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Medical management of stress urinary incontinence: Is there a future?

Current Urology Reports volume 10, pages 401–407 (2009)Cite this article

Abstract

Stress urinary incontinence (SUI) is a common problem among women worldwide. Multiple treatment modalities exist, ranging from physiotherapy to surgery. Numerous reports demonstrate mixed results for efficacy and safety of several oral agents used to treat SUI. Although there are data suggesting reasonable efficacy for several medications, surgery still remains the mainstay of treatment for most women. This article reviews the available oral agents that have been studied and assesses the data supporting their use while highlighting the limitations of each.

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References and Recommended Reading

  1. Diokno AJ, Brock BM, Brown MB, Herzog AB: Prevalence of urinary incontinence and other urological symptoms in the non-institutionalized elderly. J Urol 1986, 136:1022–1025.

    PubMed  CAS  Google Scholar 

  2. Ueda T, Yoshimura N, Yoshida O: Prognostic factors for long-term maintenance of urinary continence in patients with incontinence managed by diapers or indwelling catheters. Eur Urol 2000, 37:318–324.

    PubMed  Article  CAS  Google Scholar 

  3. Hunskaar S, Arnold EP, Burgio K, et al.: Epidemiology and natural history of urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct 2000, 11:301–319.

    PubMed  Article  CAS  Google Scholar 

  4. Fultz NH, Burgio K, Diokno AC, et al.: Burden of stress urinary incontinence for community-dwelling women. Am J Obstet Gynecol 2003, 189:1275–1282.

    PubMed  Article  Google Scholar 

  5. Norton C: Providing appropriate service for continence: an overview. Nurs Stand 1996, 10:41–45.

    PubMed  CAS  Google Scholar 

  6. Cannon TW, Yoshimura N, Chancellor MB: Innovations in pharmacotherapy for stress urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct 2003, 14:367–372.

    PubMed  Article  Google Scholar 

  7. Kayigil O, Iftekhar Ahmed S, Metin A: Coexistence of instrinsic sphincteric deficiency with type II stress incontinence. J Urol 1999, 162:1365–1366.

    PubMed  Article  CAS  Google Scholar 

  8. Norton P, Brubaker L: Urinary incontinence in women. Lancet 2006, 367:57–67.

    PubMed  Article  Google Scholar 

  9. Leach G, Dmochowski RR, Appell RA, et al.: Female Stress Urinary Incontinence Clinical Guidelines Panel summary report on surgical management of female stress urinary incontinence. The American Urological Association. J Urol 1997, 158(3 Pt 1):875–880.

    PubMed  CAS  Google Scholar 

  10. de Groat WC, Yoshimura N: Pharmacology of the lower urinary tract. Annu Rev Pharmacol Toxicol 2001, 41:691–721.

    PubMed  Article  Google Scholar 

  11. Yoshimura N, Chancellor MB: Physiology and pharmacology of the bladder and urethra (Section XIV, Chapter 56). In Campbell-Walsh Urology, vol 3, edn 9. Edited by Wein AJ. Philadelphia: Saunders; 2006:1922–1972.

    Google Scholar 

  12. Nomiya M, Yamaguchi O: A quantitative analysis of mRNA expression of alpha 1 and beta adrenoceptor subtypes and their functional roles in human normal and obstructed bladders. J Urol 2003, 170:649–653.

    PubMed  Article  CAS  Google Scholar 

  13. Thor KB, Morgan C, Nadelhaft I, et al.: Organization of afferent and efferent pathways in the pudendal nerve of the female cat. J Comp Neurol 1989, 288:263–279.

    PubMed  Article  CAS  Google Scholar 

  14. Chancellor MB, Perkin H, Yoshimura N: Recent advances in the neurophysiology of stress urinary incontinence. Scand J Urol Nephrol 2005, 39:21–24.

