Pharmacotherapy in Stress and Mixed Incontinence

Stress urinary incontinence (SUI) causes significant distress for women and is an important component of mixed urinary incontinence (MUI). Conservative treatment is noninvasive, but is time-consuming and of variable efficacy. Surgery can be effective but is associated with morbidity and mortality. Varying levels of evidence support the use of pharmacotherapy in SUI and MUI. Oestrogens have an important effect on female urogenital tissues and may provide benefits; however, concerns about the safety of hormone replacement therapy may limit this approach. Phenylpropanolamine has improved outcomes in women with SUI, but it is associated with limited efficacy and increased risk of stroke. Imipramine has demonstrated benefits, but trials have not proved methodologically rigorous. Desmopressin may be useful to control urinary leakage, with effects lasting 4–8 h. Duloxetine is the first pharmacologic treatment specifically aimed at SUI and is associated with improved urinary incontinence and quality of life.