title: The facilitatory effect of duloxetine combined with pelvic floor muscle training on the excitability of urethral sphincter motor neurons.
abstract: OBJECTIVE
  Aim of this study was to investigate the excitability of sphincter motor neurons under the influence of pelvic floor muscle training (PFMT) and duloxetine. Due to their mechanisms of action, there might be a synergistic effect of duloxetine and PFMT in regard to the facilitation of spinal reflexes controlling urethral sphincter contractions and hence continence.
  
  
  METHODS
  In ten healthy female subjects, clitoral electric stimulation (CES) and transcranial magnetic stimulation (TMS) were used to determine individual motor thresholds for external urethral sphincter (EUS) contractions before and after PFMT, duloxetine, and PFMT + duloxetine.
  
  
  RESULTS
  PFMT and duloxetine alone significantly decreased the motor thresholds for EUS contractions during CES and TMS. However, the combined treatment reduced the motor threshold for EUS contractions significantly stronger compared to PFMT or duloxetine alone.
  
  
  CONCLUSIONS
  The results are suggestive for a synergistic facilitatory effect of PFMT and duloxetine on sphincter motor neuron activation.
authors.affiliation: Neurourology, Spinal Cord Injury Center, Balgrist University Hospital, Forchstrasse 340, 8008, Zürich, Switzerland. ulrich.mehnert@paralab.balgrist.ch
authors.forename: Ulrich
authors.initials: U
authors.lastname: Mehnert
authors.forename: Sönke
authors.initials: S
authors.lastname: Boy
authors.forename: Sabina
authors.initials: S
authors.lastname: Widmer-Simitovic
authors.forename: André
authors.initials: A
authors.lastname: Reitz
authors.forename: Brigitte
authors.initials: B
authors.lastname: Schurch
mesh_terms: D000328:Adult; D003131:Combined Modality Therapy; D000068736:Duloxetine Hydrochloride; D005081:Exercise Therapy; D005260:Female; D006801:Humans; D009046:Motor Neurons / Q000187:drug effects*; D009119:Muscle Contraction; D017773:Pelvic Floor / Q000502:physiology; D017367:Selective Serotonin Reuptake Inhibitors / Q000494:pharmacology* / Q000627:therapeutic use; D013876:Thiophenes / Q000494:pharmacology* / Q000627:therapeutic use; D014521:Urethra / Q000187:drug effects*; D014550:Urinary Incontinence, Stress / Q000188:drug therapy; D014563:Urodynamics; D055815:Young Adult
chemical_list: D000068736:Duloxetine Hydrochloride; D017367:Selective Serotonin Reuptake Inhibitors; D013876:Thiophenes