***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: 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 prospect i ve , r and omized , placebo-controlled study . Participants were r and omly 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 st and ard hormone therapy Abstract 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 prospect i ve r and omized study . Patients : r and omly 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 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 OBJECTIVE 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 & 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 < 5.5 and to record adverse events . STUDY DESIGN This was a multicenter , r and omized , open , parallel-group study with an untreated control group . Postmenopausal women with recurrent symptomatic , bacteriologically confirmed urinary tract infections were r and omly 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 . RESULTS A total of 108 women were r and omly 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 . CONCLUSION 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 clinical ly significant ability to alleviate other postmenopausal urogenital symptoms . Estring is safe and well tolerated A block r and omized , double-blind , group-comparative , placebo-controlled study was conducted to assess the effect of oestriol on recurrent urinary tract infections in postmenopausal women . 40 women , median age 78 years ( 66 - 91 ) , 20 in each group , were treated with oestriol three mg p.o . per day or corresponding placebo for four weeks , followed by one mg per day for eight weeks . The main response parameter was the number of urinary tract infections per week in the two treatment periods . Both oestriol and placebo reduced the number of infections per week significantly in both periods , compared with the pretreatment period . There was no difference between oestriol and placebo treatment in the first period . In the second period , however , oestriol treatment was significantly more effective than placebo ( p = 0.05 ) . Correspondingly , there was a significant difference between the two groups in the vaginal pH at the end of the study ( p less than 0.05 ) . We conclude that oestriol reduces recurrent urinary tract infections in postmenopausal women BACKGROUND Growing antibiotic resistance warrants study ing nonantibiotic prophylaxis for recurrent urinary tract infections ( UTIs ) . Use of lactobacilli appears to be promising . METHODS Between January 2005 and August 2007 , we r and omized 252 postmenopausal women with recurrent UTIs taking part in a double-blind noninferiority trial to receive 12 months of prophylaxis with trimethoprim-sulfamethoxazole , 480 mg , once daily or oral capsules containing 109 colony-forming units of Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14 twice daily . Primary end points were the mean number of symptomatic UTIs , proportion of participants with at least 1 UTI during 12 months , time to first UTI , and development of antibiotic resistance by Escherichia coli . RESULTS The mean number of symptomatic UTIs in the year preceding r and omization was 7.0 in the trimethoprim-sulfamethoxazole group and 6.8 in the lactobacilli group . In the intention-to-treat analysis , after 12 months of prophylaxis , these numbers were 2.9 and 3.3 , respectively . The between-treatment difference of 0.4 UTIs per year ( 95 % CI , -0.4 to 1.5 ) was outside our noninferiority margin . At least 1 symptomatic UTI occurred in 69.3 % and 79.1 % of the trimethoprim-sulfamethoxazole and lactobacilli participants , respectively ; median times to the first UTI were 6 and 3 months , respectively . After 1 month of trimethoprim-sulfamethoxazole prophylaxis , resistance to trimethoprim-sulfamethoxazole , trimethoprim , and amoxicillin had increased from approximately 20 % to 40 % to approximately 80 % to 95 % in E coli from the feces and urine of asymptomatic women and among E coli causing a UTI . During the 3 months after trimethoprim-sulfamethoxazole discontinuation , resistance levels gradually decreased . Resistance did not increase during lactobacilli prophylaxis . CONCLUSIONS In postmenopausal women with recurrent UTIs , L rhamnosus GR-1 and L reuteri RC-14 do not meet the noninferiority criteria in the prevention of UTIs when compared with trimethoprim-sulfamethoxazole . However , unlike trimethoprim-sulfamethoxazole , lactobacilli do not increase antibiotic resistance . TRIAL REGISTRATION is rct n.org Identifier : IS RCT N50717094 BACKGROUND Recurrent urinary tract infections are a problem for many postmenopausal women .  Estrogen replacement restores atrophic mucosa , lowers vaginal pH , and may prevent urinary tract infections . METHODS We enrolled 93 postmenopausal women with a history of recurrent urinary tract infections in a r and omized , double-blind , placebo-controlled trial of a topically applied intravaginal estriol cream . Midstream urine cultures were obtained at enrollment , monthly for eight months , and whenever urinary symptoms occurred . Vaginal cultures and pH measurements were obtained at entry and after one and eight months . The women were assigned to receive either estriol ( n = 50 ) or placebo ( n = 43 ) , both administered intravaginally ; 36 and 24 , respectively , completed the eight months of follow-up . RESULTS The incidence of urinary tract infection in the group given estriol was significantly reduced as compared with that in the group given placebo ( 0.5 vs. 5.9 episodes per patient-year , P < 0.001 ) . Survival analysis showed that more of the women in the estriol group than in the placebo group remained free of urinary tract infection ( P < 0.001 ) . Lactobacilli were absent in all vaginal cultures before treatment and reappeared after one month in 22 of 36 estriol-treated women ( 61 percent ) but in none of the 24 placebo recipients ( P < 0.001 ) . With estriol the mean vaginal pH declined from 5.5 to 3.8 ( P < 0.001 ) , whereas there was no significant change with placebo . The rate of vaginal colonization with Enterobacteriaceae fell from 67 percent to 31 percent in estriol recipients but was virtually unchanged ( from 67 to 63 percent ) in the placebo recipients ( P < 0.005 ) . Side effects were minor , but caused 10 estriol recipients ( 28 percent ) and 4 placebo recip 
    Output:
    
Antibiotics were the most efficacious therapy but with a higher incidence of systemic side effects .
Vaginal estrogen appeared to be inferior to continuous oral antibiotic suppression ; however , use of multiple formulations of both treatment options precludes meta- analysis .
This review supports the use of antibiotic suppression , vaginal estrogen , and oral lactobacillus for prevention of recurrent UTIs in postmenopausal women .
However , the overall dearth of data suggests that this is an important but understudied population .