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Guide
Male urinary incontinence is caused by urinary sphincter and/or bladder dysfunction caused by involuntary leakage of urine from the urethra, usually divided into stress urinary incontinence (SUI), urge urinary incontinence, filling urinary incontinence
, etc 。 The etiology and pathophysiological mechanism of male urinary incontinence are very complex, resulting in many difficulties in the diagnosis and treatment of SUI, and with the widespread development of radical prostatectomy (RP) in China, male SUI shows an upward trend, but domestic urologists have not understood this disease deeply enough, resulting in some patients not being diagnosed and treated
in a timely and effective manner.
The Urology Group of the Urology Branch of the Chinese Medical Association formulated this expert consensus to standardize the diagnosis and treatment of male SUI and improve the diagnosis and treatment level
in this field in China.
Evaluation of SUI in men includes history, physical examination, urinalysis, residual urine output, urinal diary, urinary incontinence scale, urine pad test, urine flow rate measurement, urodynamic studies, cystoscopy, and imaging
.
The principle of treatment is conservative treatment, especially pelvic floor muscle training, it is recommended to consider surgical treatment after 6~12 months of treatment
, if the effect is not good.
For some patients with mixed urinary incontinence, anticholinergic and/or beta-3 agonists, botulinum toxin injection of bladder type A, sacral neuromodulation, or bladder enlargement are used first, and antiincontinence surgery
is decided based on the outcome.
For patients with low detrusor contractility, the degree of SUI and residual urine volume should be weighed to decide whether to perform anti-incontinence surgery first, and then use intermittent catheterization to empty the bladder according to the results; It is better to use intermittent catheterization and other methods to empty the bladder first, and then decide whether to do anti-incontinence surgery
according to the results.
For patients with urethral strictures, urethral stricture dilation or surgery can be performed first, and antiincontinence surgery
can be performed after urethral stricture improves and stabilizes.
Conservative treatment
Some patients with urinary incontinence (PPI) after prostate surgery have SUI symptoms that improve
with prolonged postoperative time.
Conservative management includes lifestyle interventions such as regular urination, fluid control and reduced intake of bladder-irritating foods (coffee, alcohol, and spicy foods
).
Bladder training and timed urination are recommended for patients with frequent urination
.
Intermittent catheterization may be used to empty the bladder in patients with bladder
emptying disorders or low detrusor activity.
Patients with mild-to-moderate SUI may undergo pelvic floor muscle training (e.
g.
, Kegel training) to improve urinary continence
by increasing pelvic floor muscle strength.
Prophylactic pelvic floor muscle training before RP can reduce the severity of postoperative urinary incontinence and accelerate early recovery
of urinary control function.
Pelvic floor muscle training in the early postoperative period (immediately after urinary catheter removal) can also help with the recovery
of continence.
Pelvic floor muscle training is still effective
in some patients with postoperative urinary incontinence lasting more than 1 year.
It is recommended that pelvic floor muscle training combined with biofeedback and electrical stimulation can make patients exercise
more scientifically and effectively.
The current drug treatment for male SUI is not effective
.
Surgical treatment
Topical fillers around the urethra are effective in some patients in the short term, but are not effective
in the long term.
Device implantation by surgery remains the mainstay of treatment, with the most common treatments being artificial urethral sphincter (AUS) implantation and male sling
.
It is generally believed that male sling surgery is suitable for patients with mild-moderate male SUI who do not respond to conservative treatment, and AUS implantation is suitable for patients with moderate-severe male SUI.
AUS implantation is more effective than male sling
in patients with moderate urinary incontinence.
It is important to note that bladder function such as bladder capacity, compliance, contractility, and detrusor-sphincter coordination must
be defined prior to implantation.
Surgical intervention is generally recommended 12 months after
SUI occurs.
Long-term management and follow-up of male SUI mainly include monitoring efficacy, quality of life assessment, and postoperative complications management
.
The efficacy was evaluated after at least 4~8 weeks of conservative treatment, followed up once in the 6th and 12th months, and once every 12 months thereafter
.
Surgical treatment is recommended to be followed up at least once within 4~6 weeks after surgery, mainly to understand the efficacy of surgery and recent postoperative complications, and to follow up once in the 3rd, 6th and 12th months after surgery, and once every 12 months thereafter
.
Follow-up is determined on an individual basis (see Diagnosis and Evaluation).
Follow-up should focus on adverse effects and improvements in quality of life, such as continence, dysuria, normal use of the device, urinary tract infection, urethral atrophy/erosion, scrotal pain or numbness, wound infection, etc
.
Key points of consensus recommendation:
1.
Treatment principles: (1) Conservative treatment is preferred, especially pelvic floor muscle training, and if the effect is not good after 6~12 months of treatment, surgical treatment
will be considered.
(2) Pelvic floor muscle training can be used
in combination with therapies such as biofeedback and electrical stimulation.
(3) The effect of drug treatment for male SUI is not good
.2.
Urethral filler injection treatment is generally suitable for patients with mild SUI and cannot tolerate major surgery, and there is currently no mature and usable urethral filler material
in mainland China.3.
Male urethral sling is suitable for mild to moderate male SUI patients, and Chinese surgeons mostly use intraoperative cut slings, and its effectiveness and safety are being studied and observed
.4
.
AUS implantation is suitable for SUI in men with moderate to severe disease, and the level of evidence-based medical evidence is high, which is highly recommended.
References
Urology Group, Urology Branch of Chinese Medical Association.
Chinese expert consensus on the diagnosis and treatment of male stress urinary incontinence[J].
Chinese Journal of Urology,2022,43(9):641-645.
)
