绝经激素治疗联合盆底肌训练对尿失禁患者盆底结构的影响：一项随机对照试验

Background??The prevalence of pelvic floor dysfunction in postmenopausal women is progressively increasingleading to a significant impact on both their physical and mental well-being due to stress urinary incontinence. Objective??This study investigates the impact of menopausal hormone therapyMHTin conjunction with Kegel exercises on pelvic floor structure and clinical symptoms in individuals experiencing mild to moderate stress urinary incontinenceSUI. Methods??A total of 75 patients with menopausal syndrome accompanied by mild to moderate SUI who visited the Menopause Clinic at Beijing Shijitan Hospital in 2022 were selected. They were allocated into the MHT group and the control group in a 21 ratio using a random number table methodand the MHT group was further randomly divided into subgroups receiving Tibolone and estrogen and progestogen therapyEPTin a 11 ratio. Both the control group and the MHT group underwent pelvic floor muscle trainingPFMTcommonly referred to as Kegel exercisesfor 15-30 minutes per session2-3 times dailyand 2-3 times weeklyover a continuous period of 12 months. The control group received KunTai capsules orally in combination with PFMTwith 4 capsules taken per dose3 times a dayfor 12 months. The MHT group received menopausal hormone therapy in conjunction with PFMT. The EPT subgroups include continuous combined estrogen-progestin therapy1 mg estradiol valerate + 10 mg dydrogesteroneonce dailycontinuous sequential estrogen-progestin therapyfemoston 12 coursesand the Tibolone subgroup takes tibolone orallyall of which were administered continuously for 12 months. The study examined serum estradiolE2and follicle-stimulating hormoneFSHlevels within and between groups and subgroups before and after treatment. In additionmeasurements were obtained for urethral rotation angleURAbladder detrusor thicknessBDTposterior vesicourethral anglePVUAlevator hiatus areaLHAurinary incontinence quantificationurinary incontinence scoreclinical efficacyas well as changes in the modified Kupperman Menopausal IndexKMIscoreand the modified oxford stagingMOS. Results??Upon completion of the study7 participants from the MHT group were lost to follow-up5 in the Tibolone subgroup and 2 in the EPT subgroupwith 3 participants from the control group also lost to follow-up. In the enda total of 65 participants were included. After 1 year of treatmentthere were no statistically significant differences in FSHE2and MOS between the MHT group and the control groupP>0.05. After 1 year of treatmentthere were no statistically significant differences in PUVABDTand URA between the MHT group and the control groupP>0.05.Howeverthe LHA of the MHT group was significantly lower than that of the control groupP=0.028. After 1 year of treatmentthere were no statistically significant differences in PUVABDTURAand LHA between the EPT and Tibolone subgroupsP>0.05. Statistically significant differences were found in the comparison of clinical efficacy between the control group and the MHT groupP=0.010. Converselyno statistically significant differences were observed in the comparison of clinical efficacy between the EPT and Tibolone subgroupsP=0.724. After 1 year of treatmentthe MHT group showed lower urinary incontinence quantityurinary incontinence scoreand KMI score compared to the control groupP0.05. Conclusion??The combination of MHT with PFMT yields a positive effect on the pelvic floor structure and markedly alleviates symptoms of urinary incontinence. Neverthelessthere is no significant differences between EPT and Tibolone in the improvement of pelvic floor structure and alleviation of clinical symptoms in patients.