Advertisement

International Urogynecology Journal

, Volume 26, Issue 4, pp 477–485 | Cite as

Pharmacological treatment of pure stress urinary incontinence: a narrative review

  • Mariam A. MalallahEmail author
  • Tariq F. Al-Shaiji
Review Article

Abstract

Introduction and hypothesis

Treatment escalation from conservative directly to surgical in the management of pure stress urinary incontinence (SUI) reveals a gap for effective pharmacological treatments. The introduction of a drug therapy would fill this gap and widen the treatment options. Nevertheless, various pharmaceutical agents have been used off-label and are being investigated and becoming more widely available. In this review, we examined the latest published data regarding pharmacotherapy used in the treatment of SUI.

Methods

We performed a literature review to evaluate the relevant studies pertaining to any pharmacotherapy used in the management of SUI, examining the English language literature.

Results

Currently, no drug exists that is approved by the food and drug administration for the management of SUI. A few oral pharmacological agents are occasionally used off-label. Lack of proven efficacy and high incidence of bothersome side effects of these agents limit their use. Duloxetine, a serotonin norepinephrine reuptake inhibitor, represents a major therapeutic advance for the treatment of SUI based on findings from a number of controlled clinical trials.

Conclusions

Several pharmacological agents have been used off-label and investigated for safety and efficacy, but none has demonstrated sufficient effectiveness to receive widespread verification for its use in the treatment of SUI.

Keywords

Urinary incontinence Stress urinary incontinence Pharmacotherapy Duloxetine Serotonin norepinephrine reuptake inhibitor 

Abbreviations

EMG

Electromyographic

ERT

Estrogen replacement therapy

FDA

Food and Drug Administration

IEF

Incontinence episode frequency

I-QOL

Incontinence-specific Quality of Life questionnaire score

MPA

Medroxyprogesterone acetate

NA

Noradrenalin

PGI-I

Patient Global Impression of Improvement

PMFT

Pelvic floor muscle training

PPA

Phenylpropanolamine

QOL

Quality of life

RCT

Randomized controlled trial

SNRI

Serotonin norepinephrine reuptake inhibitors

SUI

Stress urinary Incontinence

TCA

Tricyclic antidepressants

UUI

Urgency urinary incontinence

WHO/ICI

World Health Organization/International Consultation on Incontinence

Notes

Conflicts of interest

None.

Source of funding

None.

