Abstract
This paper focuses on management of urinary incontinence in elderly men. Differentiating stress, urge, mixed and continuous (overflow) incontinence is essential for selecting appropriate treatment. Symptoms of the overactive bladder that are secondary to urinary infection and outflow obstruction can be cured by correcting the primary cause. In idiopathic overactivity lower urinary tract dysfunction must be rebalanced by behavioural, pharmacological, neuromodulatory and, rarely in the elderly, by surgical modalities. Behavioural therapy comprises micturition training, toileting and pelvic floor exercises. A bladder diary is also important for therapy control and feedback. Anticholinergics are the usual pharmacological therapy but are limited by side effects, especially to the central nervous system. Slow release formulation, transdermal patches and intravesical applications have been developed to reduce them. Non-invasive neuromodulation is a useful alternative and can be applied as home treatment.
In men stress incontinence is most frequent and is often due to intrinsic sphincter insufficiency after radical prostatectomy. Special training programmes focusing on improving the strength of the striated sphincter and the control over this structure have proved to be beneficial. Initially additional electrotherapy may be helpful. For persisting and bothersome postoperative stress incontinence in men implantation of an artificial urinary sphincter is the gold standard. Duloxetine, which inhibits the re-uptake of serotonin and noradrenalin, may also be useful. Male bulbo-urethral slings still have to stand the test of time.
Ten percent of residents in nursing homes suffer from overflow incontinence for which intermittent catheterisation has proved to be practicable.
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