Stress urinary incontinence describes urine leakage that can occur with increased abdominal pressure. This occurs for example during coughing, laughing, sneezing, physical exercise or sexual activity.
For men, stress urinary incontinence most commonly follows radical prostatectomy for prostate cancer and is called post-prostatectomy incontinence (PPI). Although PPI can continue to improve for up to two years following surgery, about 10% of men who have had a prostatectomy continue to use 1 pad or more daily longer term.
Causes and Risk Factors
PPI occurs because of damage to the external sphincter muscle or surrounding nerves that control urination. Increases in abdominal pressure can then force urine involuntarily through the weakened sphincter. Risk factors include obesity, which can lead to increased pressures, and radiation, which can lead to further tissue weakening.
When to Speak with a Urologist about Post-Prostatectomy Incontinence
You should talk to a Urologist about Post-Prostatectomy Incontinence if you are bothered by urine leakage following prostatectomy.
What to Expect when Seeking Treatment
In addition to a history and physical examination, initial assessment includes urine testing to rule out infection and postvoid residual check to ensure bladder emptying. A voiding diary recording pad use aids in quantifying the degree of leakage. Cystoscopy involves passing a small flexible telescope into the bladder to assess for a physical blockage where the bladder was connected to the urethra during prior surgery. Urodynamic studies can test bladder pressures with a small catheter in the bladder to rule out leakage due to bladder muscle overactivity.
Many management options are available based on patient preference, including continued observation.
Initial conservative treatments involve pelvic floor physical therapy to maximize pelvic muscle control to aid in continence.
If bladder overactivity is contributing to leakage, oral medications including anticholinergic pills such as Detrol or Ditropan can be used to reduce bladder muscle contractions.
Options to manage the condition can rely on penile clamps and chronic condom catheterization. Possible surgical treatments include male slings and artificial urinary sphincter placement.
Male urethral sling is appropriate for mild-to-moderate stress incontinence in men who have not had radiation therapy. The procedure involves a small incision below the scrotum and there is no need for activation of the device with urination. About 75% of patients are significantly improved. The infection rate requiring revision is about 3%.
Artificial urinary sphincter placement is appropriate for moderate-to-severe stress incontinence if you have the manual dexterity needed to use the device and your bladder still has good compliance. The procedure involves a small incision below the scrotum and a small pump in the scrotum that must be activated with urination. There is a low rate of persistent severe incontinence (9%) with about 75% of patients using zero or one pad. The rate of revision surgery is about 28% at 5 years. The primary risk is infection (1-3%) and urethral erosion (5%) which would require removal of the device.