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Incontinence, Urinary Adult Male

- 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.

- 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).

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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 catheterIntermittent catheterizationEvaluate for outlet obstruction.

SURGERY/OTHER PROCEDURES

  • Urge incontinenceSacral nerve stimulation with behavioral therapyAugmentation cystoplasty and urinary diversionBotulinum toxin injection via cystoscopy
  • Stress incontinence (4)[B]Urethral bulking agents: modest success rates with low cure ratesMale sling procedures: promising short-term and intermediate results but no long-term studiesArtificial 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.