Stress Urinary Incontinence in Men

Abstract

Stress urinary incontinence is a distinctly unusual finding in men who have had no prior pelvic or urologic surgery. Seven men with stress urinary incontinence underwent urodynamic evaluation. All patients had urethral smooth muscle dysfunction manifested by decreased urethral pressure and the presence of radiographic contrast material in the proximal urethra. One patient with adenocarcinoma of the prostate had had a prior prostatectomy and subsequently had metastases with cauda equina compression. One patient had destruction of the pelvic plexus from metastastic choriocarcinoma. All other patients had neurologic lesions involving spinal roots L1 and/or L2, resulting in interference with adrenergic innervation of the proximal urethra. Thorough neurologic evaluation should be obtained in a man with stress urinary incontinence who has had no prior operation that could damage the pelvic plexus or urethral sphincter mechanisms.

Urethral pressure response to cough and voluntary perineal contraction in men without previous pelvic surgery

“…This defect in urethral response to cough is not usually checked in men with stress incontinence. However, stress incontinence was explored in some men with no prior surgery and with bladder, urethral, and perineal denervation [Woodside and McGuire, 1979;Woodside, 1982;Mundy et al, 1985]. In these patients, the stress incontinence was explained by an open bladder neck appearing in standing position.…”

“…It mainly occurs after extended pelvic surgery. Otherwise it appears to be associated with severe neurological lesions resulting in a pathologically open bladder neck and/or a marked paralysis of the pelvic muscles [Woodside, 1982;Barbalias and Blaivas, 1983]. Continence in men clearly involves both smooth and striated components of urethral sphincter [Koyanagi, 1980].…”