Male Urinary Incontinence
In men, urinary incontinence (loss of bladder control) can have a profound effect on quality of life due to fear of leaking urine on effort or physical exertion.
Overview of Male Urinary Incontinence
What is urinary incontinence?
Urinary incontinence is the loss of bladder control and the involuntary leaking of urine. It is a common problem that can have a profoundly negative impact on a persons’ quality of life. Often leading sufferers to give up hobbies and exercise for fear of the embarrassment of leaking urine.
In a man with a fully functioning urinary tract, urine is retained and stored in the bladder by the contraction of the urinary sphincter. This sits below the prostate and is supported by numerous structures above and below it and works in conjunction with the pelvic floor muscles. Its function is controlled by small nerves that pass close to the prostate.
The bladder is a muscular ball, that slowly fills as urine passes to it from the kidneys. The bladder muscle is usually relaxed in this filling or storage phase, and the urinary sphincter is contracted.
When the bladder is reaching capacity, pressure sensing nerves in the wall of the bladder send signals to the brain that the bladder is getting full, and that it is time to find a toilet. When at the urinal or toilet, a man will relax his urinary sphincter and contract his bladder, and the urine will flow out.
Causes of urinary incontinence
However, problems with the urinary tract can occur and incontinence can happen for several reasons:
1. Overflow incontinence
Overflow incontinence is where the bladder lacks the pressure sensing aspect, or the musculature power to empty. It becomes too full, and as the pressure rises, it goes above the ability of the urinary sphincter’s power to keep urine inside and it leaks out. This more commonly happens at night when you are asleep.
It is important to seek medical advice if this is the case, as left untreated it can lead to high pressure being transmitted to the kidneys and lead to kidney failure. Treatment usually involves ways to decrease the pressure in the bladder (which can be by using catheters), with a view as to whether surgery on the prostate would sufficiently relieve the amount of pressure required by the bladder muscle to empty.
2. Urge incontinence
Urge incontinence is where the bladder muscle twitches, or spasms during the filling and storage phase, when it should be relaxed. This sudden contraction of the bladder muscle can suddenly increase the pressure in the bladder and force the urine through the closed urinary sphincter, leading to leakage or incontinence of urine. These abnormal bladder spasms can be secondary to blockage from the prostate gland, intrinsic to the bladder, or secondary to other drugs such as caffeine. Or a combination of all three.
The treatment depends on the cause, so a diagnosis needs to made by a urologist, who can then advice whether lifestyle modification, medications, intravesical botox or surgery would be most appropriate.
3. Stress incontinence
Stress incontinence is when there is damage to the nerve supply, muscle or supporting structures of the urinary sphincter, most often during surgery to the prostate. A common treatment for localised prostate cancer is surgical removal of the prostate (radical prostatectomy). In removing the whole prostate gland (with the cancer contained within), damage can occur to the nerve supply to the sphincter, to the muscles of the sphincter and pelvic floor, and to the supporting ligaments and structures around the sphincter.
Treatment for this involves intensive specialist pelvic floor physiotherapy, including the Emsella chair. If insufficient progress is made then surgical intervention can be considered such as bladder neck bulking agents, urethral slings, some with balloon occlusion devices, and ultimately even artificial urinary sphincters.
There have been many advances in prostate cancer surgery over recent years, enabled by the advancements in robotic surgical systems. Continence preserving surgery has been a passion of our Urology Specialist Mr Philip Charlesworth, who has been one of the pioneers of the Retzius sparing robotic prostatectomy technique. This approaches the prostate and urinary sphincter from below, thus preserving the critical supporting structures above, together with the nerves and pelvic floor muscles. This has allowed urinary incontinence post radical prostatectomy to become largely a thing of the past for many patients.
Symptoms of Male Urinary Incontinence
Incontinence can occur at any age but is more common in older men. Men who have had their prostates removed because of cancer are also more likely to suffer from this condition. This life changing complication from surgery can affect up to 1 in 20 men.
Common symptoms of urinary male incontinence include:
- Dribbling urine after urination.
- Involuntarily leaking urine on effort or physical exertion, or on sneezing, coughing, laughing or lifting something heavy.
- The inability to hold urine long enough to reach the bathroom.
- Leaking urine at night.
- Needing to pee more frequently.
- Experiencing a sudden, intense urge to urinate.
If you are experiencing any of these or finding they are affecting your quality of life, there is no need to suffer any longer. Please make an appointment to see your doctor or one of our consultant urologists. A few simple lifestyle changes, or medical treatments, can help to ease symptoms or stop urinary incontinence.
Diagnosing Male Urinary Incontinence
Your specialist will take a thorough history and explore your current incontinence issues. You will also undergo some specialised tests including:
- Urine flowmetry analysis
- Bladder diary assessment
Assessment of the results from these test will inform the choice of most suitable treatment.
