What is urinary incontinence in men?
Urinary incontinence is defined as the involuntary loss of urine. Although often considered as a female pathology, it also affects a sizable proportion of men, particularly with advancing age. Urinary leakage in men can have a major impact on quality of life, social, professional, and intimate.
There are several types of urinary incontinence in men:
- Stress incontinence: loss of urine during exertion (cough, sneeze, laughter, lifting of weights). It is often related to a urinary sphincter deficit, particularly after surgery on the prostate.
- Urge incontinence: a sudden, irrepressible urge to urinate, leading to leakage before reaching the toilet. It is related to the overactivity of the bladder.
- Mixed incontinence: combining the two previous mechanisms.
- Overflow incontinence: leakage by overfilling of the bladder, often related to chronic urinary retention (in case of prostatic obstruction, for example).
Causes of urinary leakage in men
The main causes vary according to the type of incontinence:
After prostate surgery
Prostate surgery (radical prostatectomy for prostate cancer, less frequently surgery for adenoma) can cause stress incontinence, by damage to the urinary sphincter or the structures involved in continence. This incontinence is most often transient and improves over the months following surgery but can persist in some patients.
Urinary infections and irritations
Acute urinary infections, prostatitis, or chronic bladder irritations can cause urge incontinence.
Neurological causes
- Spinal cord injuries.
- Multiple sclerosis.
- Parkinson’s disease.
- Cerebrovascular accidents.
- Diabetic neuropathy.
Prostatic obstruction
Significant benign prostatic hyperplasia can cause chronic urinary retention with overflow incontinence.
Other causes
- Advancing age.
- Obesity.
- Chronic constipation.
- Certain medications.
Diagnosis
The diagnosis of urinary incontinence is based on:
- Detailed clinical interview: type of leakage, circumstances of occurrence, frequency, impact on quality of life, history.
- Voiding diary: recording of voids and leakages over several days.
- Clinical examination: including digital rectal examination and search for a prolapse.
- Urinary analysis: looking for an infection.
- Urinary ultrasound: assessment of post-void residual volume, bladder, prostate.
- Uroflowmetry: measurement of urinary flow.
- Urodynamic assessment: detailed exploration of the functioning of the bladder and the sphincter, before surgical treatment.
Treatments for urinary leakage in men
Treatment depends on the type of incontinence and its severity.
Behavioral and rehabilitative treatments
- Pelvic-perineal rehabilitation: with a specialized physiotherapist, particularly indicated after prostate surgery.
- Bladder training: in case of urge incontinence.
- Hygiene and dietary measures: weight loss, reduction of caffeine and alcohol consumption, treatment of constipation.
Drug treatments
- Anticholinergics or beta-3 agonists: in urgency.
- Treatment of associated benign prostatic hyperplasia.
Surgical treatments
In case of failure of medical and rehabilitative treatments, surgical solutions can be proposed:
- Sub-urethral male sling: a synthetic strap placed beneath the urethra to support it. Indicated for moderate stress incontinence.
- Artificial urinary sphincter: a hydraulic device implanted around the urethra, controlled by a pump placed in the scrotum. It is the reference treatment for severe stress incontinence.
- Botulinum toxin injection in the bladder: in refractory urge incontinence.
- Sacral neuromodulation: an implantable device stimulating the sacral nerves to regulate bladder activity.
Management by Dr Vardi
Dr Adam Vardi, urological surgeon in Paris and Neuilly-sur-Seine, supports men suffering from urinary leakage in a personalized care pathway, from the diagnostic assessment to the treatment best suited to each situation.