EPIDEMIOLOGY
The epidemiology of urinary incontinence has been less studied in men compared to women. The prevalence of urinary incontinence in men ranges from 11 to 34 percent in men older than 65 years. Urinary incontinence rates increase with age. Using a definition of at least one urinary incontinence episode in the preceding 12 months among community-dwelling men, the prevalence increases from 4.8 percent in men age 19 to 44 years, to 11.2 percent age 45 to 64 years, to 21.1 percent older than 65 years. The prevalence of daily urinary incontinence is 2 to 11 percent in men older than 65 years. Prevalence of incontinence does not appear to vary by race or ethnicity.
RISK FACTORS
Advanced age
Prostate disease, particularly with a history of prostate surgery or radiation therapy
Neurological disease such as Multiple Sclerosis and Parkinson Disease
Diabetes
Sleep Apnoea
CLASSIFICATION OF INCONTINENCE
There are four major types of urinary incontinence associated with lower urinary tract dysfunction: urgency incontinence, stress incontinence, mixed incontinence, and incontinence due to incomplete bladder emptying.
Urgency incontinence — The mechanisms responsible for urgency incontinence are poorly understood, both in men and women. The etiology of urgency incontinence is partly related to uninhibited bladder contractions (also called detrusor overactivity). This may be due to a defect in afferent sensory signaling from the urinary tract, central processing of these signals, and/or detrusor muscle dysfunction.
Stress incontinence — Stress urinary incontinence in men is most commonly due to poor urethral sphincter function. Prostate surgery is the most common cause of stress urinary incontinence in men. It can also occur in those who have had pelvic trauma or a neurologic disorder (eg, traumatic spinal cord injury, spina bifida). The two most frequently performed prostate surgeries leading to stress incontinence are transurethral resection of the prostate (TURP) and radical prostatectomy. TURP involves the resection of obstructing prostate tissue using a cystoscope. Damage to the external urethral sphincter can occur during TURP, but this is uncommon; in contemporary series, reported rates of urinary incontinence following TURP are <1 percent.
Radical prostatectomy is performed to treat prostate cancer. As the external urethral sphincter is closely approximated to the prostatic apex, this structure can be damaged during the surgical dissection. Following radical prostatectomy, it is common for men to initially experience stress incontinence. However, this typically improves or resolves over a course of 12 to 24 months. Up to 40 percent of men report some degree of long-term urinary incontinence after radical prostatectomy, but the majority of cases are mild and do not require treatment. The rate of persistent, bothersome urinary incontinence following radical prostatectomy is approximately 5 to 10 percent.
