Diagnosis

Male Urinary Incontinence

Diagnosis of male urinary incontinence

In a first clinical consultation, the physician will ask the person when urine leaks to see if the incontinence is predominantly stress incontinence (stress urinary incontinence) or incontinence due to having to rush to the toilet (urge urinary incontinence). In many patients there is a mixed picture of urgency and stress. In this case it is necessary to try to understand which is the major component and which dominates the picture.

On some occasions, we find overflow incontinence in men from 60-70 years of age in whom there are obstructive problems (prostate hyperplasia, urethral stricture). In this situation it is possible to diagnose them partly by the clinical picture (which is usually more similar to stress incontinence) but especially by the presence of chronic retention of urine.

It is important to collect data using standardized measures, which will help us to better understand what is happening to each man and to assess the severity of the problem. To do this, we have questionnaires and a diary that is given to the patient to indicate the situations in which they leak urine and the amount they leak. This will serve to see the repercussions of these leaks.

In order to evaluate the intensity of urinary incontinence, more or less exact quantitative measures are used, such as the number of times urinary incontinence forces us to change every day or the number of pads or absorbent pads we use. On the other hand, if we want a more precise estimate of the losses, we can determine it by means of the PAD test. This involves using an absorbent pad or pads for a day and weighing them to determine the grams of urine (1 gram is 1 milliliter) lost and, therefore, the intensity of the loss. However, the estimation of the intensity of urine incontinence is usually based on the alteration in the patient's quality of life.

Following this conversation, there are generally two levels of diagnosis:

1. Tests to find the origin of incontinence and to know its severity

Initially, tests will be performed to find the origin of the incontinence and to know its severity in order to objectify the magnitude of the leakage. To find the origin, diagnostic tests such as renovesicoprostatic ultrasound, blood tests with PSA and renal function and urinary cytology are used. On the other hand, to determine its severity, diaper test or PAD test is performed.

• Urinalysis: as urinary incontinence is often associated with urinary tract infections, a urinalysis with culture will help to rule out the presence of this very prevalent pathology. In the same way it is interesting in some cases to perform a urinary cytology to rule out the presence of a bladder tumor, which may well give filling clinic as urinary incontinence.
• Ultrasound: to rule out bladder stones, bladder cancer, benign prostatic hyperplasia or any type of alteration in emptying, since, as it usually occurs in older men, there may be hyperpressure in the bladder, also causing urine leakage.

2. Tests to find the depth of the origin of incontinence

Secondly, depending on the results of the first battery of tests, other explorations can be performed to try to understand in depth the origin of the condition. These tests are urethrocystoscopy, urodynamics and pelvic MRI.

• Urodynamic study: although not necessary in all patients, it serves to study bladder function and obtain relevant information to distinguish the type of incontinence. This test measures the flow of urine that a patient is able to produce with a voluntary contraction of the bladder, the capacity of the bladder, the pressure it generates, the pressures exerted by the sphincter, etc. Urodynamics is an invasive test but it provides a lot of information about the bladder at different levels. First of all, it informs us about its distensibility and volume, and whether pressure or urgency is generated with filling. In addition, it also tells us about the existence of an infravesical obstruction.

 
Normally, all these tests are performed to rule out another condition, but with a good medical history and questionnaires we can reach an accurate diagnosis.