Introduction
Male urinary incontinence is caused by urethra sphincter and/or bladder dysfunction, and is usually divided into stress urinary incontinence (SUI), urgency 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. With the widespread development of radical prostatectomy (RP) in China, male SUI has shown an upward trend, but domestic urologists have not yet understood this disease in depth enough, resulting in some patients not being promptly and effectively diagnosed and treated. The urinary control group of the Chinese Medical Association’s Urology Branch has formulated this expert consensus to standardize the diagnosis and treatment of male SUI and improve my country’s diagnosis and treatment level in this field.
Diagnosis and evaluation of
male SUI includes medical history collection, physical examination , urine analysis, residual urine measurement, urinary diary, urinary incontinence scale, urine pad test, urinary flow rate determination, urinary kinetics, cystoscopy and imaging examination.
treatment
treatment principle first choose conservative treatment , especially pelvic floor muscle training. It is recommended that surgical treatment be considered after 6 to 12 months of treatment if the effect is not good. For some patients with mixed urinary incontinence, anticholinergic and/or β3 receptor agonists, botulinum toxin type A injection, sacral neuromodulation, or bladder enlargement are first used to decide whether to perform anti-urinary incontinence surgery based on the results. For patients with low detrusor contraction, the degree of SUI and residual urine volume should be weighed to decide whether to perform anti-urinary incontinence surgery first, and then use intermittent catheterization and other methods to empty the bladder; or use intermittent catheterization and other methods to empty the bladder, and then decide whether to perform anti-urinary incontinence surgery based on the results. For patients with urethral stenosis, urethral stenosis can be dilated or surgically treated first, and anti-urinary incontinence surgery can be performed after the urethral stenosis is improved and stabilized.
Conservative treatment of
Partial prostate postoperative urinary incontinence (PPI) patients will improve with the prolonged postoperative time. Conservative treatment includes interventions in lifestyles, such as regular urination, controlling fluid intake, and reducing intake of foods that are irritating to the bladder (coffee, alcohol and spicy foods).
Bladder training and regular urination are recommended for patients with urination frequency . Intermittent catheterization can be used for patients with bladder emptying disorders or hypoactive bladder detrusor muscles. Patients with mild-to-moderate SUI can undergo pelvic floor muscle training (such as Kegel training) to improve urine control ability by increasing pelvic floor muscle strength. Preventive pelvic floor muscle training before RP can reduce the severity of postoperative urinary incontinence and accelerate the recovery of early urinary control function. Pelvic floor muscle training in the early postoperative period (immediately after catheter is removed) can also help restore urine control function. Pelvic floor muscle training is still effective in some patients whose postoperative urinary incontinence lasts for more than one year. Pelvic floor muscle training is recommended to combine biofeedback and electrical stimulation therapy to enable patients to exercise more scientifically and effectively. Currently, the drug treatment of SUI in men is not effective.
surgical treatment
local injection filler around the urethra is effective in some patients in the short term, but the long-term effect is not good. The implantation device through surgical procedures remains the main therapy, with the most common treatments being artificial urethral sphincter (AUS) implantation and male slings. It is generally believed that male sling surgery is suitable for mild-to-moderate male SUI patients who have ineffective conservative treatment, and AUS implantation is suitable for moderate-to-severe male SUI patients; the effect of AUS implantation in patients with moderate urinary incontinence is better than male sling surgery. It should be noted that bladder function must be clarified before implantation, such as bladder capacity, compliance, contractility and detrusor-sphincter coordination. The time for surgical intervention is generally recommended 12 months after SUI occurs.
Long-term management and follow-up
male SUI long-term management and follow-up mainly includes monitoring efficacy, quality of life assessment and postoperative complication management. Conservative treatment was evaluated for at least 4 to 8 weeks, followed by follow-up once in the 6th and 12th months, and followed once every 12 months thereafter.Surgical treatment is recommended to conduct at least one follow-up within 4 to 6 weeks after surgery, mainly to understand the efficacy of the surgery and recent postoperative complications. Follow-up once every 3rd, 6th and 12 months after surgery, and follow-up once every 12 months thereafter. Follow-up content is determined based on the individual patient's condition (see Diagnosis and Evaluation). During follow-up, attention should be paid to adverse reactions and whether the quality of life is improved, such as urine control status, whether dysuria , whether the device is used normally, and whether there is urinary tract infection, urethra atrophy/erosion, scrotal pain or numbness, wound infection, etc.
consensus recommendation points:
1. Treatment principles: ① Conservative treatment is preferred, especially pelvic floor muscle training. If the effect is not good after 6 to 12 months of treatment, surgical treatment will be considered. ② Pelvic floor muscle training can be combined with therapies such as biofeedback and electrical stimulation. ③ The effect of drug treatment of male SUI is not good.
2. Urethral filler injection treatment is generally suitable for patients with mild SUI and cannot tolerate major surgery. At present, there is no mature and available urethral filler material in mainland my country.
3. Male urethral sling surgery is suitable for mild-to-moderate male SUI patients. Chinese surgeons mostly use intraoperative cut suspenders, and their effectiveness and safety are under study and observation.
4.AUS implantation is suitable for SUI in moderate to severe men. It has a high level of evidence-based medical evidence and is highly recommended.
Reference
Urine control group of the Chinese Medical Association Urology Branch. Chinese Expert Consensus on Diagnosis and Treatment of Stress Urinary Incontinence in Men [J]. Chinese Journal of Urology, 2022, 43 (9): 641-645.
