One hundred and sixty-nine urinary continent females were examined with simultaneous urethro-cystometry, using a dual microtip-catheter. It was shown that the maximum urethral pressure and the urethral length increased from infancy to the age of 20--25 years. Thereafter, the values of these parameters decreased with increasing age. The bladder pressure remained constant in the different age groups. In six women, aged between 20 and 25 years, the parameters were measured three times during a menstrual cycle. No correlation between the fluctuating estrogens, gestagens, catecholamines and the urethral pressure or the urethral lengths was found.

The present investigation was performed to study the urodynamic effects of hormones on the lower urinary tract in women. Twenty-four stress incontinent and 6 continent women were randomly given E2 and E3 orally in doses of 4--8 mg per day for 3 weeks. Another group of 8 women were given a single i.m. injection of 1000 mg gestagen. All the women were examined with simultaneous urethrocystometry, including urethral pressure profile measurement, before and after treatment. After estrogen treatment the transmission of intraabdominal pressure to the urethra increased. Furthermore, there was a significant increase in maximum urethal pressure and urethral length at rest. After gestagen treatment no significant changes of the recorded parameters were observed.

A study was performed to find out how often continent women develop urinary stress-incontinence after a Manchester operation for genito-urinary prolapse, and to ascertain whether factors in the selection of patients, or steps in the surgical procedure are responsible for producing stress-incontinence postoperatively. Seventy-three of 102 consecutive patients were continent before operation. Sixteen of the 73 women (22%) became stress incontinent. Advanced age increased the risk of developing urinary stress-incontinence. Twenty-five per cent of the women more than 60 years old developed stress-incontinence, but only 1 of 13 below the age of 60. Preoperative urethral closure pressure was significantly lower in those developing urinary stress-incontinence, and closure pressure was further reduced by surgery in this group, significantly more than in the women remaining continent. Surgery significantly reduced the pressure transmission ratio in the patients who developed urinary stress-incontinence, and less in the continent ones. The preoperative pressure transmission ratio, however, was not related to the risk of developing urinary stress-incontinence after the operation. The urodynamic examinations pre- and postoperatively demonstrated important changes in the urodynamic parameters produced by the Manchester procedure, but did not prove useful in determining which patients will develop urinary stress-incontinence.

Objective To compare the effects of two postmenopausal regimens on menopausal symptoms, bleeding episodes, side effects and acceptability.Design Double-blind, randomised controlled trial.Setting Twenty-nine sites in Denmark, nine in Norway and six in Sweden.Participants Four hundred and thirty-seven postmenopausal women with menopausal complaints. None of these women had had a hysterectomy.Interventions Daily treatment with tibolone 2.5 mg (n = 218) or l7p-oestradiol 2 mg plus norethisterone acetate 1 mg (E,lNETA) (n = 219). Main outcome measures Hot flushes, sweating episodes, vaginal dryness, assessment of sexual life and bleeding patterns; at baseline and after 4, 12,24 and 48 weeks.Results Treatment with either preparation significantly reduced mean scores for hot flushes, sweating episodes and vaginal dryness. The overall discontinuation rate was 28% (tibolone 25%, E,/NETA 31%; P = 0.14), mostly during the first six months. There was a markedly lower cumulative incidence of bleeding or spotting episodes with tibolone compared with E,/NETA ( P < O.OOOl), mainly during the first six treatment cycles. Conclusions Both tibolone and E,/NETA effectively alleviate menopausal symptoms. However, tibolone caused significantly fewer bleeding or spotting episodes, which were reflected by lower overall rates of bleeding, as well as lower drop-out rates due to bleeding.

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