Urinary Incontinence in Men

Assessment and management of male urinary incontinence, including post-prostatectomy incontinence

Note: This condition is often managed initially by a GP or other specialist. Dr Hadjipavlou accepts both GP referrals and self-referrals for complex or specialist cases. Please contact the secretary to discuss whether an appointment is appropriate.

Overview

Urinary incontinence — the involuntary leakage of urine — affects a significant number of men, and its causes, assessment, and management differ from those in women. It has a considerable impact on quality of life, causing embarrassment, social withdrawal, and interference with activities and work.

In men, urinary incontinence is classified by mechanism:

Stress urinary incontinence (SUI) Leakage that occurs with physical exertion — coughing, sneezing, lifting, exercise, or even simply standing. It results from weakness or damage to the urethral sphincter mechanism, most commonly following radical prostatectomy (surgical removal of the prostate for cancer), but also after other pelvic surgery or radiotherapy.

Urge urinary incontinence (UUI) Leakage associated with a sudden, intense urge to urinate that cannot be deferred in time. It is caused by overactivity of the detrusor (bladder wall) muscle — overactive bladder (OAB). It is managed primarily with lifestyle changes and medication (see overactive bladder section).

Overflow incontinence Continuous or intermittent leakage that occurs when the bladder is overfull and cannot empty. It is caused by bladder outlet obstruction (most commonly BPH) or impaired detrusor contractility (neurogenic bladder). Incomplete bladder emptying allows the bladder to reach capacity, and urine leaks around the obstruction.

Mixed incontinence A combination of stress and urge components, which is common.

Symptoms

The pattern of leakage provides diagnostic clues:

Leakage on coughing, sneezing, or exertion — stress incontinence
Leakage preceded by a sudden, strong urge — urge incontinence
Continuous dribbling or leakage without sensation — overflow incontinence
Post-void dribbling — small amounts of urine leaking after the main void, common and usually due to pooling of urine in the bulbar urethra rather than true incontinence

Assessment includes a bladder diary — a record of fluid intake, voiding times, and leakage episodes — which provides objective information to guide management.

Diagnosis

History and bladder diary — characterises the type and severity of incontinence
Urine dipstick and culture — to exclude infection
Uroflowmetry and post-void residual ultrasound — assesses voiding function and excludes overflow incontinence
Pad weight test — quantifies urine loss over 24 hours; useful for assessing severity and monitoring treatment response
Urodynamics — detailed study of bladder and urethral function; performed when the diagnosis is uncertain or when surgical treatment is planned; includes filling cystometry and pressure-flow studies
Flexible cystoscopy — to assess the urethra and bladder neck, particularly when previous prostate surgery or radiotherapy has been performed

Treatment

Conservative treatment

Pelvic floor muscle training (PFMT) — supervised physiotherapy with a specialist pelvic health physiotherapist; should be commenced promptly after prostatectomy and continued consistently for at least three to six months; significantly improves continence outcomes
Lifestyle advice — fluid management, reducing caffeine and alcohol, weight management
Containment products — pads or sheaths (penile sheaths connected to a leg bag) to manage leakage while awaiting improvement or treatment

Pharmacological treatment

Antimuscarinic drugs or mirabegron for the urge component of mixed incontinence
Alpha-blockers or 5-ARIs for overflow incontinence secondary to BPH

Surgical treatment Surgical intervention is considered when conservative management over six to twelve months has not provided adequate improvement:

Male urethral sling — suitable for mild to moderate SUI; a synthetic tape repositions the urethra to improve continence; day-case or overnight procedure
Artificial urinary sphincter (AUS) — the reference standard for moderate to severe male SUI; provides reliable, patient-controlled continence; implanted device with cuff, balloon, and scrotal pump; requires patient dexterity to operate

Dr Hadjipavlou sees men with post-prostatectomy incontinence and complex andrological incontinence for assessment and surgical management.

Frequently Asked Questions

: For most men, stress urinary incontinence after radical prostatectomy improves significantly in the months following surgery, particularly with structured pelvic floor physiotherapy. The majority of men regain satisfactory urinary control within six to twelve months. However, a proportion of men are left with persistent incontinence that does not resolve with conservative management alone, and these men may benefit from surgical treatment such as a male sling or an artificial urinary sphincter.
: A male urethral sling is a surgical procedure designed for men with mild to moderate stress urinary incontinence, most commonly after prostatectomy. A synthetic mesh tape is placed under the urethra through a small incision in the perineum (the area between the scrotum and the anus). The sling compresses and repositions the urethra to improve continence. It is a day-case or one-night-stay procedure and does not require a catheter to be managed by the patient.
: An artificial urinary sphincter (AUS) is a surgically implanted device that recreates the function of the natural urinary sphincter. It consists of a cuff placed around the urethra, a pressure-regulating balloon in the abdomen, and a control pump in the scrotum. The patient squeezes the pump to open the cuff to allow urination. It is the most reliable surgical treatment for moderate to severe male stress urinary incontinence and is recommended when a sling is unlikely to provide adequate relief.

Need an assessment?

To arrange an appointment or discuss your situation, please contact the secretary.