To investigate urinary nerve growth factor (NGF) and brain-derived neurotrophic factor (BDNF) levels in women with mixed urinary incontinence (MUI) and to evaluate their potential value in predicting response to medical treatment with duloxetine.

Women aged 30–70 years diagnosed with MUI were prospectively enrolled between January 2022 and December 2023. Urinary NGF and BDNF levels were measured using ELISA before and one month after duloxetine treatment and normalized to urinary creatinine. A healthy control group was included for baseline comparison. Treatment success was defined as complete dryness at one-month follow-up. Patients were classified as non-responders (Group 1) or responders (Group 2). Biomarker levels were compared between groups and correlated with clinical and urodynamic parameters.

A total of 33 patients and 10 healthy controls were included. The median age was 53 (43–58) years. Baseline urinary NGF and BDNF levels did not differ significantly between patients and controls. In the overall patient cohort, urinary NGF levels showed a borderline increase after duloxetine treatment (p = 0.05). Patients with urodynamic urinary incontinence demonstrated a post-treatment increase in NGF levels (p = 0.042). Baseline NGF and BDNF levels were significantly higher in non-responders compared with responders (p = 0.047 and p = 0.022, respectively). No significant associations were observed between neurotrophins levels and specific urodynamic parameters.

Higher baseline NGF and BDNF levels were associated with poorer treatment response, indicating that elevated neurotrophin activity may reflect a more resistant or severe underlying pathophysiology. Despite these findings, the lack of correlation between neurotrophin levels and specific urodynamic parameters suggests that urinary NGF and BDNF may not directly mirror objective bladder function measures.

Higher NGF and BDNF levels were associated with poor response to duloxetine treatment, suggesting that these neurotrophic factors may serve as predictive biomarkers of treatment outcome rather than diagnostic markers. Further large-scale prospective studies with longer follow-up are needed to clarify their clinical utility in guiding individualized treatment strategies for women with MUI.