Pharmacotherapy For Stress Urinary Incontinence In Women

Öz

Urinary incontinence is a widespread debilitating and distressing condition in women and generally under-reported and undertreated. Stress urinary incontinence SUI is the most common type of incontinence.This condition is associated with social isolation, psychological impairement, restriction of physical activities and sexual dysfunction. Treatment options for SUI include conservative, medical treatment and surgery.Treatment of SUI should be individualized.Pharmacotherapy may be alternative options in womenwho do not wish to undergo a surgery or whose the surgery is contraindicated. Various drugs, including alpha receptor agonists, beta receptor antagonists, serotonin-adrenaline re-uptake inhibitors, and estrogen have been used. Among these agents, duloxetine is the only drug that has obtained approval for the treatment of SUI. In this review, the features of duloxetine therapy together with the other agents and the important aspect to be considered are discussed.

Anahtar Kelimeler

• Stress urinary incontinence,pharmacotherapy,duloxetine

Kadınlarda Stres Üriner İnkontinansın Farmakolojik Tedavisi

Öz

Üriner inkontinans kadınları zayıflatan ve sıkıntıya sokan yaygın bir durumdur ve genellikle rapor edilmez ve tedavi edilmezler. Stres üriner inkontinans SÜİ en yaygın inkontinans tipini oluşturmaktadır. SÜİ yüksek prevalansı ve yaşam kalitesine olumsuz etkileri nedeniyle önemini korumakta olan bir hastalıktır. Bu durum sosyal izolasyon, psikolojik rahatsızlık, fiziksel aktivitelerden kaçınma ve seksüel disfonksiyonla ilişkilidir. SÜİ’nin tedavisinde konservatif, medikal tedavi ve cerrahi yer almaktadır. Stres üriner inkontinansın tedavisi bireyselleştirilmelidir. Medikal tedavi, cerrahi olmak istemeyen ya da cerrahinin kontraendike olduğu kadınlarda alternatif bir seçenek olabilir. Ameliyat olamayan ya da ameliyatı istemeyen hastalar için de cerrahi dışı yöntemler bir seçenek olabilmektedir. Cerrahi dışı tedavi seçeneklerinden birisi de farmakoterapidir. Alfa reseptör agonitleri, beta reseptör agonistleri, beta reseptör antagonistleri, trisiklik antidepresanlar, antikolinerjikler, serotonin-adrenalin geri alım inhibitörleri ve östrojenleri içeren çeşitli ilaçlar kullanılmaktadır. Bu ilaçlar içerisinde SÜİ tedavisi için onay alan tek ilaç duloksetindir. Bu derlemede diğer ajanlarla birlikte duloksetin tedavisinin özellikleri ve dikkat edilmesi gereken noktalar ele alınmıştır.

Anahtar Kelimeler

• Stres üriner inkontinans,farmakoterapi,duloksetin

Kaynakça

1. Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, et al.; Standardisation Sub-Committee of the International Continence Society.. The standardisation of terminology in lower urinary tract function: report from the standardisation sub-committee of the International Continence Society. Urology. 2003 Jan;61(1):37-49
2. Oh SJ, Ku JH, Choo MS, Yun JM, Kim DY, Park WH. Health-related quality of life and sexual function in women with stress urinary incontinence and overactive bladder. Int J Urol. 2008 Jan;15(1):62-7
3. Hunskaar S, Lose G, Sykes D, Voss S. The prevalence of urinary in- continence in women in four European countries. BJU Int. 2004 Feb;93(3):324-30
4. DeLancey JOL. The pathophysiology of stres urinary incontinence in women and its implications for surgical treatment . World J Urol. 1997;15(5):268-274
5. Hilton P, Stanton SL. Urethral pressure measurement by microtransdu- cer: the results in symptom-free women and in those with genuine stress incontinence. Br J Obstet Gynaecol. 1983 Oct;90(10):919-33
6. Malallah MA, Al-Shaiji TF. Pharmacological treatment of pure stress urinary incontinence: a narrative review. . Int Urogynecol J. 2015 Apr;26(4):477-85.
7. Brune ME, O’Neill AB, Gauvin DM, Katwala SP, Altenbach RJ, Brioni JD, et al. Comparison of alpha 1-adrenoceptor agonists in canine urethral pressure profilometry and abdominal leak point pressure models. J Urol. 2001 Oct;166(4):1555-9
8. Diokno AC, Taub M. Ephedrine in treatment of urinary incontinence. Uro- logy. 1975 May;5(5):624-5