Treatments for Male Urinary Incontinence
At the Urology Partnership at Forbury Clinic, we offer a comprehensive selection of treatment options for this condition, and our specialists are renowned UK leads in pioneering the latest cutting-edge advanced technology and science available in treating this debilitating condition.
Pelvic floor exercises when done correctly have been proven in many scientific studies to improve urinary incontinence.
Like having a personal trainer at the gym, these speciality tailored exercises build up the strength within the muscles of the pelvic floor, which controls bladder incontinence.
Our specialist urology nurses will guide you through each set of techniques to ensure you get the most out of each exercise to maximise the effectiveness.
Up to 50% of patients will experience a considerable improvement in their symptoms using the correct physiotherapy alone.
Physiotherapy treatment may include the new Emsella chair. A revolutionary non-invasive and comfortable physiotherapy treatment for urinary incontinence which stimulates and strengthens the entire pelvic floor musculature. One 28-minute session of Emsella is equivalent to doing 11,000 pelvic floor exercises.
When the bladder contracts, or there is increased pressure from coughing, straining or exercise, urine can exit the bladder via the urethra and the bladder neck.
Injecting specially engineered gels bulks up the exit to the bladder, increasing the pressure needed before urine comes out. This then prevents urine leakages in patients who previously would leak on the most minimal straining or movement.
This procedure is a simple and safe operation performed under general anaesthetic as a day case. It is done endoscopically via natural orifices, meaning no cuts or scars.
- Urethral bulking injections are suitable for men who use 2 incontinence pads or less per day, where over 50% are no longer incontinent after this procedure
- Urethral bulking is suitable in those who also would prefer a minimally invasive surgical treatment option and would like to avoid undergoing more complex surgery.
The first UK experience in using urethral bulking agents to treat men with Stress Urinary Incontinence.
B Yang, W Britnell, S Foley, Royal Berkshire Hospital, Reading, UK.
ATOMs (Adjustable transobturator male system)
Our expert surgeons here at the Urology Partnership have been the pioneers in using this advanced device in the UK, and are renowned international trainers invited globally to train other surgeons in the use of ATOMs.
The procedure is performed under general anaesthetics and involves only a small scar within the perineum (patch of skin between the scrotum and the anus).
An inflatable device is inserted into the perineum which puts pressure on the exit pipe from the bladder, preventing urine leakages.
There are no mechanical parts which needs any patient input. Once inserted it will be at work all the time by itself.
Overtime, this pressure can be easily and repeatedly adjusted via a concealed port in the scrotum according to your symptoms if they were to worsen. These adjustments can be done in the comfort of our clinic rooms without anaesthetics and is therefore a much safer, faster, and more desirable option for our patients.
In over 3 in 4 men, ATOMs was successful in leaving them dry within a year of insertion.
Artificial Urinary Sphincters
For men with the most severe incontinence, and especially in those who often partake in strenuous heavy lifting exercises, an artificial urinary sphincter is another option in our arsenal to treat this debilitating condition.
These devices are inserted under general anaesthetic through a small cut in the perineum (skin between the testicles and the anus) and a small cut in the groin. Up to 90% of patients are cured by artificial urinary sphincters.
These devices are composed of a cuff which sits around the urethra (the water pipe connecting the bladder to the penis and the outside), a manual pump which sits within the scrotum and a water reservoir.
When on, the cuff is filled with water which presses the waterpipe and prevents any urine leakages.
When the time comes to empty the bladder, the patient simply presses the pump which sits in the scrotum, releasing the pressure within the cuff, and allows the urine to freely flow out of the bladder.
The two most well established and trusted sphincters are offered here at the Urology Partnership.
The AMS 800 urinary control system is the most established and commonly used sphincter device worldwide. Comprised of 3 components, this sphincter has been used for decades in over 150,000 men worldwide.
The sphincter is inserted under general anaesthetic and requires a small cut within the perineum (the skin between the testicles and the anus) and a second smaller cut in the groin.
The Zepher Surgical Implant (ZSI375) is a one-piece artificial urinary sphincter.
The unique aspect for this device is that the water reservoir and manual pump have been incorporated into one single unit which sits in the scrotum. This means a less invasive operation which requires only one cut within the perineum (the skin between the testicles and the anus) to insert this device.
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If you would like more information or wish to arrange a consultation with one of our specialist consultant urological surgeons then please either Call 0118 920 7040 or complete the form below.
Contact your GP and ask for a referral to the Urology Partnership.
All consultations, investigations and treatments are covered by major insurance companies (depending on policy).
Funding your own treatment
Self-funding initial consultation fee is £205. Follow up fees are £165.
Consultation charges are exclusive of any tests and other investigations that the consultant may wish to carry out.