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A unique feature of Epistemonikos is that it connects systematic reviews and their included studies. This allows clustering systematic reviews based on the primary studies they have in common. The concept of 'systematic reviews sharing included studies' is a proxy of 'systematic reviews answering a similar question'.

A matrix of evidence is a tabular way of displaying the cluster of systematic reviews that share included studies, and all the studies included in these reviews. It is automatically created based on the connections of the database, and can be trimmed by the user in order to reflect an accurate body of evidence for a specific question.

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The matrix of evidence is created based on the primary studies that systematic reviews have in common. For this reason it is not possible to generate a matrix of evidence from an empty review (i.e. a review that did not include any study)

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7 Primary studies 57.1%Randomized controlled trial (RCT)4 / 7
Ouslander JG2001Raz R1993Kirkengen AL1992Cardozo L1998Brandberg A1987Oliviera SA1998Privette M1988
6 Systematic reviews
Perrotta C2008Beerepoot MA2013Eells SJ2014Cardozo L2001Dueñas-Garcia O..2016Leckie K.J.2010
10 References ( articles) loading Revert Studify

Primary study

Unclassified

Urinary tract infections and estrogen use in older women.

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Authors Orlander JD , Jick SS , Dean AD , Jick H
Journal Journal of the American Geriatrics Society
Year 1992
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OBJECTIVE: To examine the relationship between exogenous estrogen use and risk of clinically diagnosed urinary tract infection (UTI) in older women. DESIGN: A case-control study. SETTING: Two hundred seventy-six general practices. PATIENTS: Cases (n = 3,616) were women, age 50-69 years, with a first recorded UTI in the calendar years 1989 or 1990. Controls (n = 19,162) were matched for age and practice. MAIN OUTCOME MEASURE: Clinical diagnosis of UTI. RESULTS: Women using estrogens for greater than or equal to 1 year had an increased risk of being diagnosed with a UTI compared to non-users, crude odds ratio (OR) 1.9 (95% CI 1.5-2.2). All of this excess risk was observed in women with intact uteri, OR 2.1 (CI 1.7-2.7). Hysterectomized women had no increased risk, OR 1.1 (CI 0.8-1.5). Controlling for diabetes, neurologic deficit, atrophic vaginitis, incontinence, and age did not affect the observed associations. CONCLUSION: Estrogen use is associated with an increased risk of UTI in older women with intact uteri but not in hysterectomized women. This observed differential effect on women with or without uteri may be explained by prescribing biases between these two groups of women, but we lack any evidence to support this conclusion over several alternative possibilities.

Primary study

Unclassified

Control of recurrent lower urinary tract infection in the postmenopausal woman.

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Authors Parsons CL , Schmidt JD
Journal The Journal of urology
Year 1982
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There were 5 postmenopausal women with severe recurrent cystitis who were placed on a protocol of intravaginal estrogen in an effort to control infection. Before therapy all patients had colonization of the vagina by 1 or more species of Enterobacteriaceae and an associated elevation of vaginal pH greater than 5.2 (normal range 4.0 to 4.5). After acute antibiotic treatment and continuous low dose intravaginal estrogen all 5 patients showed a return of vaginal pH to the normal range and disappearance of vaginal bacterial pathogens. Of the 5 women 4 have had no further urinary tract infection off antibiotics and on low dose intravaginal estrogen. One patient had a urinary tract infection in association with a flare in colitis, which was controlled with reinstitution of antibiotics and high dose intravaginal estrogen therapy.

Primary study

Unclassified

Effectiveness of estriol-containing vaginal pessaries and nitrofurantoin macrocrystal therapy in the prevention of recurrent urinary tract infection in postmenopausal women.

Journal Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
Year 2003
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We compared the efficacy and safety of estriol-containing vaginal pessary use with those of oral nitrofurantoin macrocrystal (NM) therapy for preventing urinary tract infection (UTI) in postmenopausal women with recurrent UTI. Over a period of 9 months, 86 women received an estriol-containing vaginal pessary (0.5 mg estriol) twice weekly, and 85 women received NM (100 mg) once daily. We recorded 124 episodes of UTI in women who received estriol-releasing pessaries and 48 episodes of UTI in women treated with NM (P=.0003). Twenty-eight women (32.6%) who received estriol had no episodes of UTI versus 41 women (48.2%) in the NM group. There was a significant increase in the number of superficial cells in women who received estriol, whereas in the NM group, no such changes occurred. However, there was no change in the extent of Lactobacillus colonization and in the vaginal pH in women who received estriol. Use of an estriol-containing pessary is less effective than oral NM therapy in the prevention of bacteriuria in postmenopausal women because of its failure to restore the population of lactobacilli and to reduce the vaginal pH in these women.

