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Managing Overactive Bladder and Urinary Incontinence in the Male

  • Humphrey Atiemo
  • J. Quentin ClemensEmail author
Chapter
Part of the Current Clinical Urology book series (CCU)

Abstract

This chapter reviews the diagnosis and management of overactive bladder (OAB) and urinary incontinence (UI) in men. OAB is a syndrome characterized by urinary urgency, frequency, and nocturia. In some individuals with OAB, the urgency will result in urge UI. The other major type of incontinence is stress UI, caused by a loss of urethral sphincter function. Although these symptoms occur about half as often in men as in women, they are a source of considerable bother and frustration when they are present. A thorough history, physical examination, and urinalysis are sufficient to guide initial therapy. Men with complicated symptoms (concomitant pain or hematuria, recurrent infections, poor bladder emptying, severe symptoms, prior pelvic radiation, neurologic disease, or major pelvic surgery) should be referred for specialized management. Behavioral therapies such as dietary modification, bladder training, and pelvic muscle exercises may be beneficial for symptoms of OAB, urge UI, and stress UI. Antimuscarinic medications are commonly used to treat OAB and urge UI. For refractory symptoms, sacral nerve stimulation is an effective surgical option. Stress UI in men is typically caused by prior prostate surgery. The most common treatments for male stress UI are transurethral injections of bulking agents, placement of a perineal sling, and implantation of an artificial urinary sphincter. External (condom) catheters and penile clamps are useful adjunctive measures for UI, which may be applicable for certain men.

Keywords

Urinary Incontinence Stress Urinary Incontinence Lower Urinary Tract Symptom Urge Urinary Incontinence Artificial Urinary Sphincter 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Abrams P, Artibani W, Cardozo L, et al. Reviewing the ICS 2002 terminology report: the ongoing debate. Neurourol Urodyn. 2006;25:293.CrossRefGoogle Scholar
  2. 2.
    Coyne KS, Sexton CC, Thompson CL, et al. The prevalence of lower urinary tract symptoms (LUTS) in the USA, the UK and Sweden: results from the Epidemiology of LUTS (EpiLUTS) study. BJU Int. 2009;104(3):352–60.PubMedCrossRefGoogle Scholar
  3. 3.
    Onukwugha E, Zuckerman I, McNally D, et al. The total economic burden of overactive bladder in the United States: a disease-specific approach. Am J Manag Care. 2009;15:S90–7.PubMedGoogle Scholar
  4. 4.
    Buckley BS, Lapitan MCM, Epidemiology Committee of the Fourth International Consultation on Incontinence, Paris, 2008. Prevalence of urinary incontinence in men, women, and children – current evidence: findings of the fourth International Consultation on Incontinence. Urology. 2010;76(2):265–70.Google Scholar
  5. 5.
    Stothers L, Thom DH, Calhoun EA. Urinary incontinence in men. In: Litwin MS, Saigal CS, editors. Urologic diseases in America. US Department of Health and Human Services, Public Health Service, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases. Washington, DC: US Government Publishing Office; 2007. Ch. 6, p. 193–222.Google Scholar
  6. 6.
    Shamliyan TA, Wyman JF, Ping R, et al. Male urinary incontinence: prevalence, risk factors, and preventive interventions. Rev Urol. 2009;11:145.PubMedGoogle Scholar
  7. 7.
    Thom D. Variation in estimates of urinary incontinence prevalence in the community: effects of differences in definition, population characteristics, and study type. J Am Geriatr Soc. 1998;46:473.PubMedGoogle Scholar
  8. 8.
    Tennstedt SL, Chiu GR, Link CL, et al. The effects of severity of urine leakage on quality of life in Hispanic, white and black men and women: the Boston Area Community Health survey. Urology. 2010;75:27.PubMedCrossRefGoogle Scholar
  9. 9.
    Lagro-Janssen TALM, Hilkens CJM, Klaasen RI, et al. Greater emotional and social effect of urinary incontinence in men than women. J Am Geriatr Soc. 2008;56:1779.PubMedCrossRefGoogle Scholar
  10. 10.
    Roosen A, Chapple C, Dmochowski R, et al. A refocus on the bladder as the originator of storage lower urinary tract symptoms: a systematic review of the latest literature. Eur Urol. 2009;56:810–20.PubMedCrossRefGoogle Scholar
  11. 11.