References

  1. 1.
    Abrams P, Cardozo L, Fall M et al (2002) The standardisation of terminology of lower urinary tract function: report from the standardisation sub-committee of the international continence society. Neurourol Urodyn 21:167–178CrossRefPubMedGoogle Scholar
  2. 2.
    Haylen BT, de Ridder D, Freeman RM et al (2010) An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Int Urogynecol J J21:5–26CrossRefGoogle Scholar
  3. 3.
    Hannestad YS, Rortveit G, Sandvik H et al (2000) A community-based epidemiological survey of female urinary incontinence: the Norwegian EPINCONT study. J Clin Epidemiol 53:1150–1157CrossRefPubMedGoogle Scholar
  4. 4.
    Hunskaar S, Lose G, Sykes D et al (2004) The prevalence of urinary incontinence in women in four European countries. BJU Int 93:324–330CrossRefPubMedGoogle Scholar
  5. 5.
    Iosif MD, Batra S, Ef A et al (1981) Oestrogen receptors in the human female lower urinary tract. Am J Obstet Gynecol 141:817–820PubMedGoogle Scholar
  6. 6.
    Padmanabhan P, Dmochowski R (2014) Urinary incontinence in women: a comprehensive review of the pathophysiology, diagnosis and treatment. Minerva Ginecol 66:469–478PubMedGoogle Scholar
  7. 7.
    Wilson L, Brown JS, Shin GP et al (2001) Annual direct cost of urinary incontinence. Obstet Gynecol 98:398–406CrossRefPubMedGoogle Scholar
  8. 8.
    Wilson P, Bo K, Bourcier A et al (1999) Conservative treatment in women. In: Cardozo L, Abrams P, Khoury G, Wein A (eds) Incontinence. Proceedings from the Second International Consultation on Incontinence. Health Publications, Plymouth, pp 579–634Google Scholar
  9. 9.
    Hay-Smith EJ, Bo K, Berghmans LCM et al (2001) Pelvic floor muscle training for urinary incontinence in women. Cochrane Database Syst Rev 1:CD001407PubMedGoogle Scholar
  10. 10.
    Robinson D, Anders K, Cardozo L et al (2003) What do women want?: interpretation of the concept of cure. J Pelvic Med Surg 9:273–277CrossRefGoogle Scholar
  11. 11.
    Leach G, Dmochowski RR, Appell RA et al (1997) Female stress urinary incontinence clinical guidelines panel summary report on surgical management of female stress urinary incontinence. The American Urological Association. J Urol 158:875–880CrossRefPubMedGoogle Scholar
  12. 12.
    DeLancey JOL (1997) The pathophysiology of stress urinary incontinence in women and its implications for surgical treatment. World J Urol 15(5):268–274CrossRefPubMedGoogle Scholar
  13. 13.
    Henriksson L, Anderson KE, Ulmsten U (1979) The urethral pressure profiles in continent and stress incontinent women. Scand J Urol Nephrol 13:5–10CrossRefGoogle Scholar
  14. 14.
    Hilton P, Stanton SL (1983) Urethral pressure measurement by microtransducer: the results in symptom-free women and in those with genuine stress incontinence. Br J Obstet Gynaecol 90:919–933CrossRefPubMedGoogle Scholar
  15. 15.
    Anderson KE, Appell R, Cardozo L et al (2005) Pharmacological treatment of urinary incontinence. In: Abrams P, Cardozo L, Khoury S, Wein A (eds) Incontinence: 3rd international consultation on incontinence. Health Publications, Plymouth, pp 809–854Google Scholar
  16. 16.
    Iosif CS, Bekassy Z (1984) Prevalence of genito-urinary symptoms in the late menopause. Acta Obstet Gynecol Scand 63:257–260CrossRefPubMedGoogle Scholar
  17. 17.
    Thomas TM, Plymat KR, Blannin J et al (1980) Prevalence of urinary incontinence. Br Med J 281:1243–1245CrossRefPubMedCentralPubMedGoogle Scholar
  18. 18.
    Robinson D, Cardozo L (2004) Oestrogens and the lower urinary tract. BJOG 111:10–14CrossRefPubMedGoogle Scholar
  19. 19.
    Moerher B, Hextall A, Jackson S (2003) Oestrogens for urinary incontinence in women. Cochrane Database Syst Rev 2:CD001405Google Scholar
  20. 20.
    Hextall A (2002) Oestrogens and lower urinary tract functions. Maturitas 36:83–87CrossRefGoogle Scholar
  21. 21.
