Both male and female patients suffer from involuntary loss of urine. Incontinence is divided into stress incontinence, which is due to pelvic floor weakness, loss of support of the perineal fascial structures and movement of the urethral structural support system, as well as disconnection from the central perineal tendon/body.
Pelvic floor/stress incontinence leads to involuntary loss of urine, without a sensation of urgency. In the male setting, it is typically seen after radical prostatectomy, where the prostate is removed for cancer. Post-prostatectomy male incontinence we tend to observe and manage expectantly for the first 18-24 months, and if there is ongoing problemmatic significant loss of urine with heavily soaked incontinence pads at this 2 year stage, the patient undergoes further investigation by way of voiding charts, as well as cystoscopy, ultrasound and formal urodynamics. In the absence of bladder instability or overactivity, the patient may be a candidate for an artificial urinary sphincter (AUS), which is a permanent cuff and pump system, to allow the return of a dry and continent state.
The other form of incontinence is urge urinary incontinence, where there is random and unexpected involuntary loss of urine that is associated with an intense random urgency. This relates to instability and overactivity of the bladder muscle and does not have and aetiology related to pelvic floor weakness.
Urodynamics are used as part of the assessment here. Oral medications can be trialled, as can patch transdermal systems. Botox intravesical injections can also be used to temporarily reduce detrusor bladder muscle overactivity. Botox injections into the bladder last for six to eight months and then typically need to be repeated.
In certain male patients with significant prostatic enlargement, there can be a secondary effect on the bladder muscle, causing it to become unstable. Long periods of increased bladder wall tension, as the bladder tries to overcome prostatic overflow obstruction, leads to bladder instability. The management of this condition is more complex.
Overall, a full assessment would be required by your Urologist, prior to any therapy being considered.