    Andersson KE, Gratske C, Hedlund P. The role of the transient receptor potential (TRP) superfamily if the cation-selective channels in the management of overactive bladder. BJU Int. 2010;106(8):1114–27.PubMedCrossRefGoogle Scholar
  12. 12.
    Rieken M, Mundorff NE, Bonkat G, et al. Complications of laser prostatectomy: a review of recent data. World J Urol. 2010;28:53.PubMedCrossRefGoogle Scholar
  13. 13.
    Thiel DD, Petrou SP. Electroresection and open surgery. Urol Clin North Am. 2009;36:461.PubMedCrossRefGoogle Scholar
  14. 14.
    Lerner LB, Tyson MD. Holmium laser applications of the prostate. Urol Clin North Am. 2009;36:485.PubMedCrossRefGoogle Scholar
  15. 15.
    Loughlin KR, Prasad MM. Post-prostatectomy incontinence: a confluence of 3 factors. J Urol. 2010;183:871.PubMedCrossRefGoogle Scholar
  16. 16.
    Hammerer P, Huland H. Urodynamic evaluation of changes in urinary control after radical prostatectomy. J Urol. 1997;157:233.PubMedCrossRefGoogle Scholar
  17. 17.
    Donnellan SM, Duncan HJ, MacGregor RJ, et al. Prospective assessment of incontinence after radical retropubic prostatectomy: objective and subjective analysis. Urology. 1997;49:225.PubMedCrossRefGoogle Scholar
  18. 18.
    Eastham JA, Kattan MW, Rogers E, et al. Risk factors for urinary incontinence after radical prostatectomy. J Urol. 1996;156:1707.PubMedCrossRefGoogle Scholar
  19. 19.
    Litwin MS, Hayes RD, Fink A, et al. Quality-of-life outcomes in men treated for localized prostate cancer. JAMA. 1995;273:129.PubMedCrossRefGoogle Scholar
  20. 20.
    Penson DF, McLerran D, Feng Z, et al. 5-year urinary and sexual outcomes after radical prostatectomy: results from the prostate cancer outcomes study. J Urol. 2005;173:1701.PubMedCrossRefGoogle Scholar
  21. 21.
    Begg CB, Riedel ER, Bach PB, et al. Variations in morbidity after radical prostatectomy. N Engl J Med. 2002;346:1138.PubMedCrossRefGoogle Scholar
  22. 22.
    Steineck G, Helgesen F, Adolfsson J, et al. Quality of life after radical prostatectomy or watchful waiting. N Engl J Med. 2002;347:790.PubMedCrossRefGoogle Scholar
  23. 23.
    Stanford JL, Feng Z, Hamilton AS, et al. Urinary and sexual function after radical prostatectomy for clinically localized prostate cancer: the prostate cancer outcomes study. JAMA. 2000;283:354.PubMedCrossRefGoogle Scholar
  24. 24.
    Abrams P, Andersson KE, Birder L, et al. Fourth International Consultation on Incontinence Recommen­dations of the International Scientific Committee: evaluation and treatment of urinary incontinence, pelvic organ prolapse, and fecal incontinence. Neurourol Urodyn. 2010;29:213.PubMedCrossRefGoogle Scholar
  25. 25.
    Burgio KL, Goode PS, Urban DA, et al. Preoperative biofeedback assisted behavioral training to decrease post-prostatectomy incontinence: a randomized, controlled trial. J Urol. 2006;175:196.PubMedCrossRefGoogle Scholar
  26. 26.
    Filocamo MT, Li Marzi V, Del Popolo G, et al. Effectiveness of early pelvic floor rehabilitation treatment for post-prostatectomy incontinence. Eur Urol. 2005;48:734.PubMedCrossRefGoogle Scholar
  27. 27.
    Van Kampen M, De Weerdt W, Van Poppel H, et al. Effect of pelvic floor re-education on duration and degree of incontinence after radical prostatectomy: a randomized controlled trial. Lancet. 2000;355:98.PubMedCrossRefGoogle Scholar
  28. 28.
    Bales GT, Gerber GS, Minor TX, et al. Effect of preoperative biofeedback/pelvic floor training on continence in men undergoing radical prostatectomy. Urology. 2000;56:627.PubMedCrossRefGoogle Scholar
  29. 29.
