Male urinary incontinence: prevalence, risk factors, and preventive interventions

Abstract

Urinary incontinence (UI) in community-dwelling men affects quality of life and increases the risk of institutionalization. Observational studies and randomized, controlled trials published in English from 1990 to November 2007 on the epidemiology and prevention of UI were identified in several databases to abstract rates and adjusted odds ratios (OR) of incontinence, calculate absolute risk difference (ARD) after clinical interventions, and synthesize evidence with random-effects models. Of 1083 articles identified, 126 were eligible for analysis. Pooled prevalence of UI increased with age to 21% to 32% in elderly men. Poor general health, comorbidities, severe physical limitations, cognitive impairment, stroke (pooled OR 1.54; 95% confidence interval [CI], 1.14-2.1), urinary tract infections (pooled OR 3.49; 95% CI, 2.33-5.23), prostate diseases, and diabetes (pooled OR 1.36; 95% CI, 1.14-1.61) were associated with UI. Treatment with tolterodine alone (ARD 0.17; 95% CI, 0.02-0.32) or combined with tamsulosin (ARD 0.17; 95% CI, 0.08-0.25) resulted in greater self-reported benefit compared with placebo. Radical prostatectomy or radiotherapy for prostate cancer compared with watchful waiting increased UI. Short-term prevention of UI with pelvic floor muscle rehabilitation after prostatectomy was not consistently seen across randomized, controlled trials. The prevalence of incontinence increased with age and functional dependency. Stroke, diabetes, poor general health, radiation, and surgery for prostate cancer were associated with UI in community-dwelling men. Men reported overall benefit from drug treatments. Limited evidence of preventive effects of pelvic floor rehabilitation requires future investigation.

Keywords: Drug therapy; Rehabilitation; Risk factors; Urinary incontinence.

Figure 1

Study flow diagram. *Literature search was conducted to examine diagnosis, prevalence, incidence, risk factors, and clinical interventions of urinary incontinence (UI) and fecal incontinence (FI) in adults from community and long-term care settings. †Sum of the studies not equal to the total number because of overlap in eligibility criteria. RCT, randomized clinical trial.

Figure 2

Association between risk factors and prevalence of urinary incontinence (adjusted odds ratios from individual studies and pooled analysis with random-effects models). CI, confidence interval.

Figure 3

Effects of conservative treatments on continence compared with regular care (results from randomized controlled clinical trials). RD, absolute risk difference; NPT, negative pad test; SR, self-reported; ICS, completely dry in International Continence Society-male questionnaire; VAS, visual analogue scale.

Figure 4

Effects of pharmacologic treatments on continence compared with placebo or pelvic floor muscle training (results from randomized controlled clinical trials). PFMT, pelvic floor muscle training; ER, extended release.