Dawaa Reference

Clinical reference

Stress Urinary Incontinence (Female Adult)

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources3 sources

Gynest 0.01% w/w Cream (estriol) SmPC sections 4.2 and 4.4 (eMC product 5869) · YENTREVE ® 20 mg hard gastro-resistant capsules YENTREVE ® 40 mg hard gastro-resistant capsules SmPC section 4.2 Posology and method of administration (eMC product 7441) · Urinary incontinence - disease-level clinical article (urinary-incontinence-full.txt)

Verified against4 documents
  • Gynest 0.01% w/w Cream (estriol) SmPC sections 4.2 and 4.4 (eMC product 5869)
  • YENTREVE ® 20 mg hard gastro-resistant capsules YENTREVE ® 40 mg hard gastro-resistant capsules SmPC section 4.2 Posology and method of administration (eMC product 7441)
  • Stress Urinary Incontinence - disease-level clinical article (urinary-incontinence-stress-full.txt)
  • Urinary incontinence - disease-level clinical article (urinary-incontinence-full.txt)

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (3)

  • Leakage confined to coughing, sneezing, laughing, or physical effort defines the stress-incontinence pattern [cough · sneezing · urinary incontinence]
  • Menopausal status and hypoestrogenism are checked as contributors during history-taking
  • Rising use of pads, tampons, or diapers day to day tracks how severe the leakage has become

Signs — what you find (3)

  • A positive cough stress test subjectively confirms stress incontinence on exam [cough · urinary incontinence]
  • Cystocele, rectocele, or uterine prolapse on pelvic exam are signs of pelvic relaxation [genital prolapse]
  • Prolapse extending past the hymen can mask or blunt how severe the stress leakage appears [genital prolapse]

Tests (5)

  • A cotton-swab (Q-tip) deflection of 30 degrees or more on straining defines urethral hypermobility
  • A maximum urethral closure pressure under 20 cm of water points to intrinsic sphincter deficiency
  • Leakage on Valsalva at a bladder pressure of 60 cm of water or below indicates intrinsic sphincter deficiency
  • Postvoid residual volume is measured as a standard part of the initial work-up
  • Urodynamics are not needed to work up straightforward, uncomplicated stress leakage

If not this — what else fits (5)

  • Genitourinary syndrome of menopause, driven by estrogen deficiency, can mimic stress-type leakage
  • Stroke, multiple sclerosis, Parkinson disease, or a spinal cord injury are neurologic differentials for this presentation
  • Overflow incontinence presents as continuous dribbling from urinary retention rather than effort-triggered leakage
  • Urge incontinence involves a sudden, hard-to-defer urge rather than leakage tied to physical effort
  • A pelvic mass pressing on the bladder can produce similar leakage

SourceStatPearls "Stress Urinary Incontinence" - disease-level clinical article

Presentation findings are traced to the source above.

1

DULOXETINE

1st line

Strength40 mg

Formoral.solid

Adult dose and duration

40 mg twice daily; re-evaluate after 4 weeks

Paediatric dose

Not indicated in children

Dose source

YENTREVE ® 20 mg hard gastro-resistant capsules YENTREVE ® 40 mg hard gastro-resistant capsules SmPC section 4.2 Posology and method of administration (eMC product 7441)

Why

Serotonin-noradrenaline reuptake inhibitor that increases pudendal nerve input to the urethral sphincter, improving sphincter tone and closure; used for stress urinary incontinence when first-line pelvic floor muscle training has not been sufficient.

