Pharmacotherapy of Male Incontinence

Abstract

According to EAU Guidelines on Urinary Incontinence [1] , the clinical presentations of men with symptoms and history of urinary incontinence may be grouped into four subdivisions: postmicturition dribbling, postprostatectomy incontinence, incontinence with frequency/urgency, and incontinence with a complex history (Fig. 29.1) Postprostatectomy incontinence and incontinence with urgency/frequency are symptoms that are suggestive of stress urinary incontinence (SUI), urgency urinary incontinence (UUI), mixed incontinence, and “overflow” incontinence. The etiology of these conditions mainly is sphincteric incompetence, detrusor overactivity, bladder outlet obstruction (BOO), or detrusor underactivity . Prevalence estimates of these subtypes vary somewhat. The predominant type of urinary incontinence in men is UUI, while in women it is SUI. The distribution in men is 73% UUI, 19% mixed, and only 8% SUI, as opposed to women where 49% of all cases are SUI [3] . Because UI may cause social isolation, loss of sexual function, or other psychosocial problems [4, 5] , it could have significant impact on patients' psychosocial well-being and quality of life (QOL). Studies have shown that patients suffering with UI are more depressed [6, 7] , psychologically distressed, emotionally disturbed, and socially isolated [8] . Moreover, compared with continent individuals, those patients with UI also have higher levels of anxiety, lower QOL, and poorer life satisfaction [7] . The severity of UI also is correlated with degrees of mental distress, social restrictions, and restricted activities [4, 5] . As a result, UI has an adverse effect on patients' daily lives and could become a barrier for normal social function. Current treatments for UI include behavioral (e.g., bladder training, fluid manipulation, scheduled toileting, pelvic muscle exercises), pharmacological , and surgical interventions, used either alone or in combination [9– 11] . Behavioral techniques currently are recommended as first-line therapy in the treatment of UI except for overflow incontinence due to BOO. Behavioral interventions usually are relatively inexpensive and easy to implement, but the effectiveness chiefly depends on the patient's adherence [12] . When nonpharmacological interventions have failed, drug therapy can be an option [9] . The goal of this chapter is to present the current status in pharmacotherapy options of male UI by looking into the four main subtypes of male incontinence: urgency, stress, overflow, and postprostatectomy UI.