About

17% of men over the age of 60 in the U.S. suffer from a condition known as stress urinary incontinence (SUI).¹   SUI occurs when you involuntarily leak urine when you cough, sneeze or exert yourself.²

Prostatectomy and Male Incontinence

Male patients who undergo prostatectomy, the surgical removal of the prostate gland, may experience stress urinary incontinence (SUI) after their procedure. Studies indicate that as many as 50% of men report leakage due to SUI in the first few weeks following prostate surgery after removal of the catheter.⁸ Data suggests a range of 8%-63% of men will report some degree of SUI to be a significant problem one year after their prostatectomy.^9,10

Causes of post-prostatectomy urinary incontinence include³:

• Damage to the sphincter muscle can result in stress incontinence.
• Bladder spasms can lead to urge incontinence, frequent urination, and sometimes nocturnal enuresis (also known as nighttime urinary incontinence, bedwetting, and/or sleepwetting).
• Combination sphincter damage and bladder spasms can lead to a mix of stress and urge incontinence.

FYI

SPOUSES AND CAREGIVERS

Male urinary incontinence affects not only men, but the people closest to them as well. It can often mean that men become withdrawn, depressed, and/or irritable. Some men try to keep these feelings to themselves, but inevitably, spouses, partners, and other family members share in this condition. Learning more about male incontinence and the variety of treatment options will help you talk to him in a more educated manner.

Remember, he wants to be dry as much as you want him to be. One study showed that men who wear only one pad per day experience a significantly decreased quality of life over those who are completely dry.¹

Incontinence can be a tough subject to discuss, but here are ways to start the conversation

1. I’ve noticed that you’ve been hesitant lately about going places. Is everything OK?
2. Lately, you’ve been visiting the bathroom more than usual. I’ll bet your urologist may offer some insight.
3. People who survive