9. Collste L, Lindskog M. Phenylpropanolamine in treatment of female stress urinary incontinence. Double-blind placebo controlled study in 24 patients. Urology. 1987 Oct;30(4):398-403.
10. Agency for Healthcare Policy and Research. Urinary Incontinence Gui- deline Panel. Urinary Incontinence in Adults: Clinical Practice Guideline (AHCPR publication #92-0038). Rockville, MD, US Dept. of Health and Human Services, 1992.
11. Alhasso A, Glazener CM, Pickard R, N’dow J. Adrenergic drugs for urinary incontinence in adults. Cochrane Database Syst Rev. 2005 Jul 20;(3):CD001842
12. Radley SC, Chapple CR, Bryan NP, Clarke DE, Craig DA.Effect of met- hoxamine on maximum urethral pressure in women with genuine stress incontinence: a placebo-controlled, double-blind crossover study. Neurourol Urodyn 2001;20(1):43.
13. Weil EH, Eerdmans PH, Dijkman GA, Tamussino K, Feyereisl J, Vierhout ME, et al. Randomized doubleblind placebo controlled multicenter evalu- ation of efficacy and dose finding of midodrine hydrochloride in women with mild to moderate stress urinary incontinence: a phase II study. Int Urogynecol J Pelvic Floor Dysfunct 1998;9(3):145.
14. Blue DR, Daniels DV, Gever JR, Jett MF, O’Yang C, Tang HM, et al. Phar- macological characteristics of Ro 115-1240, a selective alpha1A/1L-ad- renoceptor partial agonist: a potential therapy for stress urinary inconti- nence. BJU Int. 2004 Jan;93(1):162-70.
15. Kaisary AV. Beta adrenoceptor blockade in the treatment of female stress urinary incontinence. J d’Urol (Paris) 1984;90:351
16. Gleason DM, Reilly RJ, Bottaccini MR, Pierce MJ. The urethral continen- ce zone and its relation to stress incontinence. J Urol 1974;112:81.
17. Ishiko O, Ushiroyama T, Saji F, Mitsuhashi Y, Tamura T, Yamamoto K, et al. Beta(2)-adrenergic agonists and pelvic floor exercises for female stress incontinence. Int J Gynaecol Obstet. 2000 Oct;71(1):39-44
18. Yasuda K, Kawabe K, Takimoto Y et al. A double blind clinical trial of a beta-2 adrenergic agonist in stress incontinence. Int Urogynecol J 1993;4:146.
19. Lin HH, Sheu BC, Lo MC, Huang SC. Comparison of treatment outcomes for imipramine for female genuine stress incontinence. Br J Obstet Gyna- ecol. 1999 Oct;106(10):1089-92.
20. Khullar V, Cardozo L, Dmochowski R. Mixed incontinence: current evi- dence and future perspectives. Neurourol Urodyn. 2010 Apr;29(4):618- 22
21. Yüksel N, Duloksetin: Klinik kullanım. Klinik Psikiyatri 2009;12(Ek 1):9- 16. Treatment options for intrinsic sphincter deficiency.
22. Shah SM, Gaunay GS. Treatment options for intrinsic sphincter deficien- cy. Nat Rev Urol. 2012 Nov;9(11):638-51.
23. Jost WH, Marsalek P. Duloxetine in the treatment of stress urinary incon- tinence. Ther Clin Risk Manag. 2005;1(4):259-64
24. Mariappan P, Ballantyne Z, N’Dow JM, Alhasso AA. Serotonin and no- radrenaline reuptake inhibitors (SNRI) for stress urinary incontinence in adults (review). Cochrane Database of Systemic Reviews 2005, Issue 3, Art. No: CD 004742. DOI: 10.1002/14651858. CD 0043742.
