Maldonado P Antonio, Montoya T Ignacio, Acevedo Jesus F, Keller Patrick W, Word R Ann
Biol Reprod. 2017 Jan 1;96(1):81-92. doi: 10.1095/biolreprod.116.144428.
Although the positive effects of vaginal estrogens and the selective estrogen receptor modulator, ospemifene (OS), on the vaginal epithelium are well recognized, less is known regarding the effects of these therapies on the lower urinary tract or vaginal muscularis. Clinical evidence suggests that vaginally administered estrogen may improve overactive bladder-related symptoms. The objective of this study was to compare the effects of OS, vaginal conjugated equine estrogens (CEE), or both on the vaginal wall and lower urinary tract in a rat model of menopause. Contractile force of the bladder neck, dome, and external urethral sphincter at optimal field stimulation did not differ significantly among treatment groups. Pharmacologic responses to atropine, carbachol, and potassium chloride were similar among groups. Vaginal epithelial thickness and differentiation were differentially regulated by CEE or OS. Ospemifene altered epithelial differentiation pathways in vaginal epithelium in a unique way, and these effects were additive with local CEE. Unless contraindicated, the beneficial effects of vaginal CEE on the vaginal wall outweigh those of OS.
尽管阴道雌激素和选择性雌激素受体调节剂奥昔芬（OS）对阴道上皮的积极作用已得到充分认可，但关于这些疗法对下尿路或阴道肌层的影响却知之甚少。临床证据表明，阴道给药雌激素可能改善膀胱过度活动症相关症状。本研究的目的是在绝经大鼠模型中比较OS、阴道结合雌激素（CEE）或两者对阴道壁和下尿路的影响。在最佳场刺激下，各治疗组膀胱颈、膀胱顶部和尿道外括约肌的收缩力无显著差异。各组对阿托品、卡巴胆碱和氯化钾的药理反应相似。阴道上皮厚度和分化受CEE或OS的不同调节。奥昔芬以独特的方式改变阴道上皮中的上皮分化途径，且这些作用与局部CEE具有相加性。除非有禁忌证，阴道CEE对阴道壁的有益作用超过OS。
