Description

• 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 L) >24 hours.
• Nocturnal polyuria is where >33% of total daily urine output occurs during sleeping hours.

Epidemiology

• Stress incontinence in men is rare and is often attributable to prostate surgery, neurologic disease, or trauma.
• 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).

Prevalence

• 12.4% prevalence of UI in community-dwelling adult men in the United States
• 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 (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.
  • Medications that increase bladder contractility or exacerbate obstructive effects
• 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.

Risk Factors

• Age
• Diseases: diabetes, BPH, hypertension (HTN), major depression, neurologic disease
• History of urinary tract infections (UTIs)
• Pelvic trauma, including prostate surgery
• Polypharmacy

General Prevention

Proper management of conditions, such as symptomatic bladder outlet obstruction caused by BPH early in the course, may prevent continence problems later in life.

Commonly Associated Conditions

Male UI often has a negative impact in both mental and physical aspects of quality of life. It is an independent risk factor for depression and anxiety, and it may significantly reduce work productivity.