Male Urinary Incontinence

Male urinary incontinence can occur following surgery or radiation therapy on the prostate and bladder, neurovascular disorders and aging process.

 

PHYSIOLOGY OF BLADDER FUNCTION

Normal bladder filling depends on unique elastic properties of the bladder wall that allow it to increase in volume at a pressure lower than that of the bladder neck and urethra (otherwise urinary incontinence would occur). Despite provocative physical activities such as coughing and straining, voluntary bladder contractions should not occur and patient remains dry due to underlying normal urinary sphincter muscle.

 

THE TYPES OF URINARY INCONTINENCE

  1. Stress urinary incontinence:
    – Leakage of urine during physical movement (coughing, exercising).
    – Usually occurs following prostate surgery (such as radical prostatectomy, TURP).

  2. Urge urinary incontinence:
    – Leakage of urine at unexpected times, including during sleep.
    – This can be associated with feeling of urgency and frequency resulting in untimely urination.
    – Usually occurs following neurological conditions (such as stroke, Parkinson disease), enlarged prostate gland or post-radiation therapy.
    – Sometimes the condition occurs without any obvious cause (termed idiopathic).

  3. Overflow urinary incontinence:
    – Unexpected leakage of urine because of a full bladder.
    – Usually occurs in bladder outlet obstruction or post-radiotherapy.

  4. Mixed urinary incontinence:
    – Usually the occurrence of stress and urge incontinence together.

Men are less likely to experience less urinary incontinence than women due to anatomical (longer urethra and presence of prostate gland) and physiological differences. But both women and men develop urinary incontinence following neurological conditions (strokes, Parkinson disease and multiple sclerosis) and physical problems associated with aging. Stress urinary incontinence in men is predominantly due to prostate surgery either following endoscopic surgery for benign prostatic growth or radical surgery or radiation therapy for malignant prostate cancer.

Special test such as uroflow and urodynamics studies can provide further information on your bladder function and bladder outflow. Cystoscopy examination will rule out any stricture disease and assess prostate size.

Professor Chung holds the Chair of Male Lower Urinary Tract section for the Urological Society of Australia and New Zealand. He has published extensively on various male urinary and prostate conditions (see below) and is considered the leading surgeon expert in Australia and Asia-Pacific. He is the only surgeon in Australia invited to serve on working group on the male sexual health, lower urinary tract and pelvic floor dysfunction at the International Continence Society, and committee member of the male surgery for urinary incontinence at the International Consultation on Incontinence. He has mentored many surgeons over the years including being invited as surgeon expert and organised numerous surgical workshops around the world.

Treatment options

There are a wide variety of aids and equipments for collecting urine, preventing infection and protecting the skin and surrounding area. Pelvic floor exercise, bladder retraining and timed voiding, are a number of exercises that can be done to strengthen the urinary sphincter muscle and improve your continence level. Medications such as anti-cholinergic can decrease the urgency and urge incontinent episodes but can result in common side effects include dry mouth and eyes and constipation.

Surgery for urinary incontinence depends on the types of incontinence. For patients with stress urinary incontinence, urinary slings or artificial urinary sphincter is very safe effective. In medically-refractory urgency and urge incontinence, bladder injection of botox and implantation of sacral neuromodulation device can provide significant improvement in your condition. Patients with overflow incontinence can have either TURP (if it is prostate enlargement and obstruction) or urethroplasty (removal of strictured segments of urethra).

Some of the key articles published by Professor Chung on BPH

  • Chung E. Artificial urinary sphincter surgery in the special populations: neurological, revision, concurrent penile prosthesis and female stress urinary incontinence groups. Asian J Androl. 2020;22(1):45-50
  • Chung E, Ng BHS, Wang J, Can malleable penile prosthesis implantation improve voiding dysfunction in men with concurrent erectile dysfunction and buried penis? Investig Clin Urol. 2021;62(3):305-309
  • Gani J, Hennessey DB, Hoag N, Lee D, Chung E. A pilot study of autologous rectus fascial wrap at the time of artificial urinary sphincter placement in patients at risk of cuff erosion. Int Urol Nephrol. 2020;52(5):851-57
  • Chung E, Lee D, Gani J, Gillman M, Maher C, Brennan J, Johns Putra L, Ahmad L, Chan L. Position statement: a clinical approach to the management of adult non-neurogenic overactive bladder. Med J Australia 2018;208(1):41-45
  • Chung E. Contemporary surgical devices for male stress urinary incontinence: a review of technological advances in current continence surgery. Trans Androl Urol. 2017;6(Suppl 2):S112-S121
  • Chung E, Katz DJ, Love C. Adult male stress and urge urinary incontinence- A review of pathophysiology and treatment strategies for voiding dysfunction in men. Aust Fam Physician. 2017;46(9):611-666
  • Chung E, Smith P, Malone G and Cartmill R. Adjustable versus non-adjustable male sling for post-prostatectomy urinary incontinence: A prospective clinical trial comparing patient choice, clinical outcomes and satisfaction rate with a minimum follow up of 24 months. Neurourol Urodyn. 2016;35(4):482-6
  • Katz DJ, Love CJ, Chung E. Lower urinary tract symptoms and benign prostatic hyperplasia: old problems, new solutions. Medicine Today. 2016;17(11):14-25
  • Chung E. Stem-cell-based therapy in the file of urology: A review of stem cell basic science, clinical applications and future directions in the treatment of various sexual and urinary conditions. Expert Opin Biol Ther. 2015;15(11):1623-32
  • Chung E. Underactive bladder and detrusor underactivity: A review of pathophysiology and management strategies for this poorly understood bladder syndrome. Curr Bladder Dysfunct. Rep. 2014;9(3):250-53
  • Chung E. A state of art review on the evolution of the urinary sphincter devices for the treatment of post-prostatectomy urinary incontinence: Past, present and future innovations. J Med Eng Technol. 2014;38(6):328-32
  • Chung E and Cartmill R. Diagnostic challenges in the evaluation of persistent or recurrent urinary incontinence after artificial urinary sphincter (AUS) implantation in patients after prostatectomy. BJU Int. 2013;112( Suppl 2):32-35
  • Chung E, Ranaweera M and Cartmill R. Newer and novel artificial urinary sphincters (AUS): The development of alternatives to the current AUS device. BJU Int. 2012;110(suppl4):5-11
  • Chung E. Post-prostatectomy stress urinary incontinence: Pathophysiology and diagnosis. In: Urinary Incontinence: Causes, Epidemiology and Treatment. Nova Science Publishers, Inc, NY
  • Chung E. Surgical treatment for male stress urinary incontinence. In: Urinary Incontinence: Causes, Epidemiology and Treatment. Nova Science Publishers, Inc, NY