    Fantl JA, Bump RC, Robinson D et al (1996) Efficacy of oestrogen supplementation in the treatment of urinary incontinence. Obstet Gynaecol 88:745–749CrossRefGoogle Scholar
  22. 22.
    Jackson S, Shepherd A, Brookes S et al (1999) The effect of oestrogen supplementation on post-menopausal urinary stress incontinence: a double-blind, placebo controlled trial. Br J Obstet Gynaecol 106:711–718CrossRefPubMedGoogle Scholar
  23. 23.
    Grady D, Brown JS, Vittinghoff E et al (2001) Postmenopausal hormones and incontinence: the heart and estrogen/progestin replacement study. Obstet Gynecol 97:116–120CrossRefPubMedGoogle Scholar
  24. 24.
    Andersson K-E, Appell R, Awad S et al (2002) Pharmacological treatment of urinary incontinence. In: Abrams P, Khoury S, Wein A (eds) Incontinence. Health Publications, Plymouth, pp 481–511Google Scholar
  25. 25.
    Andersson KE (1988) Current concepts in the treatment of disorders of micturition. Drugs 35:477–494CrossRefPubMedGoogle Scholar
  26. 26.
    Wein AJ (1995) Pharmacology of incontinence. Urol Clin N Am 22:557–577Google Scholar
  27. 27.
    Diokno AC, Taub M (1975) Ephedrine in treatment of urinary incontinence. Urology 5:624–627CrossRefPubMedGoogle Scholar
  28. 28.
    Collste L, Lindskog M (1987) Phenylpropanolamine in treatment of female stress urinary incontinence. Double-blind placebo controlled study in 24 patients. Urology 40:398–403CrossRefGoogle Scholar
  29. 29.
    Andersson KE, Appell R, Cardozo L (1999) The pharmacological treatment of urinary incontinence. BJU Int 84:923–947CrossRefPubMedGoogle Scholar
  30. 30.
    Kerman WN, Viscoli CM, Brass LM et al (2000) Phenylpropanolamine and the risk of hemorrhagic stroke. N Engl J Med 343:1826–1832CrossRefGoogle Scholar
  31. 31.
    Musselman DM, Ford AP, Gennevois DJ et al (2004) A randomized crossover study to evaluate Ro115–1240, a selective alpha1A/1 L adrenoceptor partial agonist in women with stress urinary incontinence. BJU Int 93:78–83CrossRefPubMedGoogle Scholar
  32. 32.
    Wein AJ (2004) A randomized crossover study to evaluate Ro 115–1240, a selective alpha1A/1 L adrenoceptor partial agonist in women with stress urinary incontinence [editorial comment]. BJU Int 93:1115PubMedGoogle Scholar
  33. 33.
    Weil EH, Eerdmans PH, Dijkman GA et al (1998) Randomized double- blind placebo-controlled multicenter evaluation of efficacy and dose finding of midodrine hydrochloride in women with mild to moderate stress urinary incontinence: a phase II study. Int Urogynecol J 9:145–150CrossRefGoogle Scholar
  34. 34.
    Gleason DM, Reilly RJ, Bottacini MR et al (1974) The urethral continence zone and its relation to stress incontinence. J Urol 112:81–88PubMedGoogle Scholar
  35. 35.
    Barlett DM, Wein AJ (1991) Voiding dysfunction: diagnosis, classification and management. In: Gillenwater JY, Grayhack JT, Howards ST, Duckett JW (eds) Adult and pediatric urology, 2nd edn. Mosby Year Book, St. Louis, pp 1001–1099Google Scholar
  36. 36.
    Scarpero HM (2007) Pharmacological therapy for stress urinary incontinence. In: Goldman HB, Vasavada SP (eds) Female urology : a practical clinical guide. Humana Press, Totowa, p 89Google Scholar
  37. 37.
    Viktrup L, Bump RC (2003) Pharmacological agents used for the treatment of stress urinary incontinence in women. Curr Med Res Opin 19:485–490CrossRefPubMedGoogle Scholar
  38. 38.
    Ishiko O, Ushiroyama T, Saji F et al (2000) Beta(2)-adrenergic agonists and pelvic floor exercises for female stress incontinence. Int J Gynaecol Obstet 71:39–44CrossRefPubMedGoogle Scholar
  39. 39.
    Yasuda K, Kawabe K, Takimoto Y et al (1993) A double-blind clinical trial of alpha2-adrenergic agonist in stress incontinence. Int Urogynecol J 4:146–151CrossRefGoogle Scholar
  40. 40.
    Khullar V, Digesu A, Chaliha C et al (2002) “Mixed incontinence: how should it be treated?”. Neurourol Urodyn 21(4):378–379Google Scholar
  41. 41.
