Constantin S. Iosif

Estrogen receptors in the human female lower urinary tract

Cytosolic and nuclear fractions prepared from the urethra, urinary bladder, and trigonum of the bladder obtained at urethrocystectomy from four female patients were analyzed for the presence of estrogen receptors. High-affinity estradiol receptors (KD 0.7 x 10(-9)M) could be detected in both cytosolic and nuclear fractions of the urethra from all four patients. Estradiol receptors could be detected in only the nuclear fractions of the urinary bladder in two of the four preparations. In the trigonum, cytosolic and nuclear receptors could be measured in one and three preparations, respectively. The receptor concentrations in both trigonum and the bladder were lower than those in the urethra. By providing experimental evidence for the presence of estradiol receptors in the lower uninary tract, the present data advance the case for estradiol therapy in incontinent patients.

Prevalence of Genitourinary Symptoms in the Late Menopause

Abstract. One thousand two hundred women, aged 61, randomly selected from a defined geographical area in South Sweden, were interviewed by an anonymous questionnaire about their urogenital symptoms. Seventy‐five percent cooperated, of whom 29.2% admitted to some degree of urinary incontinence and 48.8% some degree of lower genital tract disorder. Stress incontinence symptoms were reported by 11.8% of the women, urge incontinence by 7.9% and both types combined—“mixed” by 9.5%. Four percent of all women (18% of stress incontinence) experienced a loss sufficient to necessitate the wearing of a sanitary napkin or change of under clothing several times a day. Thirteen percent had repeated urinary tract infections. Itch, discharge and smarting pain was reported by 15%. Thirty‐eight percent had vaginal dryness and dyspareunia. Only 4% of the women were undergoing estrogen therapy.

Female urethra: a target for estrogen action.

It is not uncommon to use estrogen therapy in patients with urinary stress incontinence. The possibility of a selective action of estrogen in the lower urinary tract was examined. Wet weight of the uterus, vagina and urethra increased significantly, and that of the urinary bladder insignificantly after estradiol treatment of ovariectomized rabbits. When ovariectomized rabbits were injected i.v. with 3H-estradiol, the tritium concentration, determined after 1 hour, was 3 to 4 times higher in urethra, urinary bladder and vagina than that in the muscle. High affinity estradiol receptors (KD approximately 1 X 10(-9) M) could be demonstrated in both the cytoplasmic and nuclear fractions prepared from the female rabbit urethra and bladder. The concentrations of estradiol receptors in the urethra and bladder were about 10 and 20 times lower respectively than those in the uterus. The present evidence for estradiol receptors in the lower urinary tract supports the case for estradiol therapy in urinary incontinence.

Progesterone receptors in the female lower urinary tract.

When female estrogenized rabbits were injected i.v. with 3H-progesterone, the tritium concentration determined after one hour was about two to three times higher in urethra, urinary bladder and vagina than in the heart. High affinity progesterone receptors (KD = 1-2 nM) could be demonstrated in both cytoplasmic and nuclear fractions prepared from estrogenized rabbit urethra, bladder and vagina. The cytosolic receptor concentration in both urethra and bladder was about half of that in the vagina. The concentration of nuclear receptors in urethra was not significantly different from that in the vagina, but in the bladder the concentration was only about one fourth of that in the vagina or urethra. The mean KD of cytosolic receptors from bladder was significantly higher than the corresponding values in urethra and vagina. Progesterone binding sites in the bladder had a broader hormonal specificity than those in the urethra or vagina. The present demonstration of specific progesterone receptors in the female urethra might provide a possible link between estrogen progesterone interaction and the appearance of urinary incontinence during pregnancy in women.

Quality of life in endometrial cancer survivors

OBJECTIVE The aim of this study was to evaluate the health-related quality of life in survivors of endometrial cancer (EC); and to identify common problems that they may encounter, in the hope of paving the way to improving their quality of life. STUDY DESIGN We investigated and compared the health conditions and quality of life between EC survivors and the general population as a control group. There were 61 EC patients who were at clinical stage I-III and survived for 5-7 years after the primary treatments. The control group was composed of 527 healthy postmenopausal women. All of them completed a self-evaluated questionnaire pertaining to personal conditions, medical surveillance, individual well-being and quality of life. RESULTS The EC survivors were divided into two groups: an older group (n = 34) and a younger group (n = 27). The latter was compared with the controls. In general, most of the EC survivors were old, low-educated women. The majority of them were in a poor condition. They were inactive, received medical surveillance and had regular medication. The distribution of various complications was higher in the older EC group while the climacteric symptoms were more common in the younger EC group. In both EC groups, the quality of life was lower than in the controls. The prevalence of somatic symptoms was higher in the older EC survivors and psychological problems were a common complaint of the younger EC survivors. CONCLUSION The quality of life was poor in the EC survivors. To improve their life quality, earlier psychological counseling should be offered to EC survivors, in particular to younger and single women, and hormone replacement therapy (HRT) should be recommended, but on a selective basis, to those patients at low risk of cancer recurrence.

