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Female Pelvic Medicine & Reconstructive Surgery:
doi: 10.1097/SPV.0b013e31825e6401
Original Articles

A Randomized Clinical Trial of the Impact of Local Estrogen on Postoperative Tissue Quality After Vaginal Reconstructive Surgery

Karp, Deborah R. MD*; Jean-Michel, Marjorie MD; Johnston, Yasmin MD; Suciu, Gabriel PhD§; Aguilar, Vivian C. MD; Davila, G. Willy MD

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Abstract

Objective: To evaluate the use and effect of early administration of vaginal estrogen via a continuous low-dose estradiol vaginal ring placed immediately after pelvic reconstructive surgery.

Methods: This was a randomized controlled trial of 65 postmenopausal women undergoing vaginal reconstructive surgery. The subjects were randomly assigned to receive an estradiol-releasing vaginal ring, placebo vaginal ring, or control without vaginal ring for 12 weeks immediately after vaginal reconstructive surgery. The primary outcome was tissue quality based on vaginal maturation 3 months postoperatively. Secondary outcome measures were subjective and objective signs of atrophy; vaginal pH; the presence of granulation tissue, microscopic inflammation, and major healing abnormalities; and the ability to tolerate an intravaginal ring.

Results: At 12 weeks, the estradiol ring group had a significantly improved maturation value (P<0.01) and objective atrophy assessment (P<0.01) compared with the placebo ring and control arms. Granulation tissue was increased in the placebo ring arm (P<0.01). Subjective atrophy scores did not differ among the groups (P=0.39).

Conclusions: Early administration of vaginal estrogen after vaginal surgery via an estradiol-releasing ring is feasible and results in improved markers of tissue quality postoperatively compared to placebo and controls.

© 2012 by Wolters Kluwer Health | Lippincott Williams & Wilkins

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