Clinical and Urodynamic Assessment of Pharmacologic Therapy of Stress Incontinence

Kiesswetter, H; F, Hennrich; Englisch, M.

doi:10.1159/000280863

Cited by 20 publications

(5 citation statements)

References 14 publications

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“…Because there are only a few reports using imipramine for treating genuine stress incontinence 11,12 , and no reports using an objective method to evaluate the effect of this drug, we performed this prospective study to assess objectively the efficacy of imipramine for women with genuine stress incontinence with the use of urodynamic study and pad weight test. We further explored the possible determining factors for treatment success and failure.…”

Section: Introductionmentioning

confidence: 99%

Comparison of treatment outcomes of imipramine for female genuine stress incontinence

Lin

Sheu

et al. 1999

BJOG

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Objective To assess the efficacy of imipramine as a treatment of genuine stress incontinence and to Design A prospective study.Setting University department of obstetrics and gynaecology.Participants Forty women with genuine stress incontinence were enrolled.Methods Each woman was treated with 25 mg imipramine three times a day for three months. Main outcome measuresEach 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 2 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 cmH,O (IQR 61-105) for the treatment success group vs 40 cmH,O (IQR 34-53) in the treatment failure group (P < 0.0001). ConclusionsThe 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.explore the possible determining factors for treatment success and failure.

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Section: Introductionmentioning

confidence: 99%

Comparison of treatment outcomes of imipramine for female genuine stress incontinence

Lin

Sheu

et al. 1999

BJOG

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“…Non-selective adrenergic drugs are used for a relief of stress urinary incontinence [13], in which low urethral pressure is a contributory mechanism. As we could not make repeated urodynamic studies, the exact mechanism of amezinium on the increase in PMR is not clear.…”

Section: Discussionmentioning

confidence: 99%

Amezinium metilsulfate, a sympathomimetic agent, may increase the risk of urinary retention in multiple system atrophy

Sakakibara¹,

Uchiyama²,

Asahina³

et al. 2003

Clinical Autonomic Research

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In 5 patients with multiple system atrophy, administration of 15 mg/day of amezinium metilsulfate, an adrenergic agent, during 6 months for the treatment of postural hypotension exacerbated post-micturition residuals as compared to that before treatment (178 ml versus 113 ml for a change of 37 %, p < 0.05). Amezinium metilsulfate most probably stimulates both alpha1B-receptors in the vascular wall and alpha1A/D-receptors in the proximal urethra.

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“…Insbesondere angesichts der jüngsten Diskussionen um das allgemeine Nutzen-Risiko-Profil systemischer Östrogenbehandlung bei menopausalen Frauen können sie deshalb zur Behandlung der Stressinkontinenz nicht empfohlen werden. (5,12,27,30,31,37).…”

Section: öStrogeneunclassified

Pharmakotherapie der Belastungsinkontinenz (Stressinkontinenz)

Jost

Marsalek

Michel

2005

Dtsch med Wochenschr

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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.

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Clinical and Urodynamic Assessment of Pharmacologic Therapy of Stress Incontinence

Cited by 20 publications

References 14 publications

Comparison of treatment outcomes of imipramine for female genuine stress incontinence

Comparison of treatment outcomes of imipramine for female genuine stress incontinence

Amezinium metilsulfate, a sympathomimetic agent, may increase the risk of urinary retention in multiple system atrophy

Pharmakotherapie der Belastungsinkontinenz (Stressinkontinenz)

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