The Urology Center Glossary terms

Incontinence (Male):

Urinary incontinence implies unwanted and unintentional leakage or loss of urine producing wet clothing, wet undergarments, wet absorbent pads or wet diapers. Millions of Americans have this problem and the total financial cost of this problem is colossal with more than 16 billion dollars spent annually in the U.S.. Unfortunately, most of this expenditure goes for pads and diapers and only a small portion of these dollars are used for treatments which have been shown to alleviate the problem. This socially stigmatizing problem is treatable in all cases and curable in most!

This socially stigmatizing problem is treatable in all cases and curable in most!

While the problem is more common in women, it is not rare in men. Urinary incontinence in men may be found in association with certain types of surgery, spinal cord injuries and neurological diseases like stroke, dementia (Alzheimer's) and Parkinson's disease. Alternatively, it may be found in association with somewhat less serious conditions such as benign enlargement of the prostate or simply with and aging bladder.

Rarely, urinary incontinence is a symptom of a serious medical problem [such as, herniated disk disease, multiple sclerosis, stroke, Parkinson's disease and spinal cord or brain tumors].

Rarely, urinary incontinence is a symptom of a serious medical problem. Careful urological examination is also needed to exclude the possibility of these and even more serious medical problems which effect not only the bladder but the body as a whole. A urologist specializing in urinary incontinence evaluation and treatment is the most qualified medical professional for the accurate characterization and treatment of all forms of urinary incontinence.

Many men are under the mistaken impression that no treatment is possible. However, most cases of isolated SUI [stress urinary incontinence] are completely reversible.

Stress urinary incontinence (SUI) sometimes develops after radical prostate cancer surgery or even less commonly after other forms of prostate, bladder or urethral surgery. Urine leakage occurs primarily with straining, coughing, sneezing, walking, standing up or with most any activity that increases the pressure on the bladder. Men commonly report that the incontinence worsens later in the day. Many men are under the mistaken impression that no treatment is available. However, most cases of isolated SUI are completely reversible.

An awareness of male anatomy is important to the understanding of stress urinary incontinence (SUI).

An awareness of male anatomy is important to the understanding of stress urinary incontinence (SUI). The urine tube that drains the bladder passes through the middle of the prostate gland. There are two sphincter muscles which control urine flow, one on either end of the prostate. The innermost sphincter, called the internal sphincter, essentially lies between the prostate and the bladder. Men have no voluntary ability to control the internal sphincter. The other sphincter, which is attached to the other (front) end of the prostate, is called the external sphincter. Men may learn to voluntarily squeeze and control the external sphincter.

It must be understood that these sphincter muscles are intimately coupled to the prostate. If just one or the other of the sphincter muscles are damaged, most men continue to be able to control urine flow and remain dry. However, if both sphincters are injured or even if the urethra near the area of the sphincters becomes scarred , SUI commonly results.

Several prostate surgeries actually cut one or the other of the sphincters by necessity. For example, radical prostate cancer surgery requires removal of part or all of the internal, sphincter that is located between the prostate and the bladder. Prostate cancer can grow near or even into this sphincter muscle. Without the purposeful removal of the internal sphincter, cancer could well be left behind. Likewise, on the very opposite end of the prostate, the external sphincter is intimately associated with the prostate. Prostate cancer commonly grows right up to the edge of the external sphincter. A great deal of patience, experience and surgical skill is required to remove the internal sphincter along with the prostate and all of the cancer, without damaging the external sphincter. Thus after radical prostate cancer surgery, men must totally depend on the external sphincter to prevent incontinence.

It also must be understood that there are circumstances in which a surgeon may perform seamless prostate surgery, yet the patient is incontinent after the surgery. In this scenario, it may be found that a man may either have had previously unrecognized damage to the external sphincter from prior surgery, radiation therapy, or the like, or he simply might no longer be able to voluntarily control the external sphincter because of advancing age. In either case, wetness results. Obviously, when an operation is performed on an organ located in such intimate association with structures which control urine outflow, incontinence will occur in a limited number of cases.

The surgeons at the urology center have performed hundreds of radical prostate cancer surgeries with results on level with those of any urology group anywhere.

