The other day, I had the pleasure of sitting down with [Dr. James Kuan](http://www.swedishurology.com/about_us/bios2.php#kuan) from [Swedish Urology Group](http://www.swedishurology.com/). He provided me with an excellent explanation of what male incontinence is and what the treatment options are. I hope you find it as informative as I did! He’s a great speaker and a great surgeon.
**Below is the transcript of the video**
**Dawn:** Hi, this is Dawn from BrokenHandle. I’m going in to talk to Dr. James Kuan of Swedish Urology about male incontinence, what it is and what the treatment options are for you.
**Dr. Kuan:** The person who we would see in our office for incontinence is generally a male who has maybe had treatment for prostate cancer, or has problems with enlarged prostate, or maybe just has incontinence for some other reason, or has a cluster of urinary symptoms that’s including incontinence.
Men come from many different medical backgrounds and I think that highlights that lots of things cause incontinence. But ultimately, when someone is in our office they’ve been referred because they are incontinent or they’ve identified and made themselves an appointment to find out more about why they’re incontinent, how they can improve their incontinence, and if it’s something they have to live with or if it’s something that there’s definitive or curative type treatments for.
I think it’s important to figure out how incontinent people are, when they’re incontinent. Is it when they cough or sneeze? Or is it when they can’t make it to the restroom in time? Because I think treatments are very different with different types of incontinence.
Some of that involves understanding what incontinence is. I think the bottom line is that incontinence means something different for everybody but, ultimately, if you’re someone who leaks urine at a time when you don’t think you should be leaking urine or it may be not socially appropriate or you can’t get to the restroom in time, that would be significant and considerable incontinence for you.
There’s no magic amount of incontinence that needs evaluation. It’s if the leakage bothers you, then there’s opportunity to evaluate that. Based on that evaluation, which sometimes takes a couple of visits, there’s a whole array of treatment options. Most men, when they come with incontinence, that’s their question: “How can I treat this?”
After that evaluation when we know how much they’re bothered or how much they’re leaking, we can look at various treatments starting with very simple things like limiting fluids, timing when you go to the restroom, not waiting longer than you know that you can typically hold your urine, not drinking caffeinated beverages, alcohol, things that can irritate or stimulate the bladder, sometimes changing the time of a diuretic medication are very easy ways that some men can reduce the leakage that they have.
A lot of men – some of those strategies aren’t necessarily helpful and they may already be using pads. And if they’re not using pads, it’s making sure that they understand what a good pad is versus a bad incontinence pad, and understanding that there are pads of different sizes for different degrees of incontinence. I think that’s an important way to manage all of these men until they get to that point where we can really define and definitively treat their incontinence.
Fortunately, for a lot of men those are all the things that we need to do. Or if they’ve got enlarged prostates, treating their enlarged prostate often results in improvement in their incontinence. But when that isn’t the case, when the easy things don’t work and we need to go onto further evaluation where men have significant incontinence using two, three, four, or five or many more pads in the day or they’re leaking at nighttime, we’re really looking at a little bit more complex options. But options that have very acceptable outcomes in terms of success, in terms of usability, and in terms of durability – keeping men dry for long periods of time.
What I’m particularly talking about is not things like catheters, not things like a condom catheter which would fit over the penis, not tubes in the bladder. But some men do require surgery for this and we’re fortunate that we have two surgeries now, where before we only had one, and each of those surgeries address a different degree of incontinence.
The most incontinent men will have a surgery called an artificial urinary sphincter. Essentially, this is like placing a small blood pressure cuff around the urethra when the sphincter or the control muscle doesn’t work and using a hydraulic pump type system that is all implanted under the skin. Men are able to control when that valve is open and urinate when that valve is open. But when it’s not time to urinate, it’s in the closed position and they’re dry. That’s what we would consider for the most severe incontinent men.
Then for the less severe incontinent men, we now have the ability to use an operation that we have done for years in women called the sling operation. In the last few years this has been adapted to men, where before this operation couldn’t really be performed in men because nobody understood how to get the sling which is like a hammock into a male so that it stays in place and it holds the urethra in the place where it can be more closed or where the sphincter can work more effectively, keeping those men dry. Those men, however, do need to have some degree of sphincter control. That’s why it would be the less incontinent men that receive that surgery.
The nice thing about both of these operations is that they are relatively short procedures, generally under two hours. They generally are done under an anesthetic and most men will stay one night at the hospital. But following that recovery, they would go home and neither would go home with a catheter.
What’s really nice about the sling is it works right away. Once the catheter is removed, those men are dry. Because the sphincter is a little bit more complex and we’re treating more complex disease, we do let things heal for a period of about six weeks before we activate the cuff and allow the incontinence to be treated by the device that is put in place.
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