Primary study

Unclassified

[Prevention and treatment of recurrent urinary system infection with estrogen cream in postmenopausal women].

Authors Xu R , Wu Y , Hu Y
Journal Zhonghua fu chan ke za zhi
Year 2001
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OBJECTIVE: To evaluate the effect and feasibility of using estrogen cream for the prevention and treatment of recurrent urinary tract infection (UTI) in postmenopausal women. METHODS: Forty-five postmenopausal women with a history of recurrent UTI were divided into two groups (group premarin and group antibiotic). Participants were assigned to apply intravaginal premarin cream (group premarin, n = 30) or oral antibiotic (group antibiotic, n = 15) for 3 months respectively. Urine routine test, midstream urine and vaginal cultures, vaginal health score (VHS), vaginal cell maturation value (MV), endometrial thickness and blood estrogen level were obtained before and after the study. RESULTS: The incidence of UTI in the group premarin was significantly reduced as compared with that in the group antibiotic (2/27 vs. 12/15, P < 0.001). In the group premarin Lactobacilli reappeared (from 0 to 59.3%) and MV (from 9.2 +/- 6.8 to 74.6 +/- 14.1) and VHS (from 5.2 +/- 0.4 to 13.4 +/- 2.5) were improved after 3 months. There was no significant change in the group antibiotic. CONCLUSION: It seems that intravaginal use of estrogen cream would effectively prevent and reduce the UTI in postmenopausal women.

Primary study

Unclassified

Urinary tract infections in postmenopausal women: effect of hormone therapy and risk factors.

Journal Obstetrics and gynecology
Year 2001
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OBJECTIVE: To assess the effects of hormone therapy on urinary tract infection frequency and to examine potential risk factors. METHODS: We used data from the Heart and Estrogen/Progestin Replacement Study, a randomized, blinded trial of the effects of hormone therapy on coronary heart disease events among 2763 postmenopausal women aged 44-79 with established coronary heart disease. Participants were randomly assigned to 0.625 mg of conjugated estrogens plus 2.5 mg of medroxyprogesterone acetate or placebo and followed for a mean of 4.1 years. History of physician-diagnosed urinary tract infections and risk factors were assessed by self-report at baseline and each annual visit. RESULTS: Urinary tract infection frequency was higher in the group randomized to hormone treatment, although the difference was not statistically significant (odds ratio [OR] 1.16, 95% confidence interval [CI] 0.99, 1.37). Statistically significant risk factors for urinary tract infections in multivariable analysis included: women with diabetes on treatment (insulin OR 1.81, 95% CI 1.40, 2.34), oral medications OR 1.44, 95% CI 1.09, 1.90), poor health (OR 1.34, 95% CI 1.14, 1.57), childbirth (OR 1.38, 95% CI 1.00, 1.90), vaginal itching (OR 1.63, 95% CI 1.07, 2.50), vaginal dryness (OR 1.30, 95% CI 1.04, 1.67), and urge incontinence (OR 1.51, 95% CI 1.30, 1.75). Urinary tract infections in the previous year were strongly associated with a single urinary tract infection (OR 7.00, 95% CI 5.91, 8.29) as well as multiple urinary tract infections (OR 18.51, 95% CI 14.27, 24.02). CONCLUSIONS: Oral hormone therapy did not reduce frequency of urinary tract infections. Potentially modifiable risk factors in postmenopausal women are different from those in younger women, and include diabetes, vaginal symptoms, and urge incontinence.

Primary study

Unclassified

[Treatment with low-dose vaginal estradiol in post-menopausal women. A double-blind controlled trial].

Journal Ugeskrift for laeger
Year 1990
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Twenty-three postmenopausal women with recurrent cystitis were allorted at random to treatment for five months with local oestrogen in the vagina or placebo treatment with the object of assessing the local effect on the vaginal epithelium and on the tendency to recurrent cystitis. The therapeutic group and the placebo group were entirely comparable prior to treatment. In the therapeutic group, the oestrogen index in vaginal scrapings was significantly higher after treatment than in the placebo group (p less than 0.01). The number of positive urine cultures and the patients/satisfaction with treatment wee not significantly different in the two groups.

