Living with Urinary Incontinence in Men

Urinary incontinence in men is often a difficult and embarrassing topic to discuss. Many men put off seeing a doctor, thinking, “I’m getting older—it’s normal.” However, this condition seriously affects their quality of life:

The need to use pads constantly
Avoiding social situations
Restrictions on sports, travel, and work
Loss of self-confidence

At this point, Prof. Dr. Volkan İzol offers his patients the following assurance:

“Urinary incontinence is a common problem among men, but it is not inevitable. With the right diagnosis and modern treatment methods, most patients can become completely dry.”

In this article, you’ll find everything from the causes of male urinary incontinence to its diagnosis and treatment, as well as surgical
options.

Causes of Urinary Incontinence in Men

Urinary incontinence in men is not caused by a single factor. The most common causes are as follows:

Sphincter Insufficiency After Prostate Surgery: Permanent incontinence develops in 5–10% of patients following radical prostatectomy.
Overactive Bladder: Sudden urgency and inability to reach the restroom in time.
Neurological Disorders: MS, Parkinson’s disease, spinal cord injuries.
Age-Related Decline in Muscle Strength: The sphincter muscle weakens.
Overflow Incontinence: Incomplete emptying of the bladder due to an enlarged prostate, leading to overflow.
Risk factors: advanced age, diabetes, history of prostate or bladder surgery, history of radiation therapy.

Types of Urinary Incontinence in Men

1. Stress Incontinence
Urine leaks when coughing, sneezing, or lifting heavy objects. This is the most common type following prostate surgery.

2. Urge Incontinence
A sudden urge to urinate and leakage before reaching the restroom. The bladder muscle is overactive.

3. Mixed Type
Symptoms of both stress and compression types are present together.

4. Overflow Type
Because the bladder cannot empty completely, urine leaks out continuously. This is usually associated with prostate obstruction.

Diagnostic Methods

The right treatment requires the right diagnosis first.

Detailed Patient History: Type of incontinence, number of pads used, surgical history.
Urinary Diary: Urination frequency and times of incontinence are recorded over a 3-day period.
Physical Examination: Sphincter strength, neurological evaluation.
Urinalysis: Is there an infection?
Uroflowmetry: Measurement of urinary flow rate.
Urodynamic Testing: Reveals the mechanism of incontinence (is it sphincter insufficiency or overactive bladder?).

Treatment for Urinary Incontinence in Men: A Detailed Review of All Options

Treatment for urinary incontinence in men should be tailored to the individual, taking into account the type and severity of the symptoms, the patient’s age, any underlying medical conditions, and the patient’s expectations.

1. Conservative Treatment and Behavioral Approaches
This is the first-line treatment for patients with mild incontinence or those who do not wish to undergo surgery.

Pelvic Floor Exercises (Kegels):
Performed to strengthen the sphincter muscles.
3–4 sets per day, 10–15 repetitions per set
Noticeable improvement within 3–6 months with regular practice
The success rate can reach up to 60% when performed under the guidance of a physical therapist.

Biofeedback and Electrical Stimulation:
It indicates whether muscle contractions are being performed correctly and accelerates the learning process.

Lifestyle Changes:
Weight loss, quitting smoking, regulating fluid intake, and reducing caffeine and alcohol consumption.
These methods are generally preferred for mild cases of stress-related eating or as part of preparation for surgery.

2. Medication
It is particularly useful for urge incontinence or mixed incontinence.
Anticholinergics: Reduce bladder contractions.
Beta-3 agonists: Increase bladder capacity and have fewer side effects.
Duloxetine: Can be used for a short time in cases of stress incontinence.
Side effects may include dry mouth, constipation, and blurred vision. Medications alone are generally not sufficient for severe stress incontinence.

3. Male Sling Surgery
It is one of the most commonly used surgical methods for moderate stress-induced incontinence.

Procedure:
A mesh is placed beneath the urethra.
This mesh supports the urethra upward, thereby strengthening the sphincter.

Benefits:
Laparoscopic surgery (minimally invasive)
45-60-minute procedure
Discharge within 1-2 days
High patient satisfaction

Success Rate:
70–80% complete resolution, 10–15% significant improvement.
Risks:
Inability to urinate due to excessive tension
Mesh infection or erosion
Decreased effectiveness over the long term

4. Artificial Urethral Sphincter (AUS – Gold Standard)
This is the preferred method for severe urinary incontinence and has the highest success rate.
How It Works:
A silicone sleeve is placed around the urethra.
The pump is placed in the pouch.
When the patient needs to urinate, they squeeze the pump, and the sleeve opens.
Once urination is complete, the sleeve refills and closes.

Benefits:
85–95% complete dryness
Pad use is largely eliminated
The patient returns to social life

Disadvantages:
It is a mechanical device and may need to be replaced after 10–15 years.
The surgery requires more advanced techniques.
Prof. Dr. Volkan İzol is one of Turkey’s leading experts in AUS surgery:
“The artificial sphincter is a lifesaver for men with severe urinary incontinence. After surgery, patients experience great relief because they no longer need to use pads.”

5. Botox Treatments
In cases of incontinence caused by an overactive bladder, Botox can be injected into the bladder.
Effective for 6–9 months
Can be repeated
Significant improvement in 70–80% of cases

6. Robotic and Laparoscopic Approaches
Used in complex cases or for patients requiring repeat surgery.
Less bleeding
Clearer visualization
Faster discharge and recovery
With robotic surgery, the tissues surrounding the urethra are repaired more precisely, and the sphincter is preserved.

7. Rehabilitation and Psychological Support
Providing psychological support to the patient is also part of the treatment.
Reducing the number of PEDs boosts motivation
Self-confidence in one’s sex life is regained
The return to social life is accelerated

Post-Treatment Follow-Up
Patients should be monitored regularly after treatment:

Once a month for the first 3 months
Checkup at 6 months
Annual follow-up after 1 year

Follow-up care after Sling or AUS surgery is very important; adjustments are made or the device is revised as needed.

Psychological and Social Dimensions

Urinary incontinence in men can lead to depression, loss of self-confidence, and a lack of sexual desire. After treatment, patients return to their social lives and their self-confidence improves.

Frequently Asked Questions

What is the success rate of the treatment?
With proper patient selection, complete continence is achieved in 80–95% of cases.
Is the artificial sphincter used for life?
Yes, but mechanical revision may be necessary after 10–15 years.
Is robotic surgery necessary?
Not for every patient, but it increases the success rate in difficult cases.

Prof. Dr. Volkan İzol’s Approach

Prof. Dr. Volkan İzol is a professor of urology in Adana who successfully performs both male sling and artificial sphincter surgeries. He conducts a thorough evaluation of his patients, takes their urodynamic test results into account, and develops the treatment plan best suited to each individual.

Conclusion

Urinary incontinence in men is a condition that significantly impairs quality of life but is treatable. There are many treatment options available, ranging from pelvic floor exercises to surgery. Thanks to minimally invasive and robotic surgery, patients can return to their social lives in a very short time. Prof. Dr. Volkan İzol achieves high success rates in the treatment of urinary incontinence in men, drawing on his extensive experience.