Male Stress Incontinence
Male stress urinary incontinence is leakage with physical exertion, coughing, or straining, most commonly following prostate treatment. Management follows the 2024 AUA/GURS/SUFU Incontinence After Prostate Treatment guideline.
Symptoms
Urine leakage with coughing, sneezing, lifting, or exercise -- distinct from urgency-related leakage, which has a different underlying cause and treatment.
Causes and risk
Radical prostatectomy is the leading cause, since it can affect the muscles and nerves that normally maintain continence. Age, higher BMI, prior urinary symptoms, radiation therapy, and nerve injury during surgery all raise risk.
How it is evaluated
History and a focused exam, sometimes with additional testing, characterize the type and severity of leakage before choosing treatment.
Treatment
Pelvic floor muscle training is first-line and works for many men, especially with milder leakage. When surgery is needed, an artificial urinary sphincter suits moderate-to-severe leakage (and is preferred after radiation), while male slings work well for mild-to-moderate cases in men who haven't had radiation. No medication cures this specific type of leakage; drugs are reserved for a coexisting urgency component.
When to seek care
Stress incontinence itself is not an emergency, though sudden new urinary retention or significant pain warrants prompt evaluation.