Rigi10™ Malleable Penile Prosthesis
Also Known As
Oestrogen, Female sex hormone, Estradiol, Estriol, Estrone, Estretrol, Feminizing hormone
Definition
Estrogen is a group of female sex hormones that can be used in certain urological treatments, particularly for addressing conditions related to the lower urinary tract in women.¹ Chemically, estrogens belong to the family of organic compounds known as steroids, with a core structure composed of 18 carbon atoms (C18H24O2) arranged as four fused rings.² The primary types include estrone (E1), estradiol (E2), estriol (E3), and estretrol (E4), with estradiol being the predominant circulating form during reproductive years.² Estrogens are primarily synthesized in the ovaries, but also in the adrenal glands and adipose tissue.²
In urological contexts, estrogen functions by binding to specific estrogen receptors (ERs) present in the lower urinary tract tissues, including the vagina, urethra, and bladder trigone.³ These receptors, when activated, initiate transcriptional processes and signaling events that influence tissue structure and function.² The decline in estrogen levels after menopause leads to significant atrophic changes in the urogenital tissues, which can result in various urological symptoms and conditions.⁴ Local estrogen therapy is particularly beneficial in treating these conditions by normalizing tissue acidity, increasing thickness and lubrication, and restoring the vaginal microbiome to reduce urinary tract infection risk.⁵
Clinical Context
Estrogen plays a significant role in maintaining the health and function of the lower urinary tract in women.³ In clinical urology, estrogen therapy is primarily used to address conditions resulting from estrogen deficiency, particularly in postmenopausal women.⁴ The lower urinary tract and vaginal tissues are rich in estrogen receptors, and estrogen depletion associated with menopause leads to alterations in these tissues, including impairments in lubrication, elasticity, pH, and blood flow.⁴
Local estrogen therapy is used to treat urogenital atrophic skin changes that occur in the vagina, urethra, and vulva when the ovaries no longer produce estrogen after menopause.⁵ Women with vaginal atrophy often present with symptoms such as vaginal dryness, sensitivity, and pain during intercourse.⁵ The skin changes that take place in the urethra and bladder trigone may result in urinary symptoms including frequency, urgency, dysuria (painful urination), and increased susceptibility to urinary tract infections (UTIs).⁵
The 2019 American Urological Association guideline for recurrent uncomplicated UTIs in women recommends vaginal estrogen therapy for peri- and post-menopausal women to reduce their risk of recurrent UTIs.⁴ Several randomized controlled trials have shown that various applications of vaginal estrogen therapy decrease the incidence and time to recurrence of UTIs in hypoestrogenic women.⁴ Importantly, vaginal estrogen increases the presence of lactobacillus in the vagina, which helps maintain a healthy vaginal microbiome and reduces UTI risk.⁴
Patient selection for estrogen therapy typically involves a clinical assessment of symptoms and, in some cases, urodynamic studies or cystoscopy, although diagnosis is often based on clinical presentation in the context of estrogen deficiency.⁵ Expected outcomes with appropriate treatment include a reduction in urinary symptoms, restoration of more normal urethral tissue, and a decrease in the frequency of UTIs.⁵