Cautions
  • Pelvic floor muscle training (PFMT) for at least 3 months is FIRST-LINE conservative therapy.
  • Nausea, dry mouth, insomnia, and dizziness are common during initiation; taper when discontinuing.
  • Contraindicated in uncontrolled hypertension and liver disease resulting in hepatic impairment.
  • The indication is on two documents now. The condition's own article has duloxetine raising the tone of the external urethral sphincter and cutting stress incontinence episodes markedly in as many as 64% of patients. The general urinary incontinence article names it under the pharmacologic management of stress incontinence, alongside vaginal estrogen cream.
  • The same article's own reservation: outside Europe it judges the balance of benefit against risk for duloxetine in stress urinary incontinence to be unfavourable, Europe being where the drug is approved for moderate to severe cases. Weigh that before starting it, and it is why the drug is not FDA-approved for this use.
Egyptian brands
Egyptian brandManufacturerIndicative price
DEPRETREVE 20MG 20 CAPS.? strength differsINTERNATIONAL DRUG INDUSTRIES > ANDALOUS PHARMA62.00 EGP (3.10/unit)
DULOPRESSIVE 20 MG 30 CAPS.? strength differsGLOBAL NAPI PHARMACEUTICALS > TA PHARMA112.00 EGP (3.73/unit)
DEPRETREVE 30MG 20 CAPS.? strength differsINTERNATIONAL DRUG INDUSTRIES > ANDALOUS PHARMA86.00 EGP (4.30/unit)
KARBALTA 30 MG 28 CAPS.? strength differsMASH PREMIERE212.00 EGP (7.57/unit)
KARBALTA 60 MG 30 CAPS.? strength differsMASH PREMIERE249.00 EGP (8.30/unit)
CYMBALTA 30 MG 28 CAPS.? strength differsELI LILLY399.00 EGP (14.25/unit)
DUXNORZET 60 MG 30 DEL. REL. H.G. CAPS.? strength differsZETA PHARMA231.00 EGP
WADILOXTIN 60 MG 28 DEL. REL. CAPS.? strength differsWADI ELNEEL BENTA280.00 EGP
2

REFERRAL & SAFETY-NETTING (NO DRUG THERAPY)

1st line
Dose source

Stress Urinary Incontinence - disease-level clinical article (urinary-incontinence-stress-full.txt)

Why

Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen.

Cautions
  • RED FLAG - Refer to a urogynaecologist or urologist for: unexplained haematuria; recurrent UTIs; incontinence that is unusually severe, or that has not responded to medical treatment; marked bladder overactivity; prolapse, or pelvic anatomy that is abnormal; a neurological condition alongside it; previous surgery for incontinence, other significant pelvic surgery, or pelvic radiotherapy; and any case where the diagnosis is in doubt or urodynamic testing came back equivocal.
3

ESTRIOL

add-on - not a substitute

Formtopical

Adult dose and duration

One applicatorful (0.5 mg estriol) intravaginally once daily at bedtime; maintenance dose of one applicatorful twice a week may be used after restoration of the vaginal mucosa has been achieved

Paediatric dose

Not indicated in children

Dose source

Gynest 0.01% w/w Cream (estriol) SmPC sections 4.2 and 4.4 (eMC product 5869)

Why

Adjunct topical oestrogen added when stress incontinence occurs alongside postmenopausal vaginal atrophy, restoring urogenital tissue integrity; it treats the atrophic component and does not replace pelvic floor training or duloxetine.

Cautions
  • Systemic absorption is minimal; systemic progestogen co-prescription is not required for vaginal estriol cream.
  • The cream perishes rubber. A latex condom or diaphragm that has been in contact with it cannot be relied on for contraception.
  • Review it yearly and try stopping every three to six months rather than repeating indefinitely.
  • Breakthrough bleeding or spotting that starts on treatment, or carries on after stopping, needs investigating - biopsy included - to rule out endometrial cancer.
  • Indicated for treatment of atrophic vaginitis and kraurosis in postmenopausal women.
  • The indication is on two documents now. The condition's own article finds local topical estrogen of benefit to the postmenopausal woman with stress incontinence. The general urinary incontinence article names vaginal estrogen cream under the pharmacologic management of stress incontinence.
  • The article's own frequency differs from the daily regimen the label sets: it describes a protocol in common use of 1 g or less per vaginal application, given 2 or 3 times a week. The dose printed here is the Gynest label's, which is the document that states a strength; the article's frequency is recorded so the difference is visible rather than hidden.
Egyptian brands
Egyptian brandManufacturerIndicative price
OVESTIN 1 MG 20 TAB? different route - not topicalSEDICO > SCHERING PLOUGH11.10 EGP (0.55/unit)

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.