STRESS URINARY INCONTINENT WOMEN, THE INFLUENCE OF AGE AND HORMONAL STATUS ON ESTROGEN RECEPTOR ALPHA AND BETA GENE EXPRESSION AND PROTEIN IMMUNOEXPRESSION IN PARAURETHRAL TISSUES

The underlying cause of stress urinary incontinence (SUI) is an anatomical abnormality associated with paraurethral connective tissue dysfunction. The question as to whether estrogens affect the quality of that tissue remains unexplained. Samples of paraurethral connective tissue from 81 women were examined (the SUI's n = 49; the control's n = 32). In both groups, the patients were subdivided into pre- and postmenopausals. Primary study outcome was comparison of the estrogen receptor alpha (ER alpha) and the estrogen receptor beta (ER beta) gene and protein in paraurethral tissue between SUI and control group. Secondary study outcome was comparison of these receptors according to hormonal status of the patients and their age. In both examined groups, we found both ER proteins. The ER alpha gene expression was detected in-19/32 (SUI) samples and in 24/31 (control), and ER beta gene expression 31/32 and 30/31 samples, respectively. The SUI's had significantly lower ER alpha gene expression premenopausally than the control's. The analysis found considerably lower ER beta and reduced ER alpha gene expression in postmenopausals, approaches the significance level. There was also significant decrease in both receptors' genes expression in post-53 women, compared to younger patients. Spearman's correlation test revealed a statistically significant decrease in ER beta gene with age. Both estrogen receptors are found in women's paraurethral tissue, so this tissue is an estrogen target. No correlation between ER beta gene expression and immunoexpression and SUI was found. The ER alpha gene seems to play a key role in SUI in the premenopausal period, but ER beta gene expression in the paraurethral connective tissue decreases with age.