Primary study

Unclassified

A randomized, open, parallel-group study on the preventive effect of an estradiol-releasing vaginal ring (Estring) on recurrent urinary tract infections in postmenopausal women.

Authors Eriksen B
Journal American journal of obstetrics and gynecology
Year 1999
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<b>OBJECTIVE: </b>The primary objective was to detect a difference in time until the first recurrence of urinary tract infection during treatment with an estradiol-releasing silicone vaginal ring (Estring; Pharmacia &amp; Upjohn, Inc, Uppsala, Sweden) compared with no estrogen treatment. The secondary objective was to detect any differences in improvement of urethral and vaginal mucosal atrophy and in the subjective assessment of urogenital symptoms. The study also sought to detect a difference in decrease of vaginal pH to &lt;5.5 and to record adverse events.<b>STUDY DESIGN: </b>This was a multicenter, randomized, open, parallel-group study with an untreated control group. Postmenopausal women with recurrent symptomatic, bacteriologically confirmed urinary tract infections were randomly assigned to receive either Estring (2 mg estradiol) or no estrogen treatment. One ring was carried vaginally for 12 weeks. The duration of treatment was 36 weeks for the Estring group and either 36 weeks or until the first recurrence for the control group. Both intent-to-treat and per-protocol analyses were performed to evaluate efficacy, whereas the safety analysis was limited to the intent-to-treat group. The primary variable was analyzed by survival analysis with the Kaplan-Meier method for estimating the survival density function. To compare the survival curves for the 2 treatment groups a log-rank test was performed for time until first recurrence.<b>RESULTS: </b>A total of 108 women were randomly assigned, 53 to the Estring group and 55 to the control group. The cumulative proportion of women remaining free of urinary tract infection was significantly higher in the Estring group than in the control group (P =.008). After 36 weeks of study the cumulative likelihood of remaining free of disease was approximately 45% in the women with the vaginal ring compared with approximately 20% in the control group. Estring lowered vaginal pH, and the time to first recurrence was effectively prolonged by Estring treatment. Vaginal and, to a lesser extent, urethral mucosal cells were significantly more mature in the Estring group. No unexpected adverse events were found.<b>CONCLUSION: </b>Estring is useful to prolong the time to next recurrence among postmenopausal women with recurrent urinary tract infection and to decrease the number of recurrences per year. The silicone vaginal ring also has a clinically significant ability to alleviate other postmenopausal urogenital symptoms. Estring is safe and well tolerated.

Primary study

Unclassified

Efficacy of low-dose intravaginal estriol on urogenital aging in postmenopausal women.

Journal Menopause (New York, N.Y.)
Year 2004
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OBJECTIVE: To assess the efficacy and safety of intravaginal estriol administration on urinary incontinence, urogenital atrophy, and recurrent urinary tract infections in postmenopausal women. DESIGN: Eighty-eight postmenopausal women with urogenital aging symptoms were enrolled in this prospective, randomized, placebo-controlled study. Participants were randomly divided into two groups, with each group consisting of 44 women. Women in the treatment group received intravaginal estriol ovules: 1 ovule (1 mg) once daily for 2 weeks and then 2 ovules once weekly for a total of 6 months as maintenance therapy. Women in the control group received inert placebo vaginal suppositories in a similar regimen. We evaluated urogenital symptomatology, urine cultures, colposcopic findings, urethral cytologic findings, urethral pressure profiles, and urethrocystometry before as well as after 6 months of treatment. RESULTS: After therapy, the symptoms and signs of urogenital atrophy significantly improved in the treatment group in comparison with the control group. Thirty (68%) of the treated participants, and only seven (16%) of the control participants registered a subjective improvement of their incontinence. In the treated participants, we observed significant improvements of colposcopic findings, and there were statistically significant increases in mean maximum urethral pressure, in mean urethral closure pressure as well as in the abdominal pressure transmission ratio to the proximal urethra. Urethrocystometry showed positive but not statistically significant modifications. CONCLUSIONS: Our results show that intravaginal administration of estriol may represent a satisfactory therapeutic choice for those postmenopausal women with urogenital tract disturbances who have contraindications or refuse to undergo standard hormone therapy.

Primary study

Unclassified

Triple therapy with Lactobacilli acidophili, estriol plus pelvic floor rehabilitation for symptoms of urogenital aging in postmenopausal women.

