- May 19, 2020
- Posted by: Prof Dr Coşkun Şahin
- Category: Urinary Incontinence
What is Urinary Incontinence in Men?
It is involuntary escape of urine. In other words, it refers to urine leakage that cannot be prevented outside the control of the person. Urinary incontinence in men differs slightly from women. Often the cause are past operations, dementia, and prostate barriers to urination.
What are the Symptoms of Urinary Incontinence in Men?
Urinary incontinence can be of different types.
Stress-type urinary incontinence: Coughing, laughing, sneezing, jumping, jumping, urine incontinence while walking up and down stairs. It is the most common type. It is seen at any age.
Urinary incontinence: The urge to urinate suddenly comes here and the person passes his urine before reaching the toilet. Generally, when entering the house from the street, the patients experience the feeling of sudden jamming at the door of the house.
Mix-type urinary incontinence: The above two types of incontinence are in the same patient
Total urinary incontinence: The patient does not understand that urine is coming. All urine escapes. Usually , the urine that accumulates in the night is
discharged suddenly when the patient leaves the bed.
What are the Causes of Urinary Incontinence in Men?
Previous surgeries (Prostate TUR, Laser surgeries)
Prostate cancer surgery called radical prostatectomy
Accidents, sphincter destruction
Urethral strictures, prostate enlargement
Dementia
Mental health is not in place
What are the risk factors for urinary incontinence in men?
Advanced Age: In aging patients, increased urination incontinence, urination (nocturia) and frequent urination (urgency) can be seen with incontinence; these occur as a result of weakening of the control mechanisms on the lower urinary system of the central nervous system due to aging.
Obesity: Increased intra-abdominal pressure due to overweight causes an increased risk of urinary incontinence. The frequency of such complaints can be reduced with weight loss.
Urethra and prostate surgery: The risk of urinary incontinence is low in prostate surgery. It is around 1-5%. This rate is higher in prostate cancer surgeries.
What happens if urinary incontinence is not treated in men?
These patients sometimes avoid shyness, sometimes trying to hide their illness, maybe going to the doctor for economic problems. They ban themselves from going out on the street. The smell of urine and the concern of the environment may impair them in a sense. It may be the case of turning into individuals who live alone socially.
What are the methods of examination in urinary incontinence in men?
The most important findings in these patients are obtained through detailed listening and answers to the questions asked. In the urological examination, the opening hole of the urine called urethral meatus is examined. If the bladder is filled on ultrasound, it is checked. If necessary, urinary tract is observed by cystoscopy. Are there any surgical wounds? In necessary cases, a test evaluating bladder pressures called urodynamics is performed.
How Is Urinary Incontinence Surgery For Men?
Artificial (Arterial) sphincter: It is more common in women than in women. The type of treatment that is placed around the urethra and should be considered as a tap, working with the control of the patient. It is quite successful. The surgery takes 2 hours. He is hospitalized for 1 day. It is started to be used after 4-6 weeks. Patient satisfaction is very high. All patients with whom we attach this sphincter are satisfied with their lives. These include even patients who do heavy work, such as farming, and continue their current work.
Artificial sphincter consists of 3 parts. The piece called cuff is wrapped around the urethra between the applique. The part called the reservoir is placed in front of the bladder, and the pump places the hand in a scrotum (bag) that the patient will use comfortably.
The location of the 3 parts of the artificial sphincter is in the visual. In artificial sphincter male urinary incontinence types, it is an effective treatment method especially for patients with daily incontinence more than 3-4 pets. Control of the instrument consisting of 3 parts is in the patient. When there is a feeling of voiding, it presses the button and after 3 minutes the system automatically turns itself off. No part of the tool is visible from the outside.
What are the Side Effects of Artificial Sphincter?
Side effects are extremely rare. Their acceptance by the patient’s body is over 90%. They are rare to remove due to infection. There is a weak possibility that the cuff that wraps around the urethra can injure the urethra. After years, there may be a partial decrease in effectiveness. In this case, there may be a need to replace the balloon or increase its volume.
Who Is Artificial Sphincter Attached To?
Artificial sphincter; It can be worn to any patient who wets more than 2 pads a day or who has completely missed his urine, has normal bladder capacity, and has mental and hand angels in place. These patients are generally those who have lost their ability to hold urine after prostate surgery or after pelvic surgery. In these patients, 1 year is expected. If they cannot hold their urine within 1 year, it will become impossible to hold them over time, and then these patients will be candidates for Artificial Sphincter surgery.
Who is not suitable for Artificial Sphincter Surgery?
It is not suitable for patients who have infections, do not use their hands, need someone else, have a small bladder capacity, and have severe urethral injury.
What is Patient Satisfaction After Artificial Sphincter Surgery?
After this surgery, patients start using the artificial sphincter from 6 weeks. 90% of patients remain completely dry, i.e. they keep their urine fully. Up to 10% can drip 1 pet per day. These devices are guaranteed by the company for 2 years, but can be used for years.
Are There Alternatives to Artificial Sphincter Surgery?
Various surgeries have been attempted for urine retention in men.
TOT Surgery: Son yıllarda en çok popüler olan ve sıklıkla yapılan bir ameliyattır. Amaç üretrayı yani idrar kanalını alttan bir hamak gibi kaldırmak ve sabitlemekten ibarettir. 15 dakikalık bir ameliyattır. Stres tipi idrar kaçırmada % 95 başarı şansı vardır. Total idrar kaçırmada da kullanılır. Bu hastalarda başarı % 50-70’e düşebilir
The passing of synthetic material under the urinary canal, which acts as a prolene mesh, as a lifter.
Urethral Compression Surgery: In this surgery, the back part of the urethra, which we call Bulbous Urethra, is fixed by a special synthetic material to the lower edges of the pelvis with nails. Although this surgery has a high chance of success at the beginning, it is low in the long run. It can be done in some selected patients. These patients are those who miss urine in a moderate mode of stress.
Synthetic Material (shown in white) compresses the urethra below the pelvis. Thus, it helps to keep urine.
Bulging materials: It can be applied in total types of urinary incontinence. The chance of success is low. Substances that are not absorbed into the bladder neck and urethra are injected by entering the contents from the urinary canal. However, this method cannot be said to be effective, so we almost do not use it today.
As seen in the photo, a kind of obstruction is created by inserting Filling Materials into the urethra or bladder neck through the urinary canal endoscopically. In this way, urine retention is helped.
Penis clamps: Mild urinary incontinence and those who do not think about surgery may be the solution.
Penis clamp. It prevents urinary incontinence by attaching to the penis.