    Mathewson-Chapman M. Pelvic muscle exercise/biofeedback for urinary incontinence after prostatectomy: an education program. J Cancer Educ. 1997;12:218.PubMedGoogle Scholar
  30. 30.
    Franke JJ, Gilbert WB, Grier J, et al. Early post-prostatectomy pelvic floor biofeedback. J Urol. 2000;163:191.PubMedCrossRefGoogle Scholar
  31. 31.
    Moore KN, Griffiths D, Houghton A. Urinary incontinence after radical prostatectomy: a randomized controlled trial comparing pelvic muscle exercises with or without electrical stimulation. BJU Int. 1999;83:57.PubMedCrossRefGoogle Scholar
  32. 32.
    Hunter KF, Moore KN, Glazener CMA. Conservative management for postprostatectomy urinary incontinence. Cochrane Database System Rev. 2007;CD001843.Google Scholar
  33. 33.
    Goode PS, Burgio KL, Johnson 2nd TM, et al. Behavioral therapy with or without biofeedback and pelvic floor electrical stimulation for persistent postprostatectomy incontinence: a randomized controlled trial. JAMA. 2011;305:151–9.PubMedCrossRefGoogle Scholar
  34. 34.
    Nabi G, Cody JD, Ellis G, et al. Anticholinergic drugs versus placebo for overactive bladder syndrome in adults. Cochrane Database Syst Rev. 2006;CD003781.Google Scholar
  35. 35.
    Helfand B, Evans RM, McVary KA. Comparison of the frequencies of medical therapies for overactive bladder in men and women: analysis of more than 7.2 million aging patients. Eur Urol. 2010;57:586–91.PubMedCrossRefGoogle Scholar
  36. 36.
    Brubaker L, Fanning K, Goldberg E. Predictors of discontinuing overactive bladder medications. BJU Int. 2010;105(9):1283–90.PubMedCrossRefGoogle Scholar
  37. 37.
    Kaplan SA, Roehrborn CG, Rovner ES, et al. Tolterodine and tamsulosin for treatment of men with lower urinary tract symptoms and overactive bladder. A randomized controlled trial. JAMA. 2006;296:2319.PubMedCrossRefGoogle Scholar
  38. 38.
    Tsakiris P, de la Rosette JJ, Michel MC, et al. Pharmacologic treatment of male stress urinary incontinence: systematic review of the literature and levels of evidence. Eur Urol. 2008;53:53.PubMedCrossRefGoogle Scholar
  39. 39.
    Filocamo MT, Li Marzi V, Del Popolo G, et al. Pharmacologic treatment in postprostatectomy stress urinary incontinence. Eur Urol. 2007;51:1559.PubMedCrossRefGoogle Scholar
  40. 40.
    Schurch B, Reitz A. Botox in urology: a new treatment modality without limitations? EAU update series. 2004;2:170–8.Google Scholar
  41. 41.
    Flynn M, Amundsen C, Perevich M, et al. Outcome of a randomized double blind, placebo controlled trial of botulinum A toxin for refractory overactive bladder. J Urol. 2009;181:2608–15.PubMedCrossRefGoogle Scholar
  42. 42.
    Khan S, Kessler T, Apostolidis A, et al. What a patient with refractory idiopathix detrusor overactivity should know about botulinum neurotoxiin type a injection. J Urol. 2009;181:1773–8.PubMedCrossRefGoogle Scholar
  43. 43.
    Herbison GP, Arnold EP. Sacral neuromodulation with implanted devices for urinary storage and voiding dysfunction in adults. Cochrane Database Syst Rev. 2009;(2):CD004202.Google Scholar
  44. 44.
    Siddiqui N, Amundsen C, Visco A, et al. Cost-effectiveness of sacral neuromodulation versus intravesical botulinum A toxin for treatment of refractory urge incontinence. J Urol. 2009;182:2799–804.PubMedCrossRefGoogle Scholar
  45. 45.
    Herschorn S, Bruschini H, Comier C, et al. Surgical treatment of stress incontinence in men. Neurourol Urodyn. 2010;29:179.PubMedCrossRefGoogle Scholar
  46. 46.
