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ADDITIONAL THERAPIES
- Pelvic floor rehabilitation (Kegel exercises) may significantly reduce both stress and urge incontinence in male patients and should be considered a part of initial management for stress UI.
- Timed voiding is a useful therapy for patients with urge incontinence.
- Overflow incontinence is usually caused by poor bladder contractility with urinary retention.
- Indwelling catheter
- Intermittent catheterization
- Evaluate for outlet obstruction.
SURGERY/OTHER PROCEDURES
- Urge incontinence
- Sacral nerve stimulation with behavioral therapy
- Augmentation cystoplasty and urinary diversion
- Botulinum toxin injection via cystoscopy
- Stress incontinence (4)[B]
- Urethral bulking agents: modest success rates with low cure rates
- Male sling procedures: promising short-term and intermediate results but no long-term studies
- Artificial urinary sphincter implant has excellent long-term continence rates and is considered gold standard (5).
COMPLEMENTARY & ALTERNATIVE MEDICINE
- Acupuncture in selected cases
- Physical therapy in selected cases
ONGOING CARE
FOLLOW-UP RECOMMENDATIONS
Patient Monitoring
Must monitor residual volume after voiding in patients taking anticholinergic medications; monitor side effects.
PROGNOSIS
Continence can be improved in almost all patients.
COMPLICATIONS
- Dermatitis
- Candidiasis
- Skin breakdown
- Social isolation
- Avoidance of sex
- Weight gain
REFERENCES
11 Khandelwal C, Kistler C. Diagnosis of urinary incontinence. Am Fam Physician. 2013;87(8):543-550.22 Gravas A, Bachmann A, Descazeaud A, et al. EAU guidelines on the management of non-neurogenic male lower urinary tract symptoms (LUTS), including benign prostatic obstruction (BPO). Arnhem: The Netherlands; European Association of Urology; 2014.33 Gormley EA, Lightner DJ, Burgio KL, et al. Diagnosis and treatment of overactive bladder (non-neurogenic) in adults: AUA/SUFU guideline. J Urol. 2012;188(6 Suppl):2455-2463.44 Lucas MG, Bedretdinova D, Bosch JL, et al. EAU Guidelines on urinary incontinence. Arnhem: The Netherlands; European Association of Urology; 2014.55 Herschorn S, Bruschini H, Comiter C, et al. Surgical treatment of stress incontinence in men. Neurourol Urodyn. 2010;29(1):179-190.
ADDITIONAL READING
- Bauer RM, Bastian PJ, Gozzi C, et al. Postprostatectomy incontinence: all about diagnosis and management. Eur Urol. 2009;55(2):322-333.
- Markland AD, Goode PS, Redden DT, et al. Prevalence of urinary incontinence in men: results from the national health and nutrition examination survey. J Urol. 2010;184(3):1022-1027.
CODES
ICD10
- R32 Unspecified urinary incontinence
- N39.3 Stress incontinence (female) (male)
- N39.41 Urge incontinence
- N39.46 Mixed incontinence
- N39.45 Continuous leakage
- N39.42 Incontinence without sensory awareness
- N39.498 Other specified urinary incontinence
- N39.490 Overflow incontinence
ICD9
- 788.30 Urinary incontinence, unspecified
- 788.32 Stress incontinence, male
- 788.31 Urge incontinence
- 788.33 Mixed incontinence (male) (female)
- 788.37 Continuous leakage
- 788.34 Incontinence without sensory awareness
- 788.38 Overflow incontinence
- 788.39 Other urinary incontinence
SNOMED
- 165232002 urinary incontinence (finding)
- 444620007 male urinary stress incontinence (finding)
- 87557004 Urge incontinence of urine (finding)
- 413343005 Mixed incontinence
- 22220005 Genuine stress incontinence (finding)
- 397878005 Overflow incontinence of urine
- 129853007 Total urinary incontinence
CLINICAL PEARLS
- Think "outside" the lower urinary tract: Comorbid medical illness and impairments are independently associated with UI; treat contributing comorbidities and rule out secondary causes.
- Always check PVR to rule out overflow incontinence.
- Have patient complete the International Prostate Symptom Score and do uroflow, PSA if indicated.
- Urodynamics if conservative management fails
- Pelvic floor rehabilitation handouts may have a significant effect for male patients than physical therapy-mediated pelvic floor rehabilitation.