Treatment of incontinence and bladder complaints in the male should be directed to the cause whenever possible. Frequently, however, only symptomatic
therapy is possible.
Urge incontinence or
overactive bladder due to obstruction should primarily be treated by eliminating the obstruction. Medical and surgical treatment methods are available for
benign prostatic hyperplasia, bladder neck
hypertrophy and
prostatic cancer. In contrast, bladder neck
sclerosis and uretheral
strictures can only be treated surgically.
Anticholinergics are primarily indicated if urge symptoms/incontinence persist after obstruction has been relieved or if
urge incontinence occurs without obstruction. Seldom, in special cases injection of Botulinustoxin A or augmentation of the bladder may be indicated. Another possible cause of urge symptoms is
urinary tract infection. This should be adequately treated according to resistance studies and the cause of the
infection determined. In cases of overflow incontinence the infravesicle obstruction must be sought and treated. If limited detrusor contractability is the cause of overflow incontinence and the bladder cannot be emptied through pressmicturition, parasympathicometics may be of help. By insufficient effect, the procedure of intermittent self-catheterization must be taught. If this is not possible, the last resort is placement of a transuretheral or percutaneous
catheter for continuous drainage. Stress incontinence is a rare complication in men, usually following prostatic surgery. It can be treated conservatively with pelvic floor training and
alpha-adrenergic receptor agonists and if necessary surgically with submucosal
collagen or
silicon injections in the sphincter area or implantation of a sphincter
prosthesis. Supravesicular
urinary diversion is occasionally necessary after conservative and less invasive surgical measures have been exhausted and symptomatic suffering persists. Neurogenic disturbances in bladder capacity and/or emptying can be treated conservatively, medically, surgically or a combination of these depending upon the site of the lesion and the resulting urodynamic patterns.