[Pharmacotherapy of stress incontinence].
Female urinary incontinence is a medical and social problem with a large prevalence. Stress urinary incontinence (SUI) is the most common form of urinary incontinence and is responsible for 49 % of all incontinence, if mixed forms are included even for 78 %. As of yet, apart from "off-label" treatment, there is no pharmacological treatment available for stress urinary incontinence. For instance, estrogens are used in menopausal patients but a substantial effect in the treatment of SUI has not been demonstrated. a-Adrenergics, such as phenylpropanolamine and midodrine, and b-adrenergics, such as clenbuterol, are also used in "off-label" therapy. A recently conducted meta-analysis of 15 randomised studies with female patients who received a- und b-adrenergics as part of their therapy, failed to detect efficacy compared to placebo. Tricyclic antidepressives, such as imipramine and doxepine, which are used for the treatment of urge incontinence, are also used "off-label" in the treatment of SUI. However, no placebo-controlled studies have been conducted so far. The serotonin-norepinephrine reuptake inhibitor duloxetine represents a new therapeutic approach in the treatment of SUI. It has shown positive effects on bladder and urethra in animal experiments, most likely through an effect on the Onuf's nucleus in the spinal cord. In randomised, placebo-controlled studies (phase II and III) in women with SUI, a significant and clinically relevant reduction in urinary incontinence episodes as well as an improvement in the quality of life compared to placebo was shown.
Jost
W H
WH
Fachbereich Neurologie und Klinische Neurophysiologie, Deutsche Klinik für Diagnostik, Wiesbaden. jost.neuro@dkd-wiesbaden.de
Marsalek
P
P
Michel
M C
MC
D018663:Adrenergic Agents / Q000627:therapeutic use*; D000928:Antidepressive Agents / Q000627:therapeutic use*; D000068736:Duloxetine Hydrochloride; D004967:Estrogens / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*; D013876:Thiophenes / Q000627:therapeutic use*; D014550:Urinary Incontinence, Stress / Q000188:drug therapy*
D018663:Adrenergic Agents; D000928:Antidepressive Agents; D000068736:Duloxetine Hydrochloride; D004967:Estrogens; D017367:Selective Serotonin Reuptake Inhibitors; D013876:Thiophenes