Men Tolerate Stress Incontinence Years Before Seeking Help

By Jane Farrell

Men who suffer from stress urinary incontinence often endure it for more than two years before asking for medical help, researchers say. And one third of those men put up with it for more than five years.

The findings, according to UT Southwestern researchers, indicate the importance of physicians’ checking for the problem.

Published in the journal Urology, the investigation called for a new routine part of male physicals, saying that general practitioners and urologists should have their patient perform a standing cough test. This involves a patient coughing while the doctor watches for any accidental urine release.

Stress urinary incontinence (SUI) occurs when physical activity or exertion – a cough, heavy lifting, exercise – causes the bladder to leak urine. About 13 million Americans suffer from some degree of incontinence, with women accounting for 85 percent of cases. However, some men who have had prostate cancer treatments involving surgery (prostatectomies) develop the condition.

“Male SUI is rare but is known to have significant negative psychosocial and emotional effects and represents a common reason for post-treatment anxiety and depression,” said Dr. Allen Morey, Professor of Urology at UT Southwestern and senior author of the study.

“Our goal is to spread the word that effective treatments exist for men with stress urinary incontinence, but also to facilitate an immediate and accurate diagnosis among stress urinary incontinence patients,” said Dr. Joceline Fuchs, Assistant Instructor of Urology and first author of the study.

There are simple and safe solutions – including minor surgeries that can either help boost a weakened sphincter muscle for patients with minimal leakage (the sling procedure) or replace the sphincter muscle altogether (installation of an artificial urinary sphincter) for more severe cases of leakage.

“Using new diagnostic techniques, we are now able to accurately diagnose and streamline treatment recommendations to resolve this bothersome problem for our patients,” said Morey, who holds the Distinguished Chair in Urology for Urologic Reconstruction, in Honor of Allen F. Morey, M.D., and the Paul C. Peters, M.D. Chair in Urology. “This study highlights an opportunity for improvement.”

According to a news release from UT Southwestern, during the study, researchers reviewed the cases of 572 men evaluated for anti-incontinence surgery in Dallas between 2007 and 2017. They found the median length of time the men had waited to seek treatment for their SUI was 32 months, with almost a third having waited more than five years. Patients in their 80s had waited a median of more than seven years.

Most recovery of urinary control occurs within the first 12 months after a prostatectomy, the study notes. Beyond the first year, improvement is unlikely. Care for such patients should include urologist-directed treatment plans that focus on non-cancer problems such as incontinence, researchers said.

Some treatment delay may also be tied to patient reluctance to undergo more surgery or due to limited geographic access to appropriate specialists, researchers said. However, patient satisfaction and quality of life improvement measures for those who do undergo anti-incontinence surgery are high, ranging from 73 to 90 percent, the news release said.

The American Cancer Society Prostate Cancer Survivorship Care Guidelines recommend screening for long-term functional effects such as urinary incontinence after prostate cancer treatment, the study points out, and those guidelines have been endorsed by the American Society of Clinical Oncology.