Importance of anogenital distance parameters on duloxetine success in women with stress urinary incontinence
, 1, 2, 1, 1, 2, 2
Abstract
Objectives: To clarify the impact of anogenital distance (AGD) on duloxetine success in the management of women with stress urinary incontinence (SUI).
Material and methods: Patients who have been diagnosed with SUI, were evaluated for inclusion in the study. Distance between anus and clitoris (AGDAC), distance between anus and fourchette (AGDAF), and length of genital hiatus (GH) were measured. All patients started duloxetine 20 mg twice daily for 2 weeks, and then patients received 40 mg duloxetine twice daily. Patients were categorized into two groups (patients who benefited from duloxetine and patients who did not benefit from duloxetine). Patient characteristics and AGD parameters were compared between these two groups.
Results: In total, 178 women were included in study and mean duration of SUI was 2.9 years. The mean body mass index (BMI) was significantly higher in patients with unsuccessful therapy (p = 0.001). In contrast, nulliparous rate was significantly higher in patients who benefited from duloxetine (p = 0.043). The distance of AGDAC (71.4 mm vs 77.9 mm, p = 0.001) and distance of GH were significantly shorter (21.7 mm and 26.7 mm, p = 0.001) in patients who were successfully treated with duloxetine. Multivariate regression analysis found that BMI < 30 kg/m2, shorter AGDAC, and GH lengths were significantly related with duloxetine success (p = 0.037, p = 0.036, and p = 0.039, respectively).
Conclusions: This study showed that duloxetine improved SUI in more than half of women and obesity was a predictive factor for duloxetine failure. In addition, shorter AGDAC length and shorter GH distance were significantly associated with duloxetine success in the management of SIU.
Keywords: AGDACAGDAFanogenital distanceDuloxetinegenital hiatusstress urinary incontinence
References
- Nygaard IE, Heit M. Stress urinary incontinence. Obstet Gynecol. 2004; 104(3): 607–620.
- Sahin MO, Sen V, Irer B, et al. The effects of menopause on the quality of life and long-term outcomes of transobturator tape treatment in women with stres urinary incontinence. Int Braz J Urol. 2020; 46(5): 716–724.
- Jha S, Ammenbal M, Metwally M. Impact of incontinence surgery on sexual function: a systematic review and meta-analysis. J Sex Med. 2012; 9(1): 34–43.
- Li J, Yang Lu, Pu C, et al. The role of duloxetine in stress urinary incontinence: a systematic review and meta-analysis. Int Urol Nephrol. 2013; 45(3): 679–686.
- Basu M, Duckett JRA. Update on duloxetine for the management of stress urinary incontinence. Clin Interv Aging. 2009; 4: 25–30.
- Athanasopoulos A, Perimenis P, Giannitsas K, et al. The relationship between the perineal length measurements and the urodynamic stress incontinence. Int Urol Nephrol. 2005; 37(4): 701–705.
- Shin YuS, You JH, On JiW, et al. Clinical significance of anatomical urethral length on stress urinary incontinence women. Int J Womens Health. 2018; 10: 337–340.
- Sánchez-Ferrer ML, Prieto-Sánchez MT, Moya-Jiménez C, et al. Anogenital distance and perineal measurements of the pelvic organ prolapse (POP) quantification system. J Vis Exp. 2018(139).
- Ekmez M, Ekmez F. Effect of anogenital distance on stress urinary incontinence. African J Urol. 2021; 27: 1–5.
- Thankamony A, Ong KK, Dunger DB, et al. Anogenital distance from birth to 2 years: a population study. Environ Health Perspect. 2009; 117(11): 1786–1790.
- Sathyanarayana S, Beard L, Zhou C, et al. Measurement and correlates of ano-genital distance in healthy, newborn infants. Int J Androl. 2010; 33(2): 317–323.
- Suzuki Y, Yoshinaga J, Mizumoto Y, et al. Foetal exposure to phthalate esters and anogenital distance in male newborns. Int J Androl. 2012; 35(3): 236–244.
- Jones K, Yang L, Lowder JL, et al. Effect of pessary use on genital hiatus measurements in women with pelvic organ prolapse. Obstet Gynecol. 2008; 112(3): 630–636.
- Vakili B, Zheng YT, Loesch H, et al. Levator contraction strength and genital hiatus as risk factors for recurrent pelvic organ prolapse. Am J Obstet Gynecol. 2005; 192(5): 1592–1598.
- Han MOk, Lee NY, Park HS. Abdominal obesity is associated with stress urinary incontinence in Korean women. Int Urogynecol J Pelvic Floor Dysfunct. 2006; 17(1): 35–39.
- Schwertner-Tiepelmann N, Schwab F, Tunn R. Do predictive parameters exist for therapy with duloxetine in women with stress urinary incontinence? Int Urogynecol J. 2014; 25(8): 1071–1079.
- Viktrup L, Yalcin I. Duloxetine treatment of stress urinary incontinence in women: effects of demographics, obesity, chronic lung disease, hypoestrogenism, diabetes mellitus, and depression on efficacy. Eur J Obstet Gynecol Reprod Biol. 2007; 133(1): 105–113.
