Effect of Routine Duloxetine Administration in the Early Postoperative Period on Post- Prostatectomy Stress Incontinence in Patients Undergoing Laparoscopic Radical Prostatectomy

Abstract

Post-prostatectomy stress incontinence (PPI) is an important health problem for patients with radical prostatectomy history. Duloxetine is a common drug, used in PPI with the out of indications in most countries. In this study, we aimed to evaluate the prophylactic effect of duloxetine administration in PPI during the early postoperative period in patients undergoing laparoscopic radical prostatectomy (LRP). The retrospective study included 209 patients who underwent LRP. Patients were divided into two groups: Group I (n=96) was initiated on pelvic floor exercises (PFE) + duloxetine in the early postoperative period and continued this regimen for a total of 12 weeks and Group II (n=113) only performed PFE for 12 weeks after surgery. Exclusion criteria were as follows: a history of neuromuscular dysfunction of bladder, post-prostatectomy urge incontinence, receiving adjuvant radiotherapy during the 12- week period, prior anti-incontinence surgery, and post-voiding urine>100 ml. The prevalence rates of urinary incontinence measured at the time of urinary catheter removal (baseline) and at weeks 3, 6, and 12 after surgery and the number of wet pads per day were compared. The study included 209 patients with a mean age of 60.68 ± 7.16 years. Baseline urinary continence rates were similar in Group I and Group II (29.2% vs. 35.4%, p=0.338). At 12 weeks, although PPI rates have decreased in both groups, there was no difference between Group I and Group II (15.6% vs. 24.8%, p=0.103). Administration of prophylactic duloxetine in the early postoperative period, which started without regard to the positivity of PPI, is not significantly effective to early postoperative urinary continence recovery.

Keywords

• post-prostatectomy incontinence
• duloxetine
• radical prostatectomy
• prostate cancer

References

1. Alan, C., Eren, A.E., Ersay, A.R., Kocoglu, H., Basturk, G., Demirci. E., 2015. Efficacy of duloxetine in the early management of urinary continence after radical prostatectomy. Curr Urol. 8, 43–8.
2. Borges, R.C., Tobias-Machado, M., Gabriotti, E.N., Dos Santos Figueiredo, F.W., Bezerra, C.A., Glina, S,. 2019. Post-radical prostatectomy urinary incontinence: is there any discrepancy between medical reports and patients' perceptions? BMC Urol. 19, 32.
3. Boy, S., Reitz, A., Wirth, B., Knapp, P. A., Braun, P. M., Haferkamp, A., Schurch, B., 2006. Facilitatory neuromodulative effect of duloxetine on pudendal motor neurons controlling the urethral pressure: a functional urodynamic study in healthy women. European urology. 50, 119–125.
4. Collado Serra, A., Rubio Briones, J., Iborra Juan, I., Ramón-Borja, J.C., Solsona Narbón, E., 2011. Postprostatectomy established stress urinary incontinence treated with duloxetine. Urology. 78, 261-6.
5. Cornu, J. N., Merlet, B., Ciofu, C., Mouly, S., Peyrat, L., Sèbe, P., Yiou, R., Vallancien, G., Debrix, I., Laribi, K., Cussenot, O., Haab, F., 2011. Duloxetine for mild to moderate postprostatectomy incontinence: preliminary results of a randomised, placebo-controlled trial. European urology. 59, 148–154.
6. de Lira, G.H.S., Fornari, A., Cardoso, L.F., Aranchipe, M., Kretiska, C., Rhoden, E.L., 2019. Effects of perioperative pelvic floor muscle training on early recovery of urinary continence and erectile function in men undergoing radical prostatectomy: a randomized clinical trial. Int Braz J Urol. 45, 1196-203.
7. Filocamo, M. T., Li Marzi, V., Del Popolo, G., Cecconi, F., Villari, D., Marzocco, M., Nicita, G., 2007. Pharmacologic treatment in postprostatectomy stress urinary incontinence. European urology. 51, 1559–1564
8. Fink, K.G., Huber, J., Wurnschimmel, E., Schmeller, N.T., 2008. The use of duloxetine in the treatment of male stress urinary incontinence. Wien Med Wochenschr. 158, 116-8.

9. Gresty, H., Walters, U., Rashid, T., 2019. Post-prostatectomy incontinence: multimodal modern-day management. Br J Community Nurs. 24, 154-9.
10. Holm, H.V., Fosså, S.D., Hedlund, H., Schultz, A., Dahl, A.A., 2014. How should continence and incontinence after radical prostatectomy be evaluated? A prospective study of patient ratings and changes with time. J Urol. 192, 1155-61.
11. Kania, P., Wośkowiak, P., Salagierski, M., 2019. Preservation of continence in radical prostatectomy patients: a laparoscopic surgeon's perspective. Cent European J Urol. 72, 32-8.
12. Nambiar, A. K., Bosch, R., Cruz, F., Lemack, G. E., Thiruchelvam, N., Tubaro, A., Bedretdinova, D. A., Ambühl, D., Farag, F., Lombardo, R., Schneider, M. P., Burkhard, F. C., 2018. EAU Guidelines on Assessment and Nonsurgical Management of Urinary Incontinence. European urology. 73, 596–609.
13. Li, J., Yang, L., Pu, C., Tang, Y., Yun, H., Han, P., 2013. The role of duloxetine in stress urinary incontinence: a systematic review and meta-analysis. Int Urol Nephrol. 45, 679-86.
14. Neff, D., Guise, A., Guralnick, M. L., Langenstroer, P., See, W. A., Jacobsohn, K. M., O'Connor, R. C., 2013. Duloxetine for the treatment of post-prostatectomy stress urinary incontinence. Can Urol Assoc J. 7, E260-2.
15. Nestler, S., Thomas, C., Neisius, A., Rubenwolf, P., Roos, F., Hampel, C., Thüroff, J. W., 2019. Long-term results of ProACT primary and repeat implantation for treatment of stress urinary incontinence in men. World journal of urology. 37, 1173–1179.
16. Pompe, R. S., Tian, Z., Preisser, F., Tennstedt, P., Beyer, B., Michl, U., Graefen, M., Huland, H., Karakiewicz, P. I., Tilki, D., 2017. Short- and Long-term Functional Outcomes and Quality of Life after Radical Prostatectomy: Patient-reported Outcomes from a Tertiary High-volume Center. European urology focus. 3, 615–620.
17. Sandhu, J. S., Breyer, B., Comiter, C., Eastham, J. A., Gomez, C., Kirages, D. J., Kittle, C., Lucioni, A., Nitti, V. W., Stoffel, J. T., Westney, O. L., Murad, M. H., McCammon, K., 2019. Incontinence after Prostate Treatment: AUA/SUFU Guideline. The Journal of urology. 202, 369–378.
18. Stanford, J. L., Feng, Z., Hamilton, A. S., Gilliland, F. D., Stephenson, R. A., Eley, J. W., Albertsen, P. C., Harlan, L. C., Potosky, A. L., 2000. Urinary and sexual function after radical prostatectomy for clinically localized prostate cancer: the Prostate Cancer Outcomes Study. JAMA. 283, 354–360.
19. Trofimenko, V., Myers, J.B., Brant, W.O., 2017. Post-Prostatectomy Incontinence: How Common and Bothersome Is It Really? Sex Med Rev. 5, 536-43.
20. Zahariou, A., Papaioannou, P., Kalogirou G., 2006. Is HCl duloxetine effective in the management of urinary stress incontinence after radical prostatectomy? Urol Int. 77, 9-12.