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Journal Archives of gynecology and obstetrics
Year 2014
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PURPOSE: To assess the effects of the combination of pelvic floor rehabilitation, intravaginal estriol and Lactobacillus acidophli administration on stress urinary incontinence (SUI), urogenital atrophy and recurrent urinary tract infections in postmenopausal women. METHODS: 136 postmenopausal women with urogenital aging symptoms were enrolled in this prospective randomized study. PATIENTS: randomly divided into two groups and each group consisted of 68 women. INTERVENTIONS: Subjects in the triple therapy (group I) received 1 intravaginal ovule containing 30 mcg estriol and Lactobacilli acidophili (50 mg lyophilisate containing at least 100 million live bacteria) such as once daily for 2 weeks and then two ovules once weekly for a total of 6 months as maintenance therapy plus pelvic floor rehabilitation. Subjects in the group II received one intravaginal estriol ovule (1 mg) plus pelvic floor rehabilitation in a similar regimen. MEAN OUTCOME MEASURES: We evaluated urogenital symptomatology, urine cultures, colposcopic findings, urethral cytologic findings, urethral pressure profiles and urethrocystometry before, as well as after 6 months of treatment. RESULTS: After therapy, the symptoms and signs of urogenital atrophy significantly improved in both groups. 45/59 (76.27%) of the group I and 26/63 (41.27%) of the group II referred a subjective improvement of their incontinence. In the patients treated by triple therapy with lactobacilli, estriol plus pelvic floor rehabilitation, we observed significant improvements of colposcopic findings, and there were statistically significant increases in mean maximum urethral pressure, in mean urethral closure pressure, as well as in the abdominal pressure transmission ratio to the proximal urethra. CONCLUSIONS: Our results showed that triple therapy with L. acidophili, estriol plus pelvic floor rehabilitation was effective and should be considered as first-line treatment for symptoms of urogenital aging in postmenopausal women.

Primary study

Unclassified

Effects of local estrogen therapy on recurrent urinary tract infections in young females under oral contraceptives.

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Journal European urology
Year 2005
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BACKGROUND: Previous studies have demonstrated the efficacy of local application of estrogen in treating postmenopausal women with recurrent urinary tract infections (RUTI) and urinary incontinence. Younger women under oral contraceptives (OC) can suffer from similar symptoms. The aim of this pilot study was to evaluate the effectiveness of local estrogens on RUTI and the impact of local hormonal supplementation on bladder neck vascularization. METHODS: 30 women (mean age 22.7 years) with a longstanding history of RUTI were included. Pre-treatment investigation included complete clinical history, urinalysis, urine culture and cystoscopy. All subjects completed a questionnaire about onset and duration of disease and quality of life before and after treatment. Local (vaginal) estrogen therapy consisted of 1mg estriol (E3) 7 times a week for two weeks and twice a week for two additional weeks. Sonographic examination of bladder vascularization was performed before and after treatment using transperineal color Doppler ultrasound (6 MHz, Acuson Sequoia 512, Mountain View, CA, USA) with a filled bladder. After angle correction, peak systolic blood flow velocity (PSBFV) and end diastolic blood flow velocity (EDBFV) were measured in 2 bladder arteries; and the Resistive Index (RI) was calculated. Flow velocity in each vessel was measured at least four times and the mean value determined. RESULTS: All patients completed the therapy course without severe side effects. Patients had a mean history of RUTI over 2.3 years; the mean period under OC was 3.2 years. In the follow-up period of 11 months after treatment, 24/30 patients reported no symptoms of cystitis and used no additional medication. Normal bladder epithelium in control cystoscopy after E3 therapy was seen in all patients with trigonal metaplasia and vulnerable, highly vascularized urothelium at the initial investigation. RI decreased from 0.945 to 0.705 after treatment (p<0.001), concomitantly the mean EDBFV increased highly significantly from 0.82 cm/sec to 4.45 cm/sec after estrogen treatment (p<0.001). INTERPRETATION: In a majority of young patients under OC and a longstanding history of RUTI, a considerable infection-free period was achieved after local application of estrogen. Decreased RI and increased EDBFV indicate vasodilatation and less peripheral vascular resistance. Responsiveness to local E3 may correspond to improved cystoscopic findings as a consequence of increased bladder perfusion.
References ( articles) loading Revert Studify
References ( articles) loading Revert Studify