    Thor KB (2002) Exploring new horizons in neurourology. Contemp Urol (Suppl):9–13Google Scholar
  42. 42.
    Susie O, Ian R (2005) Duloxetine: the long awaited drug treatment for stress urinary incontinence. Obstet Gynecol 7:117–119CrossRefGoogle Scholar
  43. 43.
    Norton P, Zinner NR, Yalcin I et al (2002) Duloxetine versus placebo in the treatment of stress urinary incontinence. Am J Obstet Gynecol 187:40–48CrossRefPubMedGoogle Scholar
  44. 44.
    Zinner N, Dmochowski R, Miklos J et al (2002) Duloxetine versus placebo in the treatment of stress urinary incontinence (SUI). Neurourol Urodyn 21:383–384Google Scholar
  45. 45.
    Shah SM, Gaunay GS (2012) Treatment options for intrinsic sphincter deficiency. Nat Rev Urol 9:638–651PubMedGoogle Scholar
  46. 46.
    Bymaster FP, Dreshfield-Ahmad LJ, Threlkeld PG et al (2001) Comparative affinity of duloxetine and venlafaxine for serotonin and norepinephrine transporters in vitro and in vivo, human serotonin receptor subtypes, and other neuronal receptors. Neuropsychopharmacology 25:871–880CrossRefPubMedGoogle Scholar
  47. 47.
    Thor KB, Katofiasc MA (1995) Effects of duloxetine, a combined serotonin and norepinephrine reuptake inhibitor, on central neural control of lower urinary tract function in the chloralose-anesthetized female cat. J Pharmacol Exp Ther 274:1014–1024PubMedGoogle Scholar
  48. 48.
    Dmochowski RR, Miklos JR, Norton PA et al (2003) Duloxetine versus placebo for the treatment of north American women with stress urinary incontinence. J Urol 170:1259–1263CrossRefPubMedGoogle Scholar
  49. 49.
    Millard RJ, Moore K, Rencken R et al (2004) “Duloxetine vs placebo in the treatment of stress urinary incontinence: a four-continent randomized clinical trial”. BJU Int 93:311–318CrossRefPubMedGoogle Scholar
  50. 50.
    Van Kerrebroeck P, Abrams P, Lange R et al (2004) Duloxetine versus placebo in the treatment of European and Canadian women with stress urinary incontinence. BJOG 111:249–257CrossRefPubMedGoogle Scholar
  51. 51.
    Ghoniem GM, Van Leeuwen JS, Elser DM et al (2005) A randomized controlled trial of duloxetine alone, pelvic floor muscle training alone, combined treatment and no active treatment in women with stress urinary incontinence. J Urol 173:1647–1653CrossRefPubMedGoogle Scholar
  52. 52.
    Katofiasc MA, Nissen J, Audia JE et al (2002) Comparison of the effects of serotonin selective, norepinephrine selective, and dual serotonin and norepinephrine reuptake inhibitors on lower urinary tract function in cats. Life Sci 71:1227–1236CrossRefPubMedGoogle Scholar
  53. 53.
    National Institute for Health and Clinical Excellence (2013) Urinary incontinence: the management of urinary incontinence in women. Clinical guidelines CG171. NICE Web site. Accessed at http://guidance.nice.org.uk/CG171
  54. 54.
    Choi KT (2008) Botanical characteristics, pharmacological effects and medicinal components of Korean Panax ginseng C A Meyer. Acta Pharmacol Sin 29:1109–1118CrossRefPubMedGoogle Scholar
  55. 55.
    Shergis JL, Zhang AL et al (2013) Quality and risk of bias in Panax ginseng randomized controlled trials: a review. Am J Chin Med 41:231–252CrossRefPubMedGoogle Scholar
  56. 56.
    Guo XX, Guo Q et al (2012) Ginsenoside rh2 induces human hepatoma cell apoptosis via bax/bak triggered cytochrome C release and caspase-9/caspase-8 activation. Int J Mol Sci 13:15523–15535CrossRefPubMedCentralPubMedGoogle Scholar
  57. 57.
    Chen YH, Lin YN, Chen WC et al (2014) Treatment of stress urinary incontinence by ginsenoside Rh2. Am J Chin Med 42(4):817–831CrossRefPubMedGoogle Scholar

Copyright information

© The International Urogynecological Association 2015

Authors and Affiliations

  1. 1.Division of Urology, Department of SurgeryAl-Adan HospitalKuwaitKuwait
  2. 2.Division of Urology, Department of SurgeryAl-Amiri HospitalKuwaitKuwait

Personalised recommendations