    Bauer RM, Bastian PJ, Gozzi C, et al. Postprostatectomy incontinence: all about diagnosis and management. Eur Urol. 2009;55:322.PubMedCrossRefGoogle Scholar
  47. 47.
    Smith DN, Appell RA, Rackley RR, et al. Collagen injection therapy for post-prostatectomy incontinence. J Urol. 1998;160:364.PubMedCrossRefGoogle Scholar
  48. 48.
    Westney OL, Bevan-Thomas R, Palmer JL, et al. Transurethral collagen injections for male intrinsic sphincter deficiency: the University of Texas-Houston experience. J Urol. 2005;174:994.PubMedCrossRefGoogle Scholar
  49. 49.
    Comiter CV. The male sling for stress urinary incontinence: a prospective study. J Urol. 2002;167:597.PubMedCrossRefGoogle Scholar
  50. 50.
    Gomes CM, Broderick GA, Sanchez-Ortiz RF, et al. Artificial urinary sphincter for post-prostatectomy incontinence: impact of prior collagen injection on cost and clinical outcome. J Urol. 2000;163:87.PubMedCrossRefGoogle Scholar
  51. 51.
    Kaufman JJ. A new operation for male incontinence. Surg Gynecol Obstet. 1970;131:295.PubMedGoogle Scholar
  52. 52.
    Schaeffer AJ, Clemens JQ, Ferrari M, et al. The male bulbourethral sling procedure for post-radical prostatectomy incontinence. J Urol. 1998;159:1510.PubMedCrossRefGoogle Scholar
  53. 53.
    Stern JA, Clemens JQ, Tiplitsky S, et al. Long-term results of the bulbourethral sling procedure. J Urol. 2005;173:1654.PubMedCrossRefGoogle Scholar
  54. 54.
    Comiter CV. Surgery insight: surgical management of postprostatectomy incontinence—the artificial urinary sphincter and male sling. Nat Clin Pract Urol. 2007;4:615.PubMedCrossRefGoogle Scholar
  55. 55.
    Comiter CV. The male perineal sling: intermediate-term results. Neurourol Urodyn. 2005;24:648.PubMedCrossRefGoogle Scholar
  56. 56.
    Onur R, Singla A. Comparison of bone-anchored male sling and collagen implant for the treatment of male incontinence. Int J Urol. 2006;13:1207.PubMedCrossRefGoogle Scholar
  57. 57.
    Dikranian AH, Chang AH, Rhee JH, et al. The male perineal sling: comparison of sling materials. J Urol. 2004;172:608.PubMedCrossRefGoogle Scholar
  58. 58.
    Rajpurkar AD, Onur R, Singla A. Patient satisfaction and clinical efficacy of the new perineal bone-anchored male sling. Eur Urol. 2005;47:237.PubMedCrossRefGoogle Scholar
  59. 59.
    Castle EP, Andrews PE, Itano N, et al. The male sling for post-prostatectomy incontinence: mean followup of 18 months. J Urol. 2005;173:1657.PubMedCrossRefGoogle Scholar
  60. 60.
    Flynn BJ, Webster GD. Evaluation and surgical management of intrinsic sphincter deficiency after radical prostatectomy. Rev Urol. 2004;6:180.PubMedGoogle Scholar
  61. 61.
    Fischer MC, Huckabay C, Nitti VW. The male perineal sling: assessment and prediction of outcomes. J Urol. 2007;177:1414.PubMedCrossRefGoogle Scholar
  62. 62.
    Ullrich NF, Comiter CV. The male sling for stress urinary incontinence: urodynamic and subjective assessment. J Urol. 2004;172:204.PubMedCrossRefGoogle Scholar
  63. 63.
    Clemens JQ, Bushman W, Schaeffer AJ. Urodynamic analysis of the bulbourethral sling procedure. J Urol. 1999;162:1977.PubMedCrossRefGoogle Scholar
  64. 64.
    Suburethral synthetic sling insertion for stress urinary incontinence in men. National Institute for Health and Clinical Excellence. Available at http://guidance.nice.org.uk/IPG256. Accessed 12 July 2010.
  65. 65.
    Rehder P, Gozzi C. Transobturator sling suspension for male urinary incontinence including post-radical prostatectomy. Eur Urol. 2007;52:860.PubMedCrossRefGoogle Scholar
  66. 66.
