What is male stress urinary incontinence (SUI)?
Stress urinary incontinence (SUI) involves the involuntary loss of urine due to increased pressure or force (i.e. “stress”) placed on the bladder. This can occur with coughing, sneezing, jumping, exercise, lifting and other physical activities.
In mild cases of stress incontinence, triggers may be vigorous physical activity such as with exercise, coughing, lifting.
In more severe cases of stress incontinence, even more gentle movements such as walking and standing up can trigger leakage.
What are the causes of male stress urinary incontinence (SUI)?
Stress urinary incontinence (SUI) in men is much less common than in women. In men SUI is usually a side effect of treatments for other conditions e.g. prostate cancer surgery (with an operation called radical prostatectomy), and prostate cancer radiotherapy. It is a rare complication of surgery for benign prostate enlargement with TURP (transurethral resection of the prostate or “prostate rebore”).
How is Stress Urinary Incontinence (SUI) different from Urge Urinary Incontinence (UUI)?
Stress urinary incontinence (SUI) occurs when there is an increase in pressure (or “stress”) on the bladder e.g. with cough, sneeze, exercise.
This is because SUI is caused by a weakness of the support structures of the bladder (such as the pelvic floor) as well as a weakness of the valve at the outlet of the bladder (urethral sphincter which is responsible for holding the urine in the bladder until it is time to urinate).
Urge urinary incontinence (UUI) is unrelated to activity. Leakage is preceded by a sudden and severe desire to pass urine that cannot be delayed. UUI is caused by an abnormality in the nerve supply and muscle function of the bladder.
Some men have mixed urinary incontinence (MUI) that is a combination of SUI and UUI.
How is male stress urinary incontinence (SUI) assessed?
The assessment of male stress urinary incontinence (SUI) is very similar to that of female SUI and includes:
- Details of bladder habits e.g. how many times in a 24-hour period toileting occurs
- Details of incontinence such as triggers, frequency, severity, pad usage, effects on quality of life
- Other medical history e.g. of conditions that can affect bladder control such as diabetes, heart failure
- Medications – both prescribed and over the counter
- Fluid intake – especially that of bladder irritants such as coffee, tea, cola drinks, alcohol
- Past history – urological surgery (e.g. radical prostatectomy surgery for prostate cancer, benign prostate surgery with TURP and open prostatectomy), pelvic radiotherapy, other pelvic surgery, neurological problems
- Physical examination
- The examination includes an examination of the abdomen looking for a distended or enlarged bladder.
- In men the examination includes a prostate assessment (also known as digital rectal examination).
- The digital rectal examination also assesses the ability to perform a pelvic floor contraction and its strength
- Basic investigations
- Bladder diary
- The bladder diary documents frequency of urination and volumes of urine passed over three 24- hour periods (not necessarily consecutive). It is an important tool in quantifying urinary symptoms, helping establish a baseline of symptoms and assessing the effectiveness of treatments.
- Urine testing with MSU
- Bladder ultrasound to assess bladder emptying (post void residual ultrasound)
- Incontinence pad weight testing – helps to objectively assess the severity of stress urinary incontinence
- Bladder diary
- Cystoscopy – is used to look for scarring at the bladder neck or in the urethra that can occur after prostate surgery and radiotherapy
- Urodynamic testing
- Urodynamic testing and cystoscopy are particularly important in men considering surgical treatment for stress urinary incontinence (SUI). These tests are not necessary before starting conservative management e.g. with pelvic floor physiotherapy
- Urodynamic testing helps determine the cause, type and severity of incontinence (i.e. due to urinary sphincter weakness or abnormal bladder function or a combination of the two)
What are the treatment options for male stress urinary incontinence (SUI)?
Both conservative and surgical treatment options are available for men with stress urinary incontinence (SUI).
The most common cause of male stress urinary (SUI) is now radical prostatectomy surgery for the treatment of prostate cancer. It is estimated that up to 60% of men will suffer from stress urinary incontinence in the early postoperative period after radical prostatectomy surgery. This is mild in most cases and decreases with the passage of time but around 4% of men can suffer significant ongoing leakage. The rates of stress urinary incontinence (SUI) reduce significantly in the first 3 months after surgery. By a year after radical prostatectomy surgery, around 14% of men experience stress urinary incontinence (SUI).
All men can benefit from the conservative treatment options discussed below. Surgical treatments are considered in men with bothersome stress urinary incontinence (SUI) that persists more than a year after the time of radical prostatectomy or earlier in men who have very severe symptoms.
Conservative treatment options for Men with SUI
Men with stress urinary incontinence can benefit from non-surgical treatment options including:
- Pelvic floor muscle physiotherapy
- Correcting problems that cause chronic constipation and coughing
- Cutting out smoking
- Continence devices and aids
- Advice regarding the appropriate choice of continence aids can be provided through specialist Urology Nurses and specialist Continence Advisors.
- Options may include the use of pads and condom drainage (an external collecting device for urine).
Surgical treatment options for Men with SUI
Before considering surgery, a full assessment of stress incontinence should be made to determine an individual’s suitability for surgery and make a recommendation regarding type of surgery. Such assessment may include:
- Assessment of stress urinary incontinence (SUI)
- Assessment of urinary incontinence
- Urodynamic testing
Many surgical treatment options exist for men with bothersome stress urinary incontinence including:
- Injectable agents for stress urinary incontinence
- Sling surgery with suburethral slings specifically designed for male stress urinary incontinence
- Artificial urinary sphincter (AUS)
Overall the artificial urinary sphincter (AUS) is regarded as the “gold standard” treatment for severe male stress urinary incontinence (SUI) occurring after radical prostatectomy surgery. Slings, injectable agents and other devices are better suited to men experiencing mild to moderate stress incontinence.