The surgeons at the urology center have performed hundreds of radical prostate cancer surgeries with results on level with those of any urology group anywhere. Experience shows that while younger men recovery urine control almost immediately, recovery in older patients occurs much more slowly. In some cases, it may take several months for older men to recover urine control. Very rarely, patients require additional surgical treatment for incontinence. No curative surgical or non-surgical prostate cancer treatment is entirely free of risk of incontinence. While SUI occurs more commonly after surgery, it also may occur after other forms of prostate and bladder treatment including radiation therapy and cryotherapy. No treatment is risk free.

SUI in men may be treated with medication, exercises, behavioral techniques, biofeedback training and surgery. Surgical treatments are reserved for severe cases. This treatment may entail cystoscopy with injection of a bulking agents such as collagen within the walls of the urethra. Injection of collagen through a cystoscope may be performed but in men this treatment is often ineffective. Formal surgical repair is generally needed. Pubourethral sling surgery is an effective alternative. However, the most effective way to manage postoperative stress urinary incontinence in men having undergone prostate cancer surgery is placement of an artificial urinary sphincter (AUS).

... the most effective way to manage postoperative stress urinary incontinence ... an artificial urinary sphincter (AUS).

The AUS involves placement of a tiny donut-like fluid filled cuff device around the urethra. The cuff is connected to a tiny pump located within the scrotum. By squeezing the pump several times, fluid is transferred from the cuff to a fluid reservoir deflating the cuff, thereby allowing the urine to pass through the urethra. Normal voiding of urine results. Fluid then automatically refills the cuff, occluding the urethra, preventing unwanted urine leakage. The results of the AUS procedure are excellent, with most patients reporting complete dryness or drastic improvement. Patients report very high satisfaction rates. The AUS does not interfere with penile erections. Furthermore, the AUS is completely concealed beneath the skin. The device cannot be seen by anyone, even when patients disrobe. The surgeons at the Urology Center are experienced with placement of the AUS device. However, most of the patients for whom we have placed the AUS had their prostate surgeries performed elsewhere. We are very happy that we do not commonly have patients who require this surgery.

Urge type urinary incontinence (UUI) is very common in men ...

Urge type urinary incontinence (UUI) is very common in men, resulting from bladder contractions which occur unpredictably. The unpredictable bladder contractions result in the involuntary loss of urine associated with a sudden and strong desire to urinate. A slight urge is often noticed after which a strong uncontrollable urge to urinate occurs, commonly on the way to the bathroom. While most cases of UUI are rather benign, sudden bladder contractions can be a sign of neurogenic bladder disease, a serious medical condition (described above). For this reason and others, a urologist specializing in urinary incontinence evaluation and treatment is needed for the accurate characterization and treatment of urge type urinary incontinence.

In men UUI is commonly associated with prostate enlargement and slowing of the urine stream.

In men UUI is commonly associated with prostate enlargement and slowing of the urine stream. Experts believe that the urinary urge feeling represents an abnormal reaction of the bladder to blockage of urine outflow because of an enlarged prostate. This association of UUI with prostate problems in men makes treatment very challenging and potentially complicated. In these cases, some men can become completely unable to urinate after receiving medications such as Ditropan or Detrol. In other situations, these medications would be standard treatments for UUI. Under these circumstances, a very thorough urology evaluation must be performed before medications are prescribed. The good news is that, except in complicated circumstances, most cases of UUI may be completely controlled using medications, exercises and behavioral techniques.

Ditropan XL is a relatively new preparation of oxybutanine, a medication designed to help control overactive bladder symptoms and UUI. The XL preparation of the drug is very different from the generic form, which is much less preferred. Detrol LA (tolteradine) is another medication which is commonly used. The Ditropan XL preparation of oxybutanine and Detrol are generally very effective with few side effects. However, these medications must be combined with additional behavioral treatments as directed by the urologist. Otherwise the medication will be much less effective.

Failure ... to thoroughly educate patients concerning ... Ditropan is a common cause of ineffective treatment.

Failure on the part of physicians and nurses to thoroughly educate patients concerning the required dietary, exercise and behavioral changes necessary to the proper use of Ditropan and Detrol is a common cause of ineffective treatment. These medications are not useful for the treatment of pure stress urinary incontinence.

