Does Medical Therapy Cure Female Stress Incontinence?

Lose, Gunnar; Diernaes, E; Rix, Per

doi:10.1159/000281444

Cited by 11 publications

(5 citation statements)

References 13 publications

(14 reference statements)

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“…It is reported that α‐adrenergic receptors exist in neurons and ganglions in the bladder trigone and posterior urethra, and stimulation inhibits bladder contracrtion 10,19 Thus, imipramine having both α‐agonist and anti‐cholinergic effects might act both by increasing urethral pressure and decreasing bladder contractility by enhancing the bladder compliance, as shown in this present study. The duration of treatment was three months because many other studies have adopted this amount of time 2,3 . Our results showed that 35% (95% CI 15–55) of women with genuine stress incontinence were cured and 25% (95% CI 8–42) improved by 2 50% by pad weight after imipramine treatment.…”

Section: Discussionmentioning

confidence: 67%

“…Women with genuine stress incontinence require individual evaluation in the choice of treatment, depending on the degree of genuine stress incontinence and past experience of treatment. Although surgical intervention is the most common treatment for women with genuine stress incontinence, the fact that more than 100 difffer‐ent surgical procedures have been described 1 shows that surgical treatment is not always satisfactory 2,3 . These procedures can lead to dysfunction of the lower urinary tract in the form of impaired voiding, residual urine, recurrent urinary infection, detrusor instability, dyspare‐unia, low abdominal pain or enterocele 3–5 .…”

Section: Introductionmentioning

confidence: 99%

“…Many investigators have shown that treatment with a‐adrenergic agents can improve stress incontinence by increasing urethral closure pressure 2,3,6–10 . They have reported that medical therapy, using mainly ephedrine‐like agents, for women with genuine stress incontinence has a 32% to 85% subjective cure rate and a 52% to 61 % improvement, without any obvious side effects.…”

Section: Introductionmentioning

confidence: 99%

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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: Discussionmentioning

confidence: 67%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Comparison of treatment outcomes of imipramine for female genuine stress incontinence

Lin

Sheu

et al. 1999

BJOG

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“…Norfenefrine possesses a favorable profile of effect and side effects in the treatment of SI. A recent study has demonstrated the effect of norfenefrine even in patients with severe SI [4], and previously published data indicate that the routine use of norfenefrine prior to planned surgery may reduce the number of operations [23].…”

Section: Discussionmentioning

confidence: 97%

Acute Effect of Norfenefrine on the Urethral Pressure Profile in Females with Genuine Stress Incontinence

Jørgensen

Lose

Alexander³

1991

Urol Int

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To study the acute effect of norfenefrine, given orally in aqueous solution, on the urethral closure function, profilometry was performed before and after administration of placebo and increasing doses of norfenefrine in 6 females with genuine stress incontinence. A weak increase in urethral pressure was observed after administration of 90 mg of norfenefrine. No changes in heart rate and blood pressure occured. The results indicate that the direct sympathomimetic effect of norfenefrine is weak. It is suggested that norfenefrine mainly acts via indirect mechanisms.

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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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Does Medical Therapy Cure Female Stress Incontinence?

Cited by 11 publications

References 13 publications

Comparison of treatment outcomes of imipramine for female genuine stress incontinence

Comparison of treatment outcomes of imipramine for female genuine stress incontinence

Acute Effect of Norfenefrine on the Urethral Pressure Profile in Females with Genuine Stress Incontinence

Pharmakotherapie der Belastungsinkontinenz (Stressinkontinenz)

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