Athanasiou Stavros, Chaliha Charlotte, Digesu G Alessandro, Sotiropoulou Myrtia, Georgoulias Nicolaos, Khullar Vik, Antsaklis Aris
Urogynaecology Unit, 1st Department of Obstetrics and Gynaecology, University of Athens, Alexandra Hospital, Athens, Greece.
Int Urogynecol J Pelvic Floor Dysfunct. 2007 Jul;18(7):763-7. doi: 10.1007/s00192-006-0230-7. Epub 2006 Oct 24.
The aim of our study was to investigate the effect of duloxetine on urethral function and sphincter ultrasound morphology in 54 women, who were referred to a urogynecology unit, with urodynamic stress incontinence. All completed a King's Health Questionnaire and a patient global assessment of improvement (PGI-I) question and underwent urethral pressure profilometry, measurement of urethral retro-resistance pressure (URP), and ultrasound of the striated urethral sphincter. The investigations were repeated after 8 weeks of duloxetine 40 mg twice daily in 36 women who continued the medication. After 8 weeks of duloxetine, the mean URP increased significantly compared to baseline (53.8 to 60.8 cm H2O; p=0.001), and sphincter thickness was significantly higher (1.8 to 2.0 mm; p<0.001). There was a significant increase in the maximum urethral closure pressure (MUCP) (52.7 to 59.2 cm H2O; p=0.006) but not of functional urethral length. Subanalysis of responders (improved on duloxetine) showed a significant increase in URP (50.3 to 59.1 cm H2O; p=0.001), sphincter thickness (1.7 to 2.1 mm; p<0.001), and MUCP (50.2 to 58.1 cm H2O; p=0.03). These changes were not seen in nonresponders. This study has demonstrated objective changes in urethral ultrasound morphology and function after duloxetine therapy, which relate to improved continence. A larger longer term study is required to assess if these changes persist over time. In summary, duloxetine therapy for urodynamic stress incontinence results in an increase in urethral closure pressure, URP measurement, and urethral striated sphincter thickness.
我们研究的目的是调查度洛西汀对54名因尿动力学压力性尿失禁而转诊至女性盆底疾病诊疗科室的女性尿道功能和括约肌超声形态的影响。所有患者均完成了国王健康问卷和患者整体改善评估（PGI-I）问题，并接受了尿道压力测定、尿道抗反流压力（URP）测量以及尿道横纹括约肌超声检查。36名继续服药的女性在每日两次服用40毫克度洛西汀8周后重复进行了上述检查。服用度洛西汀8周后，平均URP较基线水平显著升高（从53.8厘米水柱升至60.8厘米水柱；p = 0.001），括约肌厚度也显著增加（从1.8毫米增至2.0毫米；p < 0.001）。最大尿道闭合压（MUCP）显著升高（从52.7厘米水柱升至59.2厘米水柱；p = 0.006），但功能性尿道长度未增加。对有反应者（服用度洛西汀后病情改善）的亚组分析显示，URP显著升高（从50.3厘米水柱升至59.1厘米水柱；p = 0.001），括约肌厚度增加（从1.7毫米增至2.1毫米；p < 0.001），MUCP升高（从50.2厘米水柱升至58.1厘米水柱；p = 0.03）。无反应者未出现这些变化。本研究表明，度洛西汀治疗后尿道超声形态和功能出现了客观变化，这与尿失禁改善有关。需要进行更大规模的长期研究来评估这些变化是否会随时间持续存在。总之，度洛西汀治疗尿动力学压力性尿失禁可导致尿道闭合压、URP测量值及尿道横纹括约肌厚度增加。
