[Notice of expert for modality and prescriptions limits of local estrogenotherapy for urinairy inconfinence in women]

Abstract

Objective: To develop a consensus of experts on the use of local estrogens in female urinary incontinence.

Material and method: Following a formalized consensus method (DELPHI), a questionnaire was produced and sent to a first round and then to a second round of experts. The questionnaire consisted of proposals for recommendations for the use of local estrogens in the context of female urinary incontinence. The Survey Monkey^® survey software allowed the questionnaire to be distributed and the answers obtained to be analyzed.

Results: Eight experts responded to the first round questionnaire. Seven formulations were deleted, 3 amended and 4 added to the first round questionnaire following expert advice. Twenty-six experts replied to the second round questionnaire, 24 of which were complete. Ten of the 21 proposals were approved at more than 80%, including five with strong agreement regarding the recognized benefit of local estrogens in urinary incontinence due to overactive bladder, the absence of data from the literature to demonstrate over-risk of hormone-dependent cancer under local estrogens and the need for follow-up of patients under this treatment. Six proposals were not the subject of a consensus and concerned the prescription modalities (maximum duration, effective minimum dose, prescription before surgery for incontinence).

Conclusion: Although local estrogens did not have regulatory approval in urinary incontinence, more than 80% of these experts recognized their benefit in the management of urinary incontinence in women with vulvo-vaginal atrophy, particularly in the case of urinary urge incontinence.

Level of proof: 4.

Keywords: Agent cancérogène; Avis d’experts; Carcinogen; Estrogènes locaux; Expert consensus; Incontinence urinaire; Local estrogens; Urinary incontinence.