SUI: Current management and unmet needs

Stress urinary incontinence (SUI) is one common type of incontinence among women. It can have a serious impact on their quality of life. Many women are ashamed to talk about their problem and try to cope with their incontinence themselves. Those women who do seek treatment should initially undergo a basic evaluation to determine the type of incontinence which is present. In case of mild to moderate SUI conservative treatment can be initiated. This includes lifestyle modifications and pelvic floor muscle training (PFMT). PFMT is effective provided the patient is trained and able to perform a correct pelvic floor muscle contraction. PFMT is not invasive but its efficacy depends on long-term compliance. In case of failure of conservative treatment and for women with severe SUI, surgery is today the only solution. There is a wide variety of surgical procedures available of which the Burch colposuspension is best documented and is still considered the "gold standard" because of well-known long-term follow-up. The tension-free tape procedures have become very popular the latest years although more long-term follow-up data (up to 5-10 years) are needed. Only a scarcity of adequately performed randomised controlled trials (RCTs) is available which evaluated the current treatments available for SUI. There is clearly a need for large rigorous, prospective RCTs of high quality. Furthermore, there is a need for an efficacious and safe new pharmacological treatment for women with SUI. Duloxetine, a potent and balanced serotonin and noradrenaline reuptake inhibitor, is a promising candidate to fill this gap in the near future. (C) 2004 Elsevier B.V. All rights reserved.