Urinary incontinence is the involuntary loss of urine. The cause of incontinence is different in men and women.
Incontinence in men often occurs as a result of prostatic problems. Leakage can result if the prostate has completely occluded the bladder and the bladder is completely full, causing leakage as it overflows. Long term prostatic enlargement can also cause the bladder to decompensate, meaning that it loses elasticity and gets effectively smaller. Incontinence can occur because the decompensated bladder gets thick and spastic and involuntarily contracts, pushing urine out. Post-void dribbling is a situation where urine drips out of the penis after voiding is completed. This soils pants and underwear and is often very embarrassing. This occurs because urine gets trapped in the urethra and is released moments later when the prostate and sphincter relax. Unfortunately, little can be done about it.
Other forms of incontinence in men may result from injury to the urinary sphincter, most commonly from previous prostate cancer surgery, or botched BPH surgery. Other causes of incontinence are lower urinary tract injury due to radiation or neurologic disease.
Treatment of incontinence in men related to BPH is usually done through treatment of the BPH. Success is dependent on how early the problem is caught and if the bladder has the ability to recover. Bladder problems that have occurred as a result of many years of obstruction may only partially respond to treatment, if at all. There are also medications available to prevent bladder spasticity, but these must be used with caution in men. The best defense against incontinence is prevention, which is why a regular check up by a urologist is recommended.
Treatment for incontinence due to prior surgery is more complex. In this case, leakage occurs as a result of malfunction of the urinary sphincter or "valve". Treatments are aimed at restoring, replacing or enhancing the sphincter.
Intaurethral bulking agents can be injected at or near the sphincter to create a tighter seal. They have limited success in men and have to be repeated periodically in most cases.
Male sling procedures use a sling of synthetic material to reposition the sphincter or to compress the sphincter or urethra to enhance closure pressure. There are several techniques that a qualified urologist can assess for suitability. This is often effective for mild to moderate incontinence. It can be done on an outpatient or overnight status.
Artificial urinary sphincter is a mechanical device that is implanted as a new sphincter. It is controlled by the patient through a pump in the scrotum that opens and closes. This is a complex procedure and requires a specialist who has extensive experience, as we have at San Fernando Valley Urological Associates. Because it is a mechanical device it can malfunction over time, although that has become less common as of late.
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