Male urinary incontinence
Einstein Health Glossary
ICD 10 - R32
What is male urinary incontinence?
Male urinary incontinence is the medical term used to describe patients who experience involuntary urine leakage during their daily activities, whether during the day or at night.
Causes
The main causes of urinary leakage in men are sphincter deficiency after radical prostatectomy (urine leakage following surgery for prostate cancer treatment) and overactive bladder, which involves strong involuntary bladder contractions that lead to urine leakage.
Symptoms
Sphincter deficiency, which typically occurs after radical prostatectomy, is characterized by urine leakage during physical exertion—such as coughing, sneezing, lifting heavy objects, or exercising. In contrast, urine leakage related to an overactive bladder occurs suddenly. The patient experiences a sudden urge to urinate and often loses urine on the way to the bathroom.
Prevalence in Brazil
It is estimated that 1% to 5% of men who undergo radical prostatectomy will experience urine leakage after surgery. This number is decreasing due to improvements in surgical techniques and the advancement of minimally invasive (robotic) surgery. Urinary leakage associated with an overactive bladder occurs in up to 10% of elderly men.
Diagnosis
Identifying the pattern of urine leakage can help distinguish between sphincter deficiency (effort-related leakage) and overactive bladder (urgency-related leakage). However, the clinical picture is not always clear, and symptoms may overlap. The best test to determine the cause of urinary leakage is the urodynamic study.
Urodynamic study: This is performed using catheters that measure bladder and abdominal pressures. During the bladder filling phase, it is possible to determine whether the leakage is due to bladder overactivity (the bladder muscle contracts at the wrong time, causing leakage) or sphincter deficiency (the urine retention mechanism fails to hold the urine). This distinction is crucial, as it directly impacts treatment decisions.
Treatment
Treatment for male urinary incontinence due to sphincter deficiency, in mild cases, can be done through pelvic floor physical therapy to strengthen the muscles responsible for urine retention. However, when urine leakage becomes more frequent, surgical treatment is usually required. There are two main devices that can be implanted to treat urinary leakage: Sling: effective for mild leakage and artificial sphincter: more suitable for moderate to severe leakage.
Treatment for male urinary incontinence due to overactive bladder may include physical therapy, medications, and in more advanced cases, surgery. There are several medications (typically anticholinergics) that reduce or inhibit involuntary bladder contractions and work well for mild to moderate leakage. In severe or medication-resistant cases, botulinum toxin can be injected into the bladder, or a neuromodulator can be implanted to control urine leakage.