Incontinence, Urinary Adult Male
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- Urinary incontinence (UI) is a pathologic condition of an acute or chronic nature that refers to the involuntary loss of urine leading to medical, financial, social, or hygienic problems. Five main types of UI have been described: stress, urge, mixed, overflow (urinary retention), and functional UI (1).
- Stress incontinence: involuntary urine leaks secondary to increased intra-abdominal pressure being greater than the sphincter can control; may be precipitated by sneezing, laughing, coughing, exertion
- Urge incontinence: Involuntary leakage of urine associated with urgency is believed to be secondary to uncontrolled contraction of the urinary bladder. It is also called detrusor overactivity.
- Mixed incontinence: involuntary leakage of urine with urgency and with stress, such as sneezing, laughing, coughing, exertion
- Overflow incontinence: also known as urinary retention; this occurs with bladder overdistention due to impaired detrusor contraction or bladder outlet obstruction (due to benign prostatic hyperplasia [BPH], bladder stones, bladder tumors, pelvic tumors, urethral strictures, or spasms).
- Functional UI: urine leakage variable, often due to environmental or physical barriers to toileting (i.e., reduced mobility)
- Polyuria is defined by excessive amounts of urine (≥2.5 to 3.0 L) >24 hours.
- Nocturnal polyuria is where >33% of total daily urine output occurs during sleeping hours.
- Stress incontinence in men is rare and is often attributable to prostate surgery, neurologic disease, or trauma.
- Involuntary detrusor overactivity may be spontaneous or provoked and may be neurogenic or idiopathic in cause.
- Reported rates of incontinence range from 1% after transurethral resection to 2–66% after radical prostatectomy and 1–15% following transvesical prostatectomy, although rates decline with time (1).
- 12.4% prevalence of UI in community-dwelling adult men in the United States as based on the National Health and Nutrition Examination Survey (NHANES) as of 2008
- 4.5% reported moderate to severe UI, of which 48.6% experienced urge, 23.5% experienced other UI, 15.4% experienced mixed, and 12.5% experienced stress incontinence as per the NHANES report in 2010.
- UI is common in nursing home patients, with a prevalence of about 70% in the Southeastern United States from 1999 to 2002.
- Incontinence in men of all ages is approximately half as prevalent as it is in women; however, after 80 years of age, both sexes are affected equally (1).
Etiology and Pathophysiology
- Incontinence secondary to bladder abnormalities
- Detrusor overactivity results in urge incontinence.
- Detrusor overactivity commonly is associated with bladder outlet obstruction from BPH.
- Incontinence secondary to outlet abnormalities
- Sphincteric damage secondary to pelvic surgery or radiation
- Sphincteric dysfunction secondary to neurologic disease
- Commonly associated with BPH due to compression of the urethra, affecting urinary flow
- Mixed incontinence is caused by abnormalities of both the bladder and the outlet overflow or by enlarged prostate/bladder neck contracture from prostate surgery.
- Stress incontinence is caused by weakened urethral sphincter and/or pelvic floor weakness.
- Hypertension (HTN)
- History of urinary tract infections
- Major depression
- Neurologic disease
- Pelvic trauma
- Prostate surgery
Proper management of conditions, such as symptomatic bladder outlet obstruction caused by BPH early in the course, may prevent continence problems later in life; no evidence for screening in men unless patient is experiencing symptoms using the 3 Incontinence Questions tool to evaluate the type of UI (2).
Commonly Associated Conditions
- Benign prostatic hypertrophy
- Neurologic disease (cerebrovascular accident, parkinsonism, multiple sclerosis, myelodysplasia, spinal cord injury, normal pressure hydrocephalus, and cognitive impairment)
- Major depression
- Pelvic surgery, radiation, or trauma