Drug may avert surgery for severe incontinence

Women awaiting surgery to relieve severe stress urinary incontinence may gain significant relief with the drug, leading some to reconsider surgery, a study indicates.

Cymbalta (a.k.a. duloxetine) has previously been shown to be effective in women with mild to moderate stress urinary incontinence.

In the current study, Dr. Richard C. Bump, with Eli Lilly Research Laboratories in Indianapolis (the makers of Cymbalta), and colleagues randomly assigned 109 women between 33 and 75 years of age to duloxetine or an inactive "placebo" daily for 8 weeks.

All of the women had loss urine control that occurred only with physical stress such as coughing or lifting, experienced 14 or more episodes of incontinence per week and were scheduled for surgery, the investigators explain in the journal Obstetrics and Gynecology.

Compared with placebo, duloxetine significantly reduced the frequency of incontinence episodes, decreased pad use, and improved incontinence-related quality of life scores.

Cymbalta's beneficial effects were seen within two weeks of starting treatment.

After 8 weeks of treatment, 20 percent of duloxetine-treated women decided to skip the surgery compared with none of the women given placebo.

"Overall," Bump said, "the data mean that physicians and patients have an additional option besides surgery or pelvic floor muscle training for treating women with severe urinary incontinence, and will know very quickly which patients will respond to treatment."

Side effects of Cymbalta included transient mild to moderate nausea, constipation, headache and dry mouth.

SOURCE: Obstetrics and Gynecology, September 2004.