All medications have potential side effects and some medications should not be taken with others or should not be taken with certain medical conditions. Ditropan and Detrol should not be used in patients with uncontrolled narrow angle glaucoma and certain other conditions. Ditropan and Detrol should be used with caution in patients with gastroesophageal reflux. Additionally, Ditropan XL may be more effective than Detrol in patients simultaneously using antacids.

Biofeedback is a very effective method [of pelvic floor muscular retraining for bladder control]. Doctors at the Urology Center have used this treatment for years with excellent results.

Biofeedback is a very effective method by which the bladder and muscles of the pelvic floor are retrained to stop or reduced urinary wetness (incontinence) and to promote urinary dryness (continence). Doctors at the Urology Center have used this treatment for years with excellent results. It is most effective for men with UUI. Using various sensors such as patches on the skin, rectal inserts or tiny catheters, patients may view the results of their efforts to isolate pelvic floor muscles on a video monitor, such that they receive (bio)feedback of their efforts. This provides direct and immediate confirmation to patients of appropriate, as well as inappropriate, muscle training so that they may focus on correctly performing the bladder and pelvic floor retraining. This may speed the process of becoming dry.

... very difficult cases of overactive bladder symptoms or bladder/spinal cord neurological problems sometimes require InterStim neuromodulation treatment ...

Patients with very difficult cases of overactive bladder symptoms or neurological problems sometimes require neuromodulation treatment, which includes implantation of a small device which sends electrical signals to the spinal cord. The currently available implant is called an InterStim device. The electrical signals generated by the Interstim device produce a quieting effect on the bladder, allowing patients who use it to store a greater volume of urine for longer period of time without leaking urine. The device allows incontinent patients to become dry in some cases.

Interstim neuromodulation is only used in the more severe cases. Each patient may first undergo a test stimulation so that he may learn how well he may expect the device to work, once it is permanently implanted. If he likes the results, he may then undergo the outpatient implantation procedure and anticipate good results.

Long-term use of indwelling urethral Foley catheters should be the very last resort ...

A particular situation deserves special mention concerning the common use of indwelling urinary "Foley" catheters in severely mentally or physically handicapped patients who reside primarily in nursing homes. Long-term indwelling urethral Foley catheters are commonly used to treat urinary incontinence in bedridden patients who depend upon others for care. The use of Foley catheters in this way is associated with recurrent urinary tract infections, bladder stones, abscess formation, trauma to the urethra and tearing of the opening at the end of the penis. Demented or confused patients very commonly pull on the catheters, sometimes causing themselves severe trauma. Long-term use of indwelling urethral Foley catheters should be the very last resort, perhaps reserved for terminally ill patients. Almost any other method of incontinence management is preferable. Foley type urethral catheters are designed for short-term use only. A urologist specializing in urinary incontinence evaluation and treatment is the most qualified medical professional for the accurate characterization and treatment of all forms of urinary incontinence. Before men resign themselves to the use of a long-term indwelling urethral Foley catheter, urological consultation is in order.

... incontinence certainly is not an inevitable part of life, even after prostate cancer surgery.

In many cases incontinence becomes more prominent and more severe with aging. However, incontinence certainly is not an inevitable part of life, even after prostate cancer surgery. That is, unwanted urinary leakage is not at all a natural part of aging! Besides, most would agree that any age is "too young" to have such an annoying and frustrating problem, especially when effective treatment is so readily available.

Noninvasive or minimally invasive treatments such as collagen injection are now routinely available and relatively new FDA approved medications have proven safe and effective. Artificial urinary sphincter surgery is the time tested mainstay treatment for severe male stress urinary incontinence. However, new male sling surgery has proven safe and effective. Treatment success rates are now higher than ever.

There is no reason that anyone should have to live with pads, diapers, odor and wetness.

Now more than ever, men with urinary incontinence have more options. There is no reason that anyone should have to live with pads, diapers, odor and wetness. A urologist specializing in urinary incontinence evaluation and treatment is the most qualified medical professional for the accurate characterization and treatment of all forms of urinary incontinence. Effective treatment is readily available at the Urology Center and we welcome your questions.

(Please visit our Benign Prostate Enlargement Center of Excellence and Prostate Cancer Center of Excellence for information on related topics.)