This article was formulated from a clinical review of contemporary literature; a detailed analysis of all relevant studies is not the goal of this article. This is often a complication following prostate surgery, such as radical prostatectomy or transurethral resection of prostate TURP. Other causes of male SUI are iatrogenic sphincter injury eg sphincterotomy in spinal patients , neurological conditions or trauma to the pelvic floor eg pelvic trauma in motor vehicle accident. The exact incidence of SUI may vary depending on the underlying pathology, definition of SUI and source of data eg physician versus patient report.
While sphincter deficiency is often the main causative factor, 4 other bladder conditions, such as detrusor overactivity, poor bladder compliance and detrusor underactivity, can often co-exist and contribute to the pathophysiology of SUI. OAB is a clinical syndrome characterised by urinary urgency, with or without urge incontinence, usually accompanied by frequency and nocturia. The risk factors for UUI include neurological conditions, various inflammatory processes of the bladder, bladder outlet dysfunction, physiological ageing and psychosocial stressors, or the condition may be idiopathic in nature.
This is because most storage symptoms are frequently attributed to an enlarged prostate. The most common finding in patients with UUI is detrusor overactivity, which is a urodynamic observation of involuntary bladder contractions that are commonly associated with a corresponding sensation of urgency during bladder filling.
Enlarged prostate and ensuing bladder outlet obstruction can result in bladder adaptations and abnormal bladder contraction ie detrusor overactivity. It is also important to exclude other conditions that can simulate OAB-like symptoms, such as UTI, bladder stones and carcinoma in situ. Basic clinical evaluation should include comprehensive history-taking, focused physical examination, urinalysis and post-void residual measurement Table 1.
The presence of other urinary symptoms and past urological conditions or surgery provide useful information during the clinical assessment of the patient. Other relevant medical conditions, such as any neurological conditions, diabetes, previous pelvic injury and cognitive impairment, should also be assessed. Identifying the most bothersome symptom will often help direct management. The use of validated patient questionnaires, such as the International Consultation on Incontinence Questionnaire ICI-Q , can often provide symptom clarification and serve as a marker for improvement.
A three-day frequency—volume chart or bladder diary eg indicating daytime and night-time frequency of micturition, episodes of incontinence, voided volumes, hour urine output , is often very useful in men who report mixed incontinence. Physical examination should include an abdominal examination to detect any abdominal or pelvic mass eg palpable bladder , perineal examination for sensory loss, digital rectal examination for prostate size and nodules, and pelvic floor tone.
Urinalysis and microscopy are essential to exclude a UTI, while measurement of post-void residual urine offers a good estimate of voiding efficiency. A pad test ie weighing the pad to measure the volume of urinary incontinence can diagnose the severity of urinary incontinence and may be used to indicate treatment outcome.
Blood tests for renal function are recommended if compromised renal function is suspected, and in cases of polyuria in the absence of diuretics use , as documented by the frequency—volume chart, glycaemic index should be assessed. Imaging studies, such as renal tract ultrasound, provide useful information in excluding the presence of upper urinary tract dilatation and co-existing bladder pathology eg stones, tumours. Contrast studies, such as cysto-urethrography or computed tomography CT , could assist in the identification of fistulas, strictures, bladder diverticulae or tumours.
Specialised tests should be individualised with the use of cystoscopy to evaluate the presence of urethral strictures, an obstructive prostate, bladder stones or tumours. A pressure—flow study provides valuable information on detrusor function. Urodynamic studies have a role in patients with suspected voiding difficulties or neuropathy, failed treatment, or those considering surgical treatment.
Urodynamic studies provide a physiological assessment of bladder and outlet function, and demonstrate dyssynergia of bladder contraction and outlet opening, such as seen in bladder denervation. Continence assessment includes identifying the type of incontinence ie urgency, stress-related, mixed , the severity number and size of pads used, preferably pad weights and the impact on activity or quality of life.
In patients who have mixed incontinence, such as urgency and stress incontinence, it is important to determine which is more bothersome. In the presence of complicated lower urinary tract dysfunction, symptoms such as haematuria, recurrent UTIs, dysuria and pain will require further investigation or specialist referral to exclude malignant or infectious pathology. Medical comorbidities, especially conditions such as diabetes, ischaemic heart disease or congestive cardiac failure, neurological conditions, chronic pulmonary disease and obesity, can exacerbate OAB and SUI symptoms.
Treating these conditions may not eliminate incontinence, but it may lessen the severity. Initially the general practitioners GPs should order urine microscopy and culture to exclude infection, haematuria and pyuria. The patient should be advised to keep a bladder diary to record the number and time of voids in a hour period, volumes voided, incontinence episodes, fluid intake, degree of urgency and incontinence over a three-day period.
There are certain risks with this surgery, as with all surgery, that should be discussed before making your decision. The surgery can be done open or laparoscopically under general anesthesia in less than a few hours. Burch Suspension for Urinary Incontinence. There are surgical options specifically for men with SUI.
Talk with your healthcare provider to find out which treatments may work for you. Artificial Urinary Sphincter. The most effective treatment for male SUI is to implant an artificial urinary sphincter device. This device has three parts:. The artificial urinary sphincter cuff is filled with fluid which keeps the urethra closed and prevents leaks.
When you press on the pump, the fluid in the cuff is transferred to the balloon reservoir. This opens your urethra and you can urinate. Once urination is complete, the balloon reservoir automatically refills the urethral cuff in minutes. Artificial sphincter surgery can cure or greatly improve urinary control in more than 7 out of 10 men with SUI. Results may vary in men who have had radiation treatment.
They also vary in men with other bladder conditions or who have scar tissue in the urethra. Similar to female mid-urethral slings, the male sling is a narrow strap made of synthetic mesh that is placed under the urethra. It acts as a hammock to lift and support the urethra and sphincter muscles.
What is Stress Urinary Incontinence (SUI)?
Most commonly, slings for men are made of surgical mesh. The surgical incision to place the sling is between the scrotum and rectum.
The male sling is most often used in men with mild to moderate SUI. It is less effective in men who have had radiation therapy to the prostate or urethra, or men with severe incontinence. The goal of any treatment for incontinence is to improve your quality of life. Surgical treatments usually work, especially when combined with lifestyle changes. Make sure you rest for a few weeks to allow for recovery and healing.
Common sense and care will help the benefits of these surgeries last for a long time.
Continue with daily Kegel exercises to maintain pelvic muscle strength. Ideally, you should maintain a healthy weight. A large amount of weight gain or activities that strain your belly and pelvis can harm surgical repair over time.
Stress Urinary Incontinence Guideline - American Urological Association
Typically, you will be asked to visit your surgeon between six weeks and six months after surgery for a follow-up visit. Your bladder may also be tested to see how well its releasing urine and if urine remains in the bladder after going to the bathroom. If leaking symptoms remain or if you have any pain, let your surgeon know right away. In most cases, great improvements and even the cure of all leaks are possible for people who choose SUI surgery Keep in mind that the medical devices implanted with surgery may need adjustments over time.
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