Male Urinary Incontinence

Male urinary incontinence is often a result of aging and can occur following surgery and/or radiation to the prostate and bladder.

Physiology of bladder function

Normal bladder filling depends on unique elastic properties of the bladder wall that allow it to increase in volume at a pressure lower than that of the bladder neck and urethra (otherwise incontinence would occur). Bladder emptying is dependent on the relaxation of the urethral sphincter a few milliseconds before the onset of the detrusor (bladder muscle) contraction. With normal, sustained bladder contraction, the bladder empties completely.

The Types of Urinary Incontinence

Stress urinary incontinence:

Leakage of urine during physical movement (coughing, sneezing, exercising).

This usually occurs following surgery on prostate such as radical prostatectomy or TURP.

Urge urinary incontinence:

Leakage of urine at unexpected times, including during sleep. This can be associated with feeling of urgency and frequency resulting in untimely urination.

This can occurs in the setting of prostate enlargement and/or underlying bladder dysfunction from neurological conditions or unknown cause (termed idiopathic).

Overflow urinary incontinence:

Unexpected leakage of urine because of a full bladder with bladder outlet obstruction such as prostate enlargement or urethral stricture disease.

Mixed urinary incontinence:

Usually the occurrence of stress and urge incontinence together.

Men usually experience less urinary incontinence than women due to anatomical (longer urethra and presence of prostate) and physiological differences. But both women and men can become incontinent from neurologic injury (strokes, Parkinson and multiple sclerosis) and physical problems associated with aging. However stress urinary incontinence in men is predominantly due to prostate surgery either following endoscopic surgery for benign prostatic growth or radical surgery for malignant prostate cancer.

The level of incontinence differs for each person and depends upon the duration of urinary incontinence and the treatments that they have had, this may be short lived or permanent and debilitating. Special test such as uroflow and urodynamics studies can provide further information on your bladder function and bladder outflow. Cystoscopic examination will rule out any stricture disease.

There has however been a lot of progress in dealing with continence issues and there are a wide variety of aids and equipments for collecting urine, preventing infection and protecting the skin and surrounding area. Pelvic floor exercise, bladder retraining and timed voiding, are a number of exercises that can be done to strengthen the urinary sphincter muscle and improve your continence level. Medications such as anti-cholinergic can decrease the urgency and urge incontinent episodes but can result in common side effects include dry mouth and eyes and constipation.

Surgical options:

It is important for your urologist to exclude other causes of your stress urinary incontinence prior to surgery. Depending on the severity of your urinary incontinence, the following surgery may be the appropriate treatment option. Prof. Chung is the only urologist from Australia and the Asia-Pacific region invited to be a member of the 7th International Consultation on Incontinence (ICI) by the International Continence Society (ICS) on the Male Surgery for Urinary Incontinence chapter. 

1. Urethral Slings
2. Artificial urinary sphincters

In patients with urgency and urge incontinence, who have failed medical therapy or are not able to tolerate the side effects of medication, the available options include

1. Bladder botox therapy
2. Sacral neuromodulation
3. Peripheral neuromodulation