Male Incontinence, Enlarged Prostate, Urethral Stricture

Male Incontinence, Enlarged Prostate, Urethral Stricture

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Incontinence and prostate problems that affect urinary flow are common among older men, but they can often be cured or improved with the right treatment. Duke’s men’s health specialists are urologists with years of experience diagnosing the causes of male incontinence and related prostate problems including an enlarged prostate and urethral stricture. We recommend the medication, behavioral therapy and/or treatment that gives you the relief you seek.

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Understanding the Different Types of Prostate Problems

Frequent urination, an overwhelming urge to urinate, difficulty urinating, and urinary leakage are uncomfortable symptoms that can be treated, once the underlying cause is found. Conditions associated with urinary incontinence include:

  • prostatitis ( an inflammation of the prostate gland)
  • enlarged prostate gland
  • urethral stricture

Male incontinence may also be a side effect of prostate cancer treatment, or a sign of nerve damage or injury, diabetes, stroke, and multiple sclerosis

Types of Male Incontinence
Bothersome symptoms and urinary incontinence fall into several different categories. Understanding what type of urinary incontinence you are experiencing is an important first step in diagnosing and treating the underlying problem. Expert evaluation can rule out a simple cause, such as a urinary tract infection, and help to determine if you will benefit from non-invasive treatments or medications. More sophisticated imaging can determine if surgery is required.

  • Stress incontinence is urinary leakage during physical activity, coughing, laughing, or sneezing.
  • Urge incontinence occurs when you feel an immediate sense that you have to go, but release urine before you reach the toilet.
  • Mixed incontinence is a combination of stress and urge incontinence.
  • Overflow incontinence is urinary leakage that occurs because your bladder never empties. This may signal the presence of an enlarged prostate or urethral stricture.

Enlarged Prostate 
Enlarged prostate, also known as benign prostate hyperplasia (BPH), is a common problem among older men. As the prostate enlarges, it squeezes the urethra which affects the flow of urine. Symptoms include urinary leaking or dribbling and frequent urination, especially at night.

Urethral Stricture
Urethral stricture refers to the presence of scar tissue that narrows the urethra that prevents the normal flow of urine. Doctors often use the analogy of a clogged pipe. A urethral stricture can be painful and is often misdiagnosed. Some urologists may recommend a dilation or urethral incision to widen the urethra. However, the American Urological Association guidelines indicate reconstructive surgery provides the best, long-term outcome for this structural concern.

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Duke Health offers locations throughout the Triangle. Find one near you.

Male Incontinence Treatments

Non Invasive Urinary Incontinence Treatments

Bladder training and kegel exercises, which strengthen your pelvic floor muscles, may be effective in reducing male incontinence symptoms in some men. Biofeedback uses electrical stimulation to send a mild electrical current to stimulate the nerves in the bladder and pelvic floor. it may be recommended to help you strengthen and control those muscles. 

Medications

Depending on the type of incontinence you have and its underlying cause, your doctor may prescribe medication to relax the bladder and prevent abnormal spasms. 

Artificial Urinary Sphincter

The artificial urinary sphincter works by mimicking your own urinary sphincter.  It has three parts: a cuff that goes around your urethra; a pump in your scrotum and a reservoir balloon in your abdomen.  The artificial urinary sphincter keeps the urethra closed until you want to urinate.  When you need to urinate, you squeeze the pump in your scrotum moves the fluid from the cuff to the reservoir balloon.  Once the cuff is empty, the urine flows out of the bladder.  The cuff automatically fills with fluid and squeezes the urethra shut after 60-90 seconds.

Male Urethral Sling

A synthetic, mesh-like tape is surgically placed through a small incision to reposition the urethra into its normal location.  The sling elevates and supports your urethra so that your sphincter muscle can function properly.  It works best in men whose own urinary sphincter muscle looks good (this is determined using a telescope to look into your bladder) but cannot work properly due to a loss of support after the prostate is removed.  It does not work well in men whose sphincter is scarred.

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Enlarged Prostate and Urethral Stricture Treatments

Medication

Several medications are available to shrink the prostate and relieve symptoms by increasing urine flow. Medications may delay the need for surgery.

Prostate Laser Therapy

Minimally invasive procedures use different types of lasers. They deliver concentrated light energy that shrinks the prostate gland and melts or cuts away excess tissue that is blocking the urethra and preventing the flow of urine.

Transurethral Resection of the Prostate (TURP)

An electrical loop is inserted into the urethra through a thin tube, and is used to cut away the excess tissue blocking the urethra.

Urolift

Tiny implants are inserted into the prostate gland and move it out of the way so that it is no longer blocks the urethra. The prostate tissue is not cut, heated or removed.

Prostatecomy

The prostate gland may be removed through open or robotic surgery if the prostate gland is very large and other procedures aren’t effective.

Urinary Catheter

A catheter is a hollow flexible tube that drains urine from the bladder. It is inserted into the bladder through a cut in the stomach, a few inches below the navel. This is done under a local anesthetic or a light general anesthetic.

Dilation

This procedure is usually performed in the urologist's office under a local anesthetic. It stretches the urethral stricture using progressively larger dilators called "sounds." Alternatively, the stricture can be dilated with a special balloon on a catheter. Dilation is rarely a cure and needs to be periodically repeated. If the stricture recurs too rapidly you may be taught to insert a catheter into the urethra periodically to prevent early closure.

Urethroplasty

This surgical procedure removes or enlarges the narrowed part of the urethra. It may require reconstruction of the surrounding tissues. Many different reconstructive procedures can treat strictures; some require one or two operations. In all cases, the choice of repair is influenced by the characteristics of the urethral stricture. No single repair is appropriate for all situations. Open reconstruction of a short urethral stricture may involve surgery to remove the stricture and reconnect the two ends. When the urethral stricture is too long and this repair is not possible, tissue can be transferred to enlarge the segment. These repairs may need to be performed in stages in difficult circumstances.

Urethrotomy

During this procedure, a thin, lighted tube, called a cystoscope is inserted into the urethra to reach the urethral stricture. A knife blade or laser at the end of the cystoscope cuts and creates a gap in the urethral stricture. A catheter may be placed temporarily into the urethra to assist in the healing process. 

Best Hospital for Urology in North Carolina
When it comes to your care, you want the very best. Duke University Hospital's nationally ranked urology program was named best in North Carolina by U.S. News & World Report for 2019–2020.

Why Choose Duke

Accurate Diagnosis
We perform a comprehensive evaluation and use advanced imaging techniques and diagnostic equipment to accurately diagnose the cause of your prostate problem.

A Team of Specialists
As a major medical center, we work closely with other specialists when male incontinence symptoms signal other medical concerns. Likewise, because procedures such as urethral stricture surgery are complex, you benefit from our collaborative medical teams, which include experts in reconstructive urology, plastic surgery, colorectal surgery, and other specialists, as needed.

Experts in Reconstructive Urology
Duke is a high-volume, regional referral center for people who need reconstructive urologic surgery. Duke has been at the forefront in training doctors in this subspecialty of urology for more than 30 years. All of our urologists who treat male incontinence and prostate problems are board certified and have undergone years of advanced training to complete their fellowships in reconstructive urology.

High Cure Rates and Low Complication Rates
Our use of modern surgical techniques, sophisticated tools and equipment, and our skill and training are the reasons why our surgeries are so successful.

Assistance for Men Who Have Failed Previous Treatments
Many of our urethral stricture patients are referred to us or seek our care after multiple failed attempts at treatment. Often this results from being diagnosed without proper diagnostic imaging, or because they were unaware they could benefit from a single surgery that has a 98+% cure rate.