Up to 33% of patients undergoing radical prostatectomy suffer from varying degrees of incontinence.
The rate of incontinence after cystectomy and neobladder creation may be higher. The therapy for this incontinence includes pelvic floor exercises, the use of incontinence devices such as pads or condom catheters, the endourethral injection of bulking agents, or finally the placement of a male sling or an artificial urinary sphincter.
Duloxetine is a combined serotonin and norepinephrine reuptake inhibitor. As a consequence, the activity of the striated sphincter muscle increases. Duloxetine has been shown to effectively treat women with stress and mixed type incontinence. Recently, a study by B. Schlenker, C. G. Stief and colleagues from Munich Germany examined the role of duloxetine in the treatment of male patients suffering from stress urinary incontinence (SUI) after radical prostatectomy or radical cystectomy. The study is published in the June 2006 issue of European Urology.
Over a two-year period, 18 patients with SUI post radical prostatectomy or radical cystectomy with orthotopic neobladder were treated with 40 mg of duloxetine twice daily. The average number of pads pre-treatment was 8 a day. After an average of 9.4 weeks of pharmacotherapy with duloxetine, the average number of pads fell from 8.0/day to 4.2 pads/day (p < 0.0001). Fifteen of the 18 patients (83.33%) reported improvement of SUI after the use of duloxetine and 7 of 18 patients (39%) were completely dry or used one pad per day at the most for safety reasons. The mean pad use in these patients before duloxetine was 3.9 pads/day.
Six patients reported no side effects at all; the majority reported mild side effects such as fatigue (4), dry mouth (3), nausea (1), or insomnia (1). Most of the side effects vanished within 4 weeks but 6 patients (33.3%) discontinued the medication due to adverse events.
The preliminary results from this pilot study suggest good efficacy of duloxetine for the treatment of SUI in men post pelvic surgery. The side effect profile of the drug did lead to the drop out of 1/3 rd of patients however. The patients must be educated on the high incidence of the main side effect of massive fatigue or insomnia.
By Michael J. Metro, MD
Eur Urol. 2006 June; 49 (6):1075-78
Schlenker B, Gratzke C, Reich O, Schorsch I, Seitz M, Stief CG
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