Purpose of review: In the absence of an effective and well tolerated drug for stress urinary incontinence, pharmacological therapy for this condition has remained in the off-label prescription of some products particularly estrogens and alpha-adrenergic agonists. In this review we provide an update of the most recent developments on the pharmacological therapy for stress urinary incontinence.
Recent findings: In recent years studies have uncovered a role for central neurotransmitters in control of the lower urinary tract and specific targets for pharmacological intervention have been identified. Duloxetine inhibits presynaptic neuron reuptake of serotonin and norepinephrine, in the sacral spinal cord, increasing urethral closure forces and thereby reducing episodes of stress urinary incontinence. In clinical trials in women with stress urinary incontinence, duloxetine has demonstrated efficacy in reducing incontinence episodes and increasing quality of life with no serious adverse effects. Nausea was the most common adverse event, being reported as mild-to moderate in severity and transient in most of patients.
Summary: Although estrogens produce some effects on the urethral epithelium and may be useful in patients with atrophic vaginitis, at present, there is no good evidence supporting its use in women with stress urinary incontinence. Alpha-adrenoreceptor agonists have been found to be effective in stress urinary incontinence, but the use of these drugs is limited due to some major safety concerns related to cardiovascular side effects. Duloxetine is a new selective norepinephrine and serotonin reuptake inhibitor that has proven efficacy for the treatment of stress urinary incontinence in women.