Is HCl Duloxetine Effective in the Management of Urinary Stress Incontinence after Radical Prostatectomy?

Abstract

Introduction: Up to 70% of patients who undergo radical prostatectomy complain about urine leakage, but persistent stress incontinence 1 year after surgery affects <5% of them. HCl duloxetine is a dual serotonin and norepinephrine reuptake inhibitor that relieves the symptoms of stress urinary incontinence. The purpose of this study was to evaluate the efficacy of HCl duloxetine in the management of urinary incontinence after radical prostatectomy and its impact in urodynamic parameters such as maximal urethral closure pressure (MUCP), abdominal leak point pressure (ALPP) and retrograde leak point pressure (RLPP). Material and Methods: The study included 18 men with stress urinary incontinence 12 months after radical prostatectomy. All underwent a pad test to quantify the degree of urine loss and a urodynamic evaluation before and after a three month treatment with HCl duloxetine. The intrinsic sphincter was evaluated by ALPP and RLPP and the striated sphincter by MUCP. Results: At the pretreatment evaluation the mean ALPP was 52.1 cm H₂O, the mean MUCP was 52.5 cm H₂O and the mean RLPP was 43.1 cm H₂O. After 3 months of HCl duloxetine treatment the mean ALPP was 59.1 cm H₂O, the mean MUCP was 67.3 cm H₂O and the mean RLPP was 45.1 cm H₂O. There was a statistically significant correlation among RLPP, MUCP and ALPP before treatment. After HCl duloxetine treatment there was significant correlation between RLPP and ALPP. Conclusion: The use of HCl duloxetine results in mild increase of MUCP and in significant reduction of urine loss. Its action on the extrinsic sphincter does not provide a complete treatment option for postprostatectomy incontinence.

Duloxetine for the treatment of post-prostatectomy stress urinary incontinence

“…19 Several clinical studies investigating the role of duloxetine in post-prostatectomy SUI have been published. 5,[7][8][9][10] Filocamo and colleagues reported duloxetine and pelvic floor physical therapy may allow for earlier return to continence as compared to physical therapy alone following catheter removal in the immediate postoperative period. 7 Similarly, two additional studies found an approximate 50% reduction in pad usage with patients taking duloxetine to manage post-prostatectomy SUI.…”

“…5,8 Zarariou and colleagues reported minimal urodynamic improvements, but a significant reduction in clinical pad use after a 3-month course of duloxetine. 9 A Spanish study evaluated the efficacy of duloxetine in 68 patients with post-prostatectomy SUI at least 1 year post-prostatectomy. 10 The authors reported statistically significant improvements in daily pad requirements and incontinence questionnaire results.…”

“…The discontinuation rate in our study is comparable to other published studies. 5,[7][8][9][10] Other pharmacologic agents have been investigated for the treatment of post-prostatectomy SUI. Alpha-adrenergic agonists, including midodrine, norephrine and ephedrine, as well as beta-2-antagonists, have been used.…”

“…6 The use of duloxetine in men is an active area of investigation and represents a potential nonsurgical therapy for post-prostatectomy SUI. 5,[7][8][9][10] The goal of our investigation is to evaluate the efficacy and reported side effects in patients with mild to moderate post-prostatectomy SUI treated with duloxetine.…”

Sexually dimorphic urethral activity in response to pharmacological activation of 5-HT1A receptors in the rat

“…However, epidemiological studies have suggested that men are sometimes severely afflicted with SUI (27) and suffer greater emotional impacts than women (44). Currently, duloxetine has not been approved for treating SUI in men, but the drug has been used off label in some pilot studies; the studies (17,40,48) showed that the drug may produce a marked improvement in men with urinary incontinence.The rat model has now gained great popularity as the main species for developing pharmacologically based treatments of SUI. Effects of a 5-HT receptor agonist on regulatory bladder functions have been extensively investigated in female animals (5,6,15,19,23,28,43).…”