Comparison of treatment outcomes for imipramine for female genuine stress incontinence.
OBJECTIVE
To assess the efficacy of imipramine as a treatment of genuine stress incontinence and to explore the possible determining factors for treatment success and failure.


METHODS
A prospective study.


METHODS
University department of obstetrics and gynaecology.


METHODS
Forty women with genuine stress incontinence were enrolled.


METHODS
Each woman was treated with 25 mg imipramine three times a day for three months.


METHODS
Each woman had a 20-minute pad test and urodynamic study including uroflowmetry, both filling and voiding cystometry, and stress urethral pressure profile before and after treatment.


RESULTS
After treatment, 35% (n = 14) were cured, 25% (n = 10) improved by > or = 50% and in the remaining 40% (n = 16) treatment failed. The efficacy of successful treatment was 60% (95% CI 44.8-75.2). The median age and parity, as well as menopausal status, showed no statistical differences between the two groups. The pre-treatment data including pad weight, functional urethral length, maximal urethral pressure, bladder compliance at urgency, bladder capacity, and average and maximal flow rates showed no statistical differences between the two groups except urethral closure pressure (P = 0.001). Besides, the functional urethral length and urethral closure pressure were significantly improved in the treatment success group. After medication, the median functional urethral length was 3 cm (intraquantile range [IQR] 2.3-3) in the treatment success group vs 2.3 cm (IQR 2-3) in the treatment failure group (P = 0.028). The urethral closure pressure was 77 cmH2O (IQR 61-105) for the treatment success group vs 40 cmH2O (IQR 34-53) in the treatment failure group (P < 0.0001).


CONCLUSIONS
The efficacy of imipramine for genuine stress incontinence was 60% (95% CI 44.8-75.2). The pre-treatment high urethral closure pressure may serve as a predictor for treatment success.
Lin
H H
HH
Department of Obstetrics and Gynaecology, College of Medicine and the Hospital, National Taiwan University, Taipei.
Sheu
B C
BC
Lo
M C
MC
Huang
S C
SC
D018759:Adrenergic Uptake Inhibitors / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007099:Imipramine / Q000627:therapeutic use*; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome; D014550:Urinary Incontinence, Stress / Q000188:drug therapy* / Q000503:physiopathology; D014563:Urodynamics
D018759:Adrenergic Uptake Inhibitors; D007099:Imipramine