Urinary incontinence in men Unintentional loss of urine in men

Unintentional loss of urine in male patients may occur following physical exertion, coughing or sneezing - stress urinary incontinence - or may be associated with the sudden urge to urinate - urge urinary incontinence. In some cases, both mechanisms may contribute to the involuntary urine loss and a careful and individualized approach to the patient is essential to clarify the causes of incontinence and to prescribe appropriate treatment.

Stress urinary incontinence in men occurs more frequently after procedures for the treatment of prostate cancer (mainly radical prostatectomy, but also external radiation therapy). In this type of treatments, the urinary sphincter, muscle structure that under normal conditions ensures that there are no urine losses, can be injured. However, it should be noted that performing prostate surgery does not lead necessarily to stress urinary incontinence. Patients previously submitted to surgery present an anatomic change that leads to a greater risk of changes in bladder function, and may also present with urinary incontinence or both types.

It is therefore essential that the male patient with urinary incontinence be correctly studied clinically and using complementary diagnostic tests, including the complete Urodynamic Study, which plays a fundamental role in these cases.

While urgency urinary incontinence (overactive bladder) can be treated with medication, stress urinary incontinence in humans usually requires surgical treatment.

In cases of mild to moderate urinary incontinence, injection of bulking agents into the urethra (substance injected underneath the urethral lining, throughout the circumference of the urethra, to create a urinary sphincter-like ring) may be an option therapeutic effect is temporary.

Another option for mild to moderate urinary incontinence may be the placement of a synthetic tape under the urethra through a minimally invasive procedure; this tape causes moderate compression of the urethra, contributing to continence.

The third surgical procedure is the placement of an artificial urinary sphincter. This consists essentially of an armband placed around the urethra and can be opened by the patient himself when he wants to urinate through a button that is under the skin, next to the testicles (none of the components of the device is external or visible). The artificial urinary sphincter allows the treatment of moderate to severe urinary incontinence and is an excellent option also in complex cases or after failure of other previous treatments.