Quality of life in long-term survivors of cervical cancer

OBJECTIVE The aim of this study was to evaluate the quality of life within a sample of cervical cancer survivors. STUDY DESIGN In this study, 46 cervical cancer survivors at clinical stage I or II and one survivor at stage 0, were evaluated. Two control groups were selected from an ongoing cohort study, in which 527 women were postmenopausal and 344 women were postmenopausal with HRT. All controls and cancer survivors completed a self-evaluating questionnaire pertaining to personal conditions, medical surveillance, individual well-being and quality of life. RESULTS Eighteen cervical cancer survivors were ovaries preserved. A total of 28 survivors, who had an oophorectomy, were compared with the controls. Most of the cancer survivors had a good socio-economic background and an active lifestyle. Forty-two percent were currently under medical surveillance and used medication regularly. The ratio of HRT users was higher in the oophorectomy group (36% in both short- and long-term therapy). With regard to the quality of life, there were no remarkable differences between oophorectomy survivors and controls. Except that the psychological condition in the ovaries preserved group was worse, the rest of the findings concerning the quality of life derived from the ovaries preserved group were rather close to that of the oophorectomy group. CONCLUSION The quality of life in long-term cervical cancer survivors is generally satisfactory. The positive results may be due to the higher ratio of HRT use, ovarian preservation, good education, working conditions, as well as an active lifestyle.

PREVALENCE OF STRESS INCONTINENCE AMONG WOMEN DELIVERED BY ELECTIVE CESARIAN SECTION

A retrospective investigation into the prevalence of stress incontinence in women delivered by elective cesarian section (without experience of labor) in Lund from 1974 to 1979, was carried out in 1980. Of 264 women whose replies were solicited, 204 responded. The others had moved about and could not be reached.

Effects of long-term treatment with estrogen and progesterone on in vitro muscle responses of the female rabbit urinary bladder and urethra to autonomic drugs and nerve stimulation

Ovariectomized virginal rabbits were treated with either estrogen or progesterone for 4 to 6 months. In vitro responses of muscle strips of the bladder and circular urethra were examined. Estrogen resulted in bladder contractions in response to noradrenaline and phenylephrine, whereas these agonists were without effect or evoked weak relaxations in castrated animals (and normals). Estrogen also caused a rightward shift of the frequency-contraction curve to nerve stimulation. Progesterone increased bladder sensitivity to contraction-evoking bethanechol. Contractile urethral responsiveness to bethanechol increased after both steroids. Urethral sensitivity to noradrenaline, evoking contraction, increased following estrogen. Further, estrogen abolished the marked relaxatory urethral response to nerve stimulation of castrated (and normal) rabbits and caused contraction only, which was abolished by a combination of alpha-adrenoceptor antagonists and scopolamine. When comparing the present results with those of other studies, it is evident that hormone-induced changes become manifest at an early stage. The present animal study gives support for the use of estrogen in the therapy of stress incontinence and, further, it provides no objections to the use of progesterone in combination with estrogen in this condition.

Sexual Function after Colpo-Urethrocystopexy in Middle-Aged Women

This is the first prospective study to analyse sexual function in women following an incontinence operation. The author has personally interviewed and examined 156 patients, first before and then 1-2 years after operation. 32% of the women with stress incontinence had had sexual problems before surgery. This proportion decreased after surgery to 10%. Colpo-urethrocystopexy elevates the anterior vaginal wall and tilts the axis of the vagina. These corrections do not affect the sexual function of the vagina. None of the patients developed dyspareunia after surgery.

Karyotypic characteristics of borderline malignant tumors of the ovary: Trisomy 12, trisomy 7, and r(1) as nonrandom features

Clonal karyotypic abnormalities were detected in five of 14 cytogenetically analyzed borderline malignant ovarian tumors of clinical stages I-II. One mucinous and one seropapillary tumor had trisomy 7 and r(1)(p36q42) as the sole chromosome abnormality, respectively. Trisomy 12 was found in the remaining three cases. It was the only change in one mucinous and one serous tumor, whereas the third, a seropapillary borderline tumor, had the karyotype 49,XX,+5,+8, +12. These findings, especially when collated with those of previous reports on ovarian borderline tumor cytogenetics, indicate that +12 is the most consistent chromosomal aberration in this group of neoplasms and that also +7 and r(1) are nonrandom features. From the karyotypic point of view, benign ovarian tumors and well-differentiated carcinomas are similar to borderline ovarian tumors, with the possible exception that the former have no tendency to form r(1). Highly malignant carcinomas, on the other hand, are typically much more complex. Chromosome-level changes therefore cannot account for the putative phenotypic passage through the most innocuous tumor stages as epithelial ovarian neoplasms go from benign to fully malignant.