About

17% of men over the age of 60 in the U.S. suffer from a condition known as stress urinary incontinence (SUI).¹   SUI occurs when you involuntarily leak urine when you cough, sneeze or exert yourself.²

Prostatectomy and Male Incontinence

Male patients who undergo prostatectomy, the surgical removal of the prostate gland, may experience stress urinary incontinence (SUI) after their procedure. Studies indicate that as many as 50% of men report leakage due to SUI in the first few weeks following prostate surgery after removal of the catheter.⁸ Data suggests a range of 8%-63% of men will report some degree of SUI to be a significant problem one year after their prostatectomy.^9,10

Causes of post-prostatectomy urinary incontinence include³:

• Damage to the sphincter muscle can result in stress incontinence.
• Bladder spasms can lead to urge incontinence, frequent urination, and sometimes nocturnal enuresis (also known as nighttime urinary incontinence, bedwetting, and/or sleepwetting).
• Combination sphincter damage and bladder spasms can lead to a mix of stress and urge incontinence.

FYI

SPOUSES AND CAREGIVERS

Male urinary incontinence affects not only men, but the people closest to them as well. It can often mean that men become withdrawn, depressed, and/or irritable. Some men try to keep these feelings to themselves, but inevitably, spouses, partners, and other family members share in this condition. Learning more about male incontinence and the variety of treatment options will help you talk to him in a more educated manner.

Remember, he wants to be dry as much as you want him to be. One study showed that men who wear only one pad per day experience a significantly decreased quality of life over those who are completely dry.¹

Incontinence can be a tough subject to discuss, but here are ways to start the conversation

1. I’ve noticed that you’ve been hesitant lately about going places. Is everything OK?
2. Lately, you’ve been visiting the bathroom more than usual. I’ll bet your urologist may offer some insight.
3. People who survive cancer tend to have a new lease on life, but you seem down. Are you experiencing complications from your surgery?
4. A woman I know was recently telling me about how her husband has been cured from incontinence. I’m so excited for them.
5. I know you don’t want anyone to know about your bladder control issues, but I recently heard about some treatments that could help.
6. Have you been to your urologist for a follow-up?

1. Cooperberg M, Master V, Carroll P. Health related quality of life significance of single pad urinary incontinence following radical prostatectomy. J Urol. 2003;170(2 Pt 1):512-515.

Insurance Coverage

Most insurers cover the diagnosis and medical treatment of male incontinence. Medicare has a national coverage policy for incontinence, which includes implants (sling or artificial urinary sphincter). Most commercial health insurers also cover male slings or the AUS when it is deemed medically necessary for the patient. Contact the insurer to verify coverage under a specific plan.

Symptoms

Types of Incontinence

Stress incontinence is the involuntary leakage of urine when coughing, sneezing, straining, or doing anything that puts stress on the abdomen. Some people with severe stress incontinence have nearly constant urine loss (sometimes referred to as total incontinence). In adults, this usually occurs because the urinary sphincter does not close adequately.2,3,4

Urge incontinence is characterized by an abrupt and intense urge to urinate immediately followed by uncontrollable urine release.2,3,4

Mixed incontinence involves more than one type of incontinence, typically from bladder malfunction and sphincter damage. Men with this combined problem usually experience “mixed incontinence” symptoms with a combination of both urge and stress incontinence.2,3,4

Continuous incontinence is constant leakage, usually associated with a fistula (an abnormal connection or pathway); it occurs only rarely in males. Enuresis refers to any involuntary loss of urine and should be distinguished from nocturnal enuresis, or urinary loss during sleep.4

Overflow incontinence is the uncontrollable dribbling of small amounts of urine from an overfilled bladder that does not empty well.2

Functional incontinence is the urine loss resulting from the inability to get to a toilet. Typically due to a physical or mental impairment, unrelated to the control of urination. For example, a person with dementia due to Alzheimer disease may not recognize the need to urinate or not be able to locate a toilet in time. People who are bedridden may be unable to walk to the toilet or reach a bedpan.2

Diagnosis

The inability to control one’s bladder can be a common side effect of prostate cancer surgery, when the muscles that control urination can be damaged.

Treatments

Your doctor may recommend limiting liquids, avoiding caffeine and alcohol, and kegel exercises to strengthen your pelvic floor muscles and improve bladder control.⁴  These strategies may provide some temporary relief of SUI, but there are also surgical treatment options such as the sling implant and the artificial urinary sphincter that can be considered.

Behavioral techniques often include bladder training, which consists of scheduled bathroom trips at specific times to retrain the bladder. In addition, fluid and diet management may be considered; which may involve the limitation of caffeine and alcohol, as well as avoiding consumption of liquids within a few hours of bedtime.

Physical therapy often includes Kegel exercises, designed to help strengthen the muscles that support the bladder. In addition, biofeedback, or electrical stimulation, may help gain awareness and control of urinary tract muscles.

Medication may be prescribed to decrease involuntary bladder contractions. However, medication is not typically effective for severe cases or stress incontinence.¹¹

Absorbent products may be considered when incontinence is inconsistent, persistent, or both. These undergarment solutions can be used alone, or in combination with other broad treatment options as needed. Absorbent products may be disposable or reusable, and are often recognized as liners, pads, or collection devices.

Collagen injections add bulk to the bladder neck and provide increased resistance to prevent urine leakage.

Another option that may work for some men is an Implantable Male Solutions…

Sling implants (also known as a suburethral sling) are devices that are placed within the body via surgery. Sling implants reposition the urethra and provide support to surrounding muscles for enhanced urethral closure and the reduction or elimination of unintended urine flow, especially when coughing, sneezing or lifting.¹² The implanted device works automatically, requiring no action on the patient’s part.¹⁸

• Presented at  a urologic congress and published in peer-reviewed journals, clinical studies encompassing over 500 patients, showed an average success rate (cured + improved) at 81%.^19-25
• In a study of 42 patients, 94% would recommend the procedure to a friend.¹³

Artificial urinary sphincter (AUS) is a device that is placed within the body via surgery.  The AUS device contains an inflatable cuff that fits around the urethra that mimics the function of a normal, healthy urinary sphincter. A pump is implanted inside the scrotum to control transfer of fluid between the cuff and a reservoir that is implanted in the abdomen. At rest, the cuff is filled with fluid keeping the urethra closed and preventing urine flow until the man is ready to urinate. To urinate, the pump is squeezed by hand 2-5 times, deflating the cuff, opening the urethra and allowing urine to exit the body. After urination, a button on the pump is pressed and fluid from the reservoir returns to the cuff, closing the urethra once again.¹⁴

• With over 150,000 patients treated, the AUS has been referred to as the “Gold Standard” for treating male stress urinary incontinence (SUI) following prostate surgery.^15,17
• In one study of 50 patients, 90% reported satisfaction. 92% would have an AUS placed again, and 96% would recommend it to a friend. ¹⁶

Resources

1. Anger JT, Saigal CS et al. The prevalence of urinary incontinence among community dwelling men: results from the National Health and Nutrition Examination Study. J Urol. 2006; 176:2103-2108.

2. Chapple, C, Milsom, I. Urinary incontinence and pelvic prolapse epidemiology and pathophysiology. In: McDougal WS, Wein JW, Kovoussi, AC, et al. Campbell-Walsh Urology. 10th ed. Philadelphia, PA: WB Saunders Elsevier: 2012:1871-1895.

3. Prostate Cancer, www.cancer.org/cancer/prostatecancer/index.  American Cancer Society Web site. Accessed June 20, 2013.

4. Sandhu, J. Treatment options for male stress urinary incontinence. Nat Rev Urol. 2010;7:223.