    Bauer RM, Mayer ME, Gratzke C, et al. Prospective evaluation of the functional sling suspension for male postprostatectomy stress urinary incontinence: results after 1 year. Eur Urol. 2009;56:928.PubMedCrossRefGoogle Scholar
  67. 67.
    Davies TO, Bepple JL, McCammon KA. Urodynamic changes and initial results of the AdVance male sling. Urology. 2009;74:354.PubMedCrossRefGoogle Scholar
  68. 68.
    Wilson SK, Delk JR, Henry GD, et al. New surgical technique for sphincter urinary control system using upper transverse scrotal incision. J Urol. 2003;169:261.PubMedCrossRefGoogle Scholar
  69. 69.
    Kendrici M, Gupta S, Shaw K, et al. Synchronous prosthetic implantation through a transscrotal incision: an outcome analysis. J Urol. 2006;175:2218.CrossRefGoogle Scholar
  70. 70.
    Henry GD, Graham SM, Cleves MA, et al. Perineal approach for artificial urinary sphincter implantation appears to control male stress incontinence better than the transscrotal approach. J Urol. 2008;179:1475.PubMedCrossRefGoogle Scholar
  71. 71.
    O’Connor RC, Lyon MB, Guralnick MB, et al. Long-term follow-up of single versus double cuff artificial urinary sphincter insertion for the treatment of severe postprostatectomy stress urinary incontinence. Urology. 2008;71:90.PubMedCrossRefGoogle Scholar
  72. 72.
    Guralnick ML, Miller E, Toh KL, et al. Transcorporal artificial urinary sphincter cuff placement in cases requiring revision for erosion and urethral atrophy. J Urol. 2002;167:2075.PubMedCrossRefGoogle Scholar
  73. 73.
    Fleshner N, Herschorn S. The artificial urinary sphincter for post-radical prostatectomy incontinence: impact on urinary symptoms and quality of life. J Urol. 1996;155:1260.PubMedCrossRefGoogle Scholar
  74. 74.
    Haab F, Trockman BA, Zimmern PE, et al. Quality of life and continence assessment of the artificial urinary sphincter in men with minimum 3.5 years of followup. J Urol. 1997;158:435.PubMedCrossRefGoogle Scholar
  75. 75.
    Litwiller SE, Kim KB, Fone PD, et al. Post-prostatectomy incontinence and the artificial urinary sphincter: a long-term study of patient satisfaction and criteria for success. J Urol. 1996;156:1975.PubMedCrossRefGoogle Scholar
  76. 76.
    Lai HH, Hsu EI, Teh BS, et al. 13 years of experience with artificial urinary sphincter implantation at Baylor College of Medicine. J Urol. 2007;177:1021.PubMedCrossRefGoogle Scholar
  77. 77.
    Elliott DS, Barrett DM. Mayo Clinic long-term analysis of the functional durability of the AMS 800 artificial urinary sphincter: a review of 323 cases. J Urol. 1998;159:1206.PubMedCrossRefGoogle Scholar
  78. 78.
    Clemens JQ, Schuster TG, Konnak JW, et al. Revision rate following artificial urinary sphincter placement for post-radical prostatectomy incontinence: actuarial analysis. J Urol. 2001;166:1372.PubMedCrossRefGoogle Scholar
  79. 79.
    Venn SN, Greenwall TJ, Mundy AR. The long-term outcome of artificial urinary sphincters. J Urol. 2000;164:702.PubMedCrossRefGoogle Scholar
  80. 80.
    Klijn AJ, Hop WCJ, Mickisch G, et al. The artificial urinary sphincter in men incontinent after radical prostatectomy: 5 years actuarial adequate function rates. BJU Int. 1998;82:530.CrossRefGoogle Scholar
  81. 81.
    Fisher MB, Aggarwal N, Vuruskan H, et al. Efficacy of artificial urinary sphincter implantation after failed bone-anchored male sling for postprostatectomy incontinence. Urology. 2007;70:942.PubMedCrossRefGoogle Scholar
  82. 82.
    Kumar A, Litt ER, Ballert KN, et al. Artificial urinary sphincter versus male sling for post-prostatectomy incontinence – what do patients choose? J Urol. 2009;181:1231.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2012

Authors and Affiliations

  1. 1.Department of UrologyUniversity of Michigan Medical CenterAnn ArborUSA

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