Abstract
Stress urinary incontinence (SUI) is a symptom experienced by a large number of female patients and is defined as ‘involuntary leakage of urine on exertion or coughing’. It is estimated that one in three women suffer from urinary incontinence, of whom more than half have SUI. Despite its often significant effect on patients’ quality of life (QoL), it is greatly underdiagnosed. SUI occurs primarily owing to the effects of pregnancy and childbirth, as well as age, obesity and the menopause. Conservative treatment measures, such as lifestyle change or pelvic floor muscle training, have problems with compliance and there have been no drugs licensed to treat SUI. Recently, a medical treatment option, duloxetine, has become available, which could have a positive impact on the future management of this common problem. Duloxetine, a dual serotonin–noradrenaline reuptake inhibitor, is believed to work by increasing the activity of the urethral striated muscle sphincter. It has been shown to improve incontinence episode frequency significantly compared with placebo, and lead to marked improvements in QoL scores. However, adverse events are troublesome and nausea remains the most common reason for discontinuation of treatment. Further studies are needed to evaluate its long-term efficacy and safety.