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Urinary incontinence in men

Key sources
The following summarized guidelines for the evaluation and management of urinary incontinence in men are prepared by our editorial team based on guidelines from the European Association of Urology (EAU 2022) and the American Urological Association (AUA/SUFU 2019; 2012).
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Guidelines

1.Diagnostic investigations

History and physical examination: elicit a complete medical history including symptoms and comorbidities, medications, and perform a focused physical examination in the evaluation of male patients with urinary incontinence.
A
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  • Assessment of PVR

  • Urodynamic testing

  • Bladder EMG

2.Medical management

Antimuscarinic agents: offer antimuscarinic agents or mirabegron in adult patients with urge urinary incontinence failed conservative treatment.
A

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  • Duloxetine

3.Nonpharmacologic interventions

Lifestyle modifications: offer lifestyle modifications for improving urinary incontinence, although evidence is lacking.
B

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  • Incontinence pads

  • Bladder training

  • Prompted voiding

4.Therapeutic procedures

Intravesical injection of botulinum toxin
Offer bladder wall injections of onabotulinumtoxin A (100 U) in patients with overactive bladder/urge urinary incontinence refractory to medical therapy.
B
Inform patients about the limited duration of response, risk of UTI, and possible prolonged need for clean intermittent self-catheterization (ensure that they are willing and able to do so).
A

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  • Sacral nerve stimulation

  • Artificial urinary sphincter

  • Noncircumferential compression device

5.Surgical interventions

Augmentation cystoplasty
Offer augmentation cystoplasty in patients with overactive bladder/urge urinary incontinence refractory to all other treatment options and able and willing to perform self-catheterization.
B
Inform patients undergoing augmentation cystoplasty of the high risk of complications, the risk of having to perform clean intermittent self-catheterization, and the need for life-long surveillance.
A

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  • Urinary diversion

6.Specific circumstances

Patients undergone prostatectomy, preoperative counseling: counsel patients undergoing radical prostatectomy regarding the following:
all known factors that could affect continence
B
risk of sexual arousal incontinence and climacturia
B
expected incontinence in the short-term that generally improves to near baseline by 12 months after surgery but may persist and require treatment.
A

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  • Patients undergone prostatectomy (evaluation)

  • Patients undergone prostatectomy (pelvic floor muscle training)

  • Patients undergone prostatectomy (transobturator slings)

  • Patients undergone prostatectomy (artificial urinary sphincter)

  • Patients undergone prostatectomy (noncircumferential compression device)

  • Patients undergone prostatectomy (periurethral injection of bulking agents)

  • Patients undergone prostatectomy (surgery)

  • Patients undergone prostatectomy (management of persistent/recurrent incontinence)

  • Patients undergone prostatectomy (management of erectile dysfunction)