Urinary Incontinence in Elderly Men: Update on Evaluation and Treatment

Abstract

To provide an overview of the appropriate evaluation of elderly men with urinary incontinence and an updated review of treatment options available to these patients. Adding pelvic floor physical therapy to bladder training exercises is more effective for treating overactive bladder than bladder training alone. Beta-3 adrenergic agonists are a safe and effective alternative to anticholinergic therapy in older adults. Sacral neuromodulation is safe and effective in older adults and may benefit men with incomplete bladder emptying. A de-obstructing surgery may benefit men with both underactive bladder and bladder outlet obstruction, given that a majority will recover detrusor function following intervention. In post prostatectomy incontinence, the artificial urinary sphincter is more effective in men with moderate to severe incontinence, though it is associated with a higher rate of complications. Many options are available to the elderly male patient with urinary incontinence. Careful consideration of patient’s functional status, frailty, mental health status, and social support systems are needed to guide the appropriate treatment options.