What is incontinence?
Incontinence is defined as involuntary loss of urine that is a social or hygienic problem.
What causes this in males?
There are 4 major types of incontinence:
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Stress incontinence occurs from activities that increase intra-abdominal pressure. These include lifting, bending, coughing, or exercise. The most common cause for male stress incontinence is damage to the urinary sphincter from prostate cancer treatments like surgery, radiation therapy, and cryotherapy. The treatment for this this type of incontinence usually requires surgical therapy.
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Urge incontinence is associated with a preceding strong urge to void. It is usually associated with other overactive bladder symptoms like urinary frequency, urgency, and nighttime urination. The most common cause for this type is overactive bladder from benign prostatic hyperplasia (BPH), an enlarged prostate. This can be treated with medications for overactive bladder or with surgery.
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Mixed incontinence is a combination of stress and urge incontinence.
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Overflow incontinence is associated with over distention of the bladder from obstruction or poor bladder function, resulting in urine overflow. The most common causes for this type include BPH, urethral stricture, and neurogenic bladder.
How do you treat stress incontinence in males?
The treatment depends on the degree of incontinence. There are no FDA-approved medications for treatment of stress incontinence in males.
In patients with very mild incontinence, bulking agents like collagen, macroplastique, or durasphere can be injected in the urethra. The procedure is minimally invasive and can be performed in an outpatient setting. However, the response is unpredictable and lacks durability.
Synthetic slings can be placed in patients with mild to moderate incontinence. The most common sling is the Advance sling that is a transobturator sling. It is a minimally invasive outpatient procedure that allows for normal voiding. Success rates vary between 60-80%, depending on the degree of incontinence.
In patients with moderate to severe incontinence or in patients with prior radiation therapy, insertion of artificial urinary sphincter gives the best chance for cure. It is a short procedure, which requires an overnight stay. The device consists of a cuff, which is wrapped around the urethra to keep it closed. When the patient wishes to void, he squeezes a pump located in the scrotum to open the urethral cuff. The procedure has been found to be successful and satisfying in up to 90% of patients; however, 20-30% of patients may need revision surgery within the next 10 years due to implant malfunction, infection, erosion, or urethral atrophy.
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