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Use of Duloxetine for Postprostatectomy Stress Urinary Incontinence: A Systematic Review.
Eur Urol Focus. 2020 Jun 27 [Online ahead of print]EU

Abstract

CONTEXT

The recommended treatment of postprostatectomy stress urinary incontinence (PPSUI) after failure of pelvic floor muscle training is primarily surgical intervention with a male sling or artificial urinary sphincter. The use of pharmacological therapy in this setting is unlicensed and controversial.

OBJECTIVE

To systematically review the available evidence regarding the efficacy and safety of duloxetine for the treatment of stress urinary incontinence following prostate surgery (radical or endoscopic).

EVIDENCE ACQUISITION

The EMBASE, MEDLINE/PubMed, and Cochrane Central Register of Controlled Trials were searched from inception up until April 17, 2020. All studies evaluating the role of duloxetine in men with PPSUI were included. Two reviewers independently screened all articles, searched the reference lists of retrieved articles, and performed data extraction. The quality of evidence and risk of bias were assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE); Cochrane; and Risk of Bias in Nonrandomised Studies of Interventions (ROBINS-I) tools.

EVIDENCE SYNTHESIS

The search yielded 234 studies. After excluding duplicates, 140 titles and abstracts were screened, and eight reports (348 patients) were eligible for inclusion in the final review. Duloxetine was assessed in two scenarios: (1) early use to reduce the time to attain continence and (2) treatment of persistent PPSUI. Most men had mild-to-moderate incontinence at baseline. Overall, duloxetine resulted in a mean dry rate of 58% (25-89%), mean improvement in pad number of 61% (12-100%), and mean improvement in 1-h pad weight of 68% (53-90%) at short-term follow-up (mean 1-9 mo; low to moderate certainty of evidence). However, mean adverse event rates were relatively high, and treatment was discontinued in 38% (low certainty of evidence).

CONCLUSIONS

Duloxetine has demonstrated good short-term cure and/or improvement in treating men with persistent PPSUI, as well as in reducing the time to attain continence. However, a proportion of men discontinue treatment due to adverse events. The overall certainty evidence is moderate to low, with heterogeneity between studies and methodological limitations. However, we have highlighted the need for further randomised trials with longer follow-up, utilising consistent outcome reporting measures. Despite these limitations, the findings from this review will aid patient counselling regarding this less invasive treatment option, thereby allowing personalisation of care centred around the values and preferences of individual patients.

PATIENT SUMMARY

Duloxetine has good success rates in the short term, in terms of improving incontinence symptoms in men who have undergone prostate surgery. However, some men experience side effects bad enough to require cessation of treatment. Further studies are needed to determine whether duloxetine maintains its effectiveness in the long term.

Authors+Show Affiliations

Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK.Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK.Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK. Electronic address: Sachin.malde@gstt.nhs.uk.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

32605820

Citation

Kotecha, Pinky, et al. "Use of Duloxetine for Postprostatectomy Stress Urinary Incontinence: a Systematic Review." European Urology Focus, 2020.
Kotecha P, Sahai A, Malde S. Use of Duloxetine for Postprostatectomy Stress Urinary Incontinence: A Systematic Review. Eur Urol Focus. 2020.
Kotecha, P., Sahai, A., & Malde, S. (2020). Use of Duloxetine for Postprostatectomy Stress Urinary Incontinence: A Systematic Review. European Urology Focus. https://doi.org/10.1016/j.euf.2020.06.007
Kotecha P, Sahai A, Malde S. Use of Duloxetine for Postprostatectomy Stress Urinary Incontinence: a Systematic Review. Eur Urol Focus. 2020 Jun 27; PubMed PMID: 32605820.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Use of Duloxetine for Postprostatectomy Stress Urinary Incontinence: A Systematic Review. AU - Kotecha,Pinky, AU - Sahai,Arun, AU - Malde,Sachin, Y1 - 2020/06/27/ PY - 2020/05/11/received PY - 2020/05/27/revised PY - 2020/06/12/accepted PY - 2020/7/2/entrez KW - Adverse events KW - Duloxetine KW - Postprostatectomy incontinence KW - Stress urinary incontinence KW - Systematic review JF - European urology focus JO - Eur Urol Focus N2 - CONTEXT: The recommended treatment of postprostatectomy stress urinary incontinence (PPSUI) after failure of pelvic floor muscle training is primarily surgical intervention with a male sling or artificial urinary sphincter. The use of pharmacological therapy in this setting is unlicensed and controversial. OBJECTIVE: To systematically review the available evidence regarding the efficacy and safety of duloxetine for the treatment of stress urinary incontinence following prostate surgery (radical or endoscopic). EVIDENCE ACQUISITION: The EMBASE, MEDLINE/PubMed, and Cochrane Central Register of Controlled Trials were searched from inception up until April 17, 2020. All studies evaluating the role of duloxetine in men with PPSUI were included. Two reviewers independently screened all articles, searched the reference lists of retrieved articles, and performed data extraction. The quality of evidence and risk of bias were assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE); Cochrane; and Risk of Bias in Nonrandomised Studies of Interventions (ROBINS-I) tools. EVIDENCE SYNTHESIS: The search yielded 234 studies. After excluding duplicates, 140 titles and abstracts were screened, and eight reports (348 patients) were eligible for inclusion in the final review. Duloxetine was assessed in two scenarios: (1) early use to reduce the time to attain continence and (2) treatment of persistent PPSUI. Most men had mild-to-moderate incontinence at baseline. Overall, duloxetine resulted in a mean dry rate of 58% (25-89%), mean improvement in pad number of 61% (12-100%), and mean improvement in 1-h pad weight of 68% (53-90%) at short-term follow-up (mean 1-9 mo; low to moderate certainty of evidence). However, mean adverse event rates were relatively high, and treatment was discontinued in 38% (low certainty of evidence). CONCLUSIONS: Duloxetine has demonstrated good short-term cure and/or improvement in treating men with persistent PPSUI, as well as in reducing the time to attain continence. However, a proportion of men discontinue treatment due to adverse events. The overall certainty evidence is moderate to low, with heterogeneity between studies and methodological limitations. However, we have highlighted the need for further randomised trials with longer follow-up, utilising consistent outcome reporting measures. Despite these limitations, the findings from this review will aid patient counselling regarding this less invasive treatment option, thereby allowing personalisation of care centred around the values and preferences of individual patients. PATIENT SUMMARY: Duloxetine has good success rates in the short term, in terms of improving incontinence symptoms in men who have undergone prostate surgery. However, some men experience side effects bad enough to require cessation of treatment. Further studies are needed to determine whether duloxetine maintains its effectiveness in the long term. SN - 2405-4569 UR - https://www.unboundmedicine.com/medline/citation/32605820/Use_of_Duloxetine_for_Postprostatectomy_Stress_Urinary_Incontinence:_A_Systematic_Review L2 - https://linkinghub.elsevier.com/retrieve/pii/S2405-4569(20)30165-6 DB - PRIME DP - Unbound Medicine ER -
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