    PubMed  Article  Google Scholar 

  15. de Groat WC, Theobald RJ: Reflex activation of sympathetic pathways to vesical smooth muscle and parasympathetic ganglia by electrical stimulation of vesical afferents. J Physiol 1976, 259:223–237.

    PubMed  Google Scholar 

  16. Thor KB, Katofiasc MA: Effects of duloxetine, a combined serotonin and norepinephrine reuptake inhibitor, on central neural control of lower urinary tract function in the cholarose-anesthestized female cat. J Pharmacol Exp Ther 1995, 274:1014–1024.

    PubMed  CAS  Google Scholar 

  17. Dmochowski RR, Miklos JR, Norton PA, et al.: Duloxetine versus placebo for the treatment of North American women with stress urinary incontinence. J Urol 2003, 170:1259–1263.

    PubMed  Article  CAS  Google Scholar 

  18. van Kerrebroeck P, Abrams P, Lange R, et al.: Duloxetine versus placebo in the treatment of European and Canadian women with stress urinary incontinence. BJOG 2004, 111:249–257.

    PubMed  Article  CAS  Google Scholar 

  19. Millard RJ, Moore K, Rencken R, et al.: Duloxetine vs placebo in the treatment of stress urinary incontinence: a four-continent randomized clinical trial. BJU Int 2004, 93:311–318.

    PubMed  Article  CAS  Google Scholar 

  20. Schagen van Leeuwen JH, Lange RR, Jonasson AF, et al.: Efficacy and safety of duloxetine in elderly women with stress urinary incontinence or stress-predominant mixed urinary incontinence. Maturitas 2008, 60:138–147.

    PubMed  Article  CAS  Google Scholar 

  21. Bump RC, Voss S, Beardsworth A, et al.: Long-term efficacy of duloxetine in women with stress urinary incontinence. BJU Int 2008, 102:214–218.

    PubMed  Article  CAS  Google Scholar 

  22. Viktrup L, Yalcin I: Duloxetine treatment of stress urinary incontinence in women: effects of demographics, obesity, chronic lung disease, hypoestrogenism, diabetes mellitus, and depression of efficacy. Eur J Obstet Gynecol Reprod Biol 2007, 133:105–113.

    PubMed  Article  CAS  Google Scholar 

  23. Moller LA, Lose G, Jorgensen T: The prevalence and bothersomeness of lower urinary tract symptoms in women 40–60 years of age. Acta Obstet Gynecol Scand 2000, 79:298–305.

    PubMed  Article  CAS  Google Scholar 

  24. Parazzini F, Colli E, Origgi G, et al.: Risk factors for urinary incontinence in women. Eur Urol 2000, 37:637–643.

    PubMed  Article  CAS  Google Scholar 

  25. Perucchini D, DeLancey JO, Ashton-Miller JA, et al.: Age effects on urethral striated muscle. I. Changes in number and diameter of striated muscle fibers in the ventral urethra. Am J Obstet Gynecol 2002, 186:351–355.

    PubMed  Article  Google Scholar 

  26. Pandit M, DeLancey JO, Ashton-Miller JA, et al.: Quantification of intramuscular nerves within the female striated urogenital sphincter muscle. Obstet Gynecol 2000, 95:797–800.

    PubMed  Article  CAS  Google Scholar 

  27. Weinstein DL, Cohen JS, Liu C, et al.: Duloxetine in the treatment of women with stress urinary incontinence: results from DESIRE (Duloxetine Efficacy and Safety for Incontinence in Racial and Ethnic populations). Curr Med Res Opin 2006, 22:2121–2129.

    PubMed  Article  CAS  Google Scholar 

  28. Eli Lilly and Company: Duloxetine hydrochloride prescribing information. Available at http://pi.lilly.com/us/cymbalta-pi.pdf. Accessed April 2009.

  29. Schlenker B, Gratzke C, Reich O, et al.: Preliminary results on the off-label use of duloxetine for the treatment of stress incontinence after radical prostatectomy or cystectomy. Eur Urol 2006, 49:1075–1078.

    PubMed  Article  CAS  Google Scholar 

  30. Zahariou A, Papaioannou P, Kalogirou G: Is HCl duloxetine effective in the management of urinary stress incontinence after radical prostatectomy? Urol Int 2006, 77:9–12.

    PubMed  Article  CAS  Google Scholar 

  31. Filocamo MT, Li Marzi V, Del Popolo G, et al.: Pharmacologic treatment in postprostatectomy stress urinary incontinence. Eur Urol 2007, 51:1559–1564.

    PubMed  Article  CAS  Google Scholar 

  32. Alhasso AA, Glazner CMA, Pickard R, N’Dow J: Adrenergics drugs for urinary incontinence. Cocrance Database of Systematic Reviews 2005, 3:CD001842.

  33. Diokno AC, Taub M: Ephedrine in treatment of urinary incontinence. Urology 1975, 5:624–625.

    PubMed  Article  CAS  Google Scholar 

  34. Awad SA, Downie JW, Kiruluta HG: Alpha-adrenergic agents in urinary disorder of the proximal urethra. Br J Urol 1978, 50:332–335.

    PubMed  Article  CAS  Google Scholar 

  35. Kerman WN, Viscoli CM, Brass LM, et al.: Phenylpropanolamine and the risk of hemorrhagic stroke. NEJM 2000, 343:1826–1832.

    Article  Google Scholar 

  36. Gnad H, Burmucic R, Petritsch P, Steindorfer P: Conservative therapy of female stress incontinence. Double-blind study with the alpha-sympathomimetic midodrin. Fortschritte der Medizin 1984, 102:578–580.

    PubMed  CAS  Google Scholar 

  37. Weil EH, Erdmans PH, Dijkman GA, et al.: Randomized double-blind placebo-controlled multicenter evaluation of efficacy and dose finding of midodrine hydochloride in women with mild to moderate stress urinary incontinence: a phase II study. Int Urogynecol J Pelvic Floor Dysfunct 1998, 9:145–150.

    PubMed  Article  CAS  Google Scholar 

  38. Tsakiris P, de la Rosette JJ, Michel MC, Oelke M: Pharmacologic treatment of male stress urinary incontinence: systematic review of the literature and levels of evidence. Eur Urol 2008, 53:53–59.

    PubMed  CAS  Article  Google Scholar 

  39. Musselman DM, Ford AP, Gennevois DJ, et al.: A randomized crossover study to evaluate RO 115-1240, a selective alpha 1a/1L-adrenoceptor partial agoinist in women with stress urinary incontinence. BJU Int 2004, 93:73–83.

    Article  Google Scholar 

  40. Ishiko O, Ushiroyama T, Saji F, et al.: Beta 2-adrenergic agonists and pelvic floor exercises for female stress incontinence. Int J Gynaecol Obstet 2000, 71:39–44.

    PubMed  Article  CAS  Google Scholar 

  41. Yasuda K, Kawabe K, Takimoto K: A double-blind clinical trial of a Beta 2 adrenergic agoinist in stress incontinence. Int Urogynecol J 1993, 4:146–151.

    Article  Google Scholar 

  42. Noguchi M, Eguchi, Ichiki J, et al.: Therapeutic efficacy of clenbuterol for urinary incontinence after radical prostatectomy. Int J Urol 1997, 4:480–483.

    PubMed  Article  CAS  Google Scholar 

  43. Zozikov B, Kunchev SI, Varlev C: Application of clenbuterol in the treatment of urinary incontinence. Int Urol Nephrol 2001, 33:413–416.

    PubMed  Article  CAS  Google Scholar 

  44. Phull H, Salkani M, Escobar C, et al.: The role of angiotensin II: a rat model. Neurourol Urodyn 2007, 26:81–88.

    PubMed  Article  CAS  Google Scholar 

  45. Karram MM, Yeko TR, Sauer MV, Bhatia NN: Urodynamic changes following hormone replaement therapy in women with premature ovarian failure. Obstet Gynecl 1989, 74:208–211.

    CAS  Google Scholar 

  46. Larsson B, Andersson K, Batra S, et al.: Effects of estradiol on norepinephrine-induced contraction, alpha adrenoceptor number and norepinephrine content in the female rabbit urethra. J Pharmacol Exp Ther 1984, 229:557–563.

    PubMed  CAS  Google Scholar 

  47. Fantl JA, Cardozo L, McClish DK: Estrogen therapy in the management of urinary incontinence in postmenopausal women: a meta-analysis. First report of the Hormones and Urogenital Therapy Committee. Obstet Gynecol 1994, 83:12–18.

    PubMed  CAS  Google Scholar 

  48. Al-Badr A, Ross S, Soroka D, Drutz HP: What is the available evidence for hormone replacement therapy in women with stress urinary incontinence? J Obstet Gynaecol Can 2003, 25:567–574.

    PubMed  Google Scholar 

  49. Moehrer B, Hextall A, Jackson S: Oestrogens for urinary incontinence in women. Cochrane Database Systematic Review 2003, 2:CD001405.

    Google Scholar 

  50. Grady D, Brown JS, Vittinghoff E, et al.: Postmenopausal hormones and incontinence:the Heart and Estrogen/Progestin Replacement Study. Obstet Gynecol 2001, 97:116–120.

    PubMed  Article  CAS  Google Scholar 

  51. Cummings SR, Eckert S, Krueger KA, et al.: The effect of raloxifene on risk of breast cancer in postmenopausal women: results from the MORE randomized trial. Multiple Outcomes of Raloxifene Evaluation. JAMA 1999, 281:2189–2197.

    PubMed  Article  CAS  Google Scholar 

  52. Davies GC, Huster WJ, Lu Y, et al.: Adverse events reported by postmenopausal women in controlled trials with raloxifene. Obstet Gynecol 1999, 93:558–565.

    PubMed  Article  CAS  Google Scholar 

  53. Waetjen LE, Brown JS, Modelska K, et al.: Effect of raloxifene on urinary incontinence: a randomized controlled trial. Obstet Gynecol 2004, 103:261–266.

    PubMed  CAS  Google Scholar 

  54. Gilja I, Radej M, Kovacic M, Parazajder J: Conservative treatment of female stress incontinence with imipramine. J Urol 1984, 132:909–910.

    PubMed  CAS  Google Scholar 

  55. Lin HH, Sheu BC, Lo MC, Huang SC: Comparison of treatment outcomes of imipramine for female genuine stress incontinence. Br J Obstet Gynaecol 1999, 106:1089–1092.

    PubMed  CAS  Google Scholar 

  56. Reid GF, Fitzpatrick JM, Worth PH: The treatment of patients with urinary incontinence after prostatectomy. Br J Urol 1980, 52:532–534.

    PubMed  Article  CAS  Google Scholar 

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Author information

Affiliations

  1. Department of Urology, University of Miami Miller School of Medicine, 1611 NW 10th Avenue, Miami, FL, 33136, USA

    Angelo E. Gousse

Authors
  1. Daniel J. Caruso
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  2. Christopher S. Gomez
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  3. Angelo E. Gousse
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Correspondence to Angelo E. Gousse.

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Caruso, D.J., Gomez, C.S. & Gousse, A.E. Medical management of stress urinary incontinence: Is there a future?. Curr Urol Rep 10, 401–407 (2009). https://doi.org/10.1007/s11934-009-0063-2

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  • DOI: https://doi.org/10.1007/s11934-009-0063-2

Keywords

  • Urinary Incontinence
  • Stress Urinary Incontinence
  • Raloxifene
  • Duloxetine
  • Midodrine