25. Shamliyan T, Wyman J, Kane RL. Comparative effectiveness review no. 36: Nonsurgical treatments for urinary incontinence in adult women: diagnosis and comparative effectiveness. Rockville (MD): Agency for Heathcare Research and Quality; 2012. Available: https://www.effecti- vehealthcare.ahrq.gov/ehc/products/169/834/urinary-incontinence-tre- atment-report-130909.pdf (accessed 2014 Mar. 26
26. Maund E, Guski LS, Gİtzsche PC. Considering benefits and harms of duloxetine for treatment of stress urinary incontinence: a meta-analysis of clinical study reports. CMAJ. 2017 Feb 6;189(5):E194-E203.
27. Ghoniem GM, Van Leeuwen JS, Elser DM, Freeman RM, Zhao YD, Yalcin I, et al.; Duloxetine/Pelvic Floor Muscle Training Clinical Trial Group. A randomized controlled trial of duloxetine alone, pelvic floor muscle trai- ning alone, combined treatment, and no treatment in women with stress urinary incontinence. J Urol 2005;173:1647. 31.
28. Mehnert U, Boy S, Widmer-Simitovic S, Reitz A, Schurch B. The facilita- tory effect of duloxetine combined with pelvic floor muscle training on the excitability of urethral sphincter motor neurons. Int Urogynecol J Pelvic Floor Dysfunct. 2009 Jun;20(6):659-66. Powered by TCPDF (www.tcp- df.org)
29. Sarısoy G, Kaçar ÖF, Pazvantoğlu O. Duloksetin-Siprofloksasin birlikye kullanımıyla ilişkili serotonin sendromu: olgu bildirimi. Klinik Psikofarma- koloji Bülteni 2012; 22(1): 79-82.
30. Michel MC, Minarzyk A, Schwerdtner I, Quail D, Methfessel HD, Weber HJ. Observational study on safety and tolerability of duloxetine in the tre- atment of female stress urinary incontinence in German routine practice. Br J Clin Pharmacol. 2013 Apr;75(4):1098-108
31. Kitta T, Miyazato M, Chancellor MB, de Groat WC, Nonomura K, Yoshi- mura N. Alpha2-adrenoceptor blockade potentiates the effect of duloxe- tine on sneeze induced urethral continence reflex in rats. J Urol. 2010 Aug;184(2):762-8.
32. Thor KB, Katofiasc MA. Effects of duloxetine, a combined serotonin and norepinephrine reuptake inhibitor, on central neural control of lower uri- nary tract function in the chloralose-anesthetized female cat. J Pharma- col Exp Ther. 1995 Aug;274(2):1014-24.
33. National Instıtute for Clinical and Health Excellence. Urinary incontinen- ce:the management of urinary incontinence in women. Clinical guidelines CG171. NICE website. Accessed at http://guidance.nice.org.uk/CK171
34. Thüroff JW, Abrams P, Andersson KE, Artibani W, Chapple CR, Dra- ke MJ, et al. EAU guidelines on urinary incontinence. Eur Urol. 2011 Mar;59(3):387-400.
35. Cody JD, Jacobs ML, Richardson K, Moehrer B, Hextall A. Oestrogen therapy for urinary incontinence in post-menopausal women. Cochrane Database Syst Rev. 2012 Oct 17;10:CD001405.
36. Hextall A. Oestrogens and lower urinary tract function. Maturitas. 2000 Aug 31;36(2):83-92
37. Sugaya K, Sekiguchi Y, Satoh T, Shiroma K, Kadekawa K, Ashitomi K, et al. Effect of propiverine hydrochloride on stress urinary incontinence. Int J Urol. 2014 Oct;21(10):1022-5.
38. Nishijima S, Sugaya K, Kadekawa K, Ashitomi K, Ueda T, Yamamoto H. Propiverine increases urethral wall catecholamine levels and bladder leak point pressure in rats. Int J Urol. 2016 Jan;23(1):93-9.
39. Arcaniolo D, Conquy S, Tarcan T.Flavoxate: present and future. Eur Rev Med Pharmacol Sci. 2015;19(5):719-31.