Urodynamic evaluation of prasterone vaginal treatment of mild to moderate urge incontinence in women with vulvovaginal atrophy: multicenter prospective study

Objective: This study aimed to evaluate the effects of intravaginal prasterone treatment on urge urinary symptoms in women affected by genitourinary syndrome of menopause. Methods: The study was conducted on postmenopausal women with vulvovaginal atrophy and symptoms of increased urinary frequency and urgency with an Overactive Bladder Screener score of >8. Participants underwent urodynamic examination and completed the International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF) questionnaire before and after 3 months of treatment. Wilcoxon signed rank test for the paired sample was used to compare continuous non parametric variables. Results: Twenty women were prospectively enrolled (January 2022 to January 2024). The median age and menopausal age were 59 years (interquartile range, 56.0-66.5 y) and 50 years (interquartile range, 49.0-52.5 y), respectively. According to the ICIQ-SF, the mean scores before and after treatment were 9.6 (SD, 5.1) and 2.63 (SD, 2.24), respectively (P > 0.001). According to the urodynamic examination, the median volume infused increased from 70 to 123 mL (P = 0.001) for the first stimulus, from 115 to 202 mL (P = 0.001) for the normal stimulus, from 199 to 290 mL (P = 0.001) for the urge stimulus, and from 251 to 343 mL (P = 0.001) for the maximal bladder filling capacity. At the end of the study, the 42.1% of women reported very much and much better improvement according to the Patient Global Impression of Improvement score. Conclusions: After 3 months of prasterone treatment, women reported a statistically significant objective increase in bladder compliance through a later voiding stimulus and a subjective reduction in urge incontinence episodes through the validated ICIQ-SF questionnaire.