到了大型流行病学研究的挑战，这些研究调查了全身激素替代疗法作为心血管疾病和骨质疏松症一级和二级预防措施的使用情况。本文旨在研究性激素（雌激素和孕激素）对下尿路的影响，并综述目前关于全身及阴道雌激素在管理下尿路症状和泌尿生殖萎缩中作用的证据。
