Male Urinary Incontinence

Urinary incontinence consists of spontaneous urine leakage in an involuntary manner.

It is not in itself a disease, but the consequence of other treatments or pathologies.

This pathology is rare in men and, therefore, the Ministry of Health itself recommends that patients are treated in benchmark centres. Our Unit is considered as such within this field.

There are three types of incontinence:

Our Unit is considered a benchmark centre in the diagnosis and treatment of urinary incontinence.

Stress urinary incontinence

Involuntary urination caused by an increase in abdominal pressure, for example, during coughing, sneezing, while getting up, walking, weightlifting, etc. The reason is usually found in an anatomical alteration of the sphincter system and the pelvic floor.

The main causes of stress urinary incontinence in men are:

  • Radical prostatectomy (prostate cancer surgical treatment).
  • Surgery for benign prostatic hyperplasia (if the external sphincter is affected).

Urge urinary incontinence

Involuntary urination secondary to involuntary bladder contraction while the bladder is filling. There is a strong urgency to go to the bathroom, with associated urinary leakage and night-time incontinence.

The main causes of urge urinary incontinence in men are:

  • Neurological diseases.
  • Radiotherapy in the treatment of prostate cancer.
  • Benign prostatic hyperplasia.

Mixed urinary incontinence

It combines both mechanisms. There are other types of involuntary urinary leakage, such as overflow incontinence. It occurs when the bladder is full of urine and the pressure it exerts on the sphincter exceeds its holding capacity. It occurs in patients who, normally due to benign prostatic hyperplasia, retain large amounts of urine chronically, due to their inability to empty the bladder.

To reach diagnosis, it is essential to ask the patient how does it happen, in which situations, which are the triggers, the amount, if they need absorbent pads, if it happens during the night, etc. In this context, it is very useful to use a voiding diary, where the patient writes down the amount of liquid ingested and the number of urination events taking place throughout the day, quantifying the volume of urine evacuated during each of them. This registry must be completed for at least 3 days.

Other tests used during evaluation include: ultrasound of the urinary system, flowmetry and urodynamic testing (which reproduces the functioning of the bladder) and the PAD test, which quantifies the grams of urine leaked (by weighing the absorbent pads before and after use). Urinary tract infections and urethral stenosis (strictures) should also be ruled out.

  • Super-specialised urologist for urinary incontinence
  • Flowmetry
  • Flexible and compact cystoscope
  • Urodynamic testing
  • Flexible and compact ureterorenoscope
  • Radiology: urethrocystography, CT, NMR
  • Pelvic floor rehabilitation
  • Suburethral sling
  • Suburethral adjustable sling
  • Urinary sphincter

For the treatment of urinary incontinence, hygiene and dietetic measures are recommended (drinking less water in the afternoon and evening).

Drugs such as anticholinergics and beta-3 agonists may be used for urge incontinence. Botulinum toxin injections into the bladder muscle have been used in recent years with encouraging results. Its disadvantage is that the effect only lasts 6-9 months, so the treatment must be repeated.

In the case of stress urinary incontinence, pelvic floor exercises are the first step of the treatment. When this is not enough, there are several therapeutic options depending on the severity of the leakage:

  • Injections of artificial materials into the bladder neck and sphincter area that occlude urine output. They fail to cure incontinence and their results are variable.
  • Slings or suburethral tapes: these are sling-shaped meshes that elevate and normally reposition the urethra (which is modified in patients who have undergone surgery for prostate cancer). This restores, as much as possible, the sphincter position, achieving continence. They may be placed through the obturator foramen or behind the pubic bone. These tapes can be fixed (placed at the time of surgery and cannot be readjusted) or adjustable. They are used in patients with medium or severe incontinence (between 200-400 grams in the pad tests). Cure rates may be up to 75%. As a complication, erosion of the mesh and chronic pelvic pain (0.4%), and difficulty in emptying the bladder (1-5%) may occur.
  • Artificial sphincters: These devices clasp the urethra (either in a completely circumferential manner or partially) and are filled with serum to occlude it, thus preventing urine leaks. At the moment of micturition, the serum passes into a reservoir, leaving the urethra with its normal calibre and enabling urine output. Therefore, sphincters have three components: the cuff, which clasps the urethra; the reservoir, placed behind the pubic bone; and the pump, located in the scrotum (which moves the serum between the two other components). They are used in the treatment of severe stress urinary incontinence (more than 400 grams in the PAD test), especially after surgery for prostate cancer. Placement in patients undergoing radiotherapy should be avoided because of the risk of urethral erosion. They achieve an improvement in incontinence in up to 70% of cases.
  • Cunningham clamp: clamps that are placed on the penis and occlude the urethra from the outside in order to avoid leakage. To be used in patients that are not suitable for surgery. It is a mitigation measure.
  • Absorbent pads.

Although urinary incontinence is not life-threatening, it does significantly diminish a patient’s quality of life. Therefore, a correct diagnosis must be made, and the best therapeutic alternative offered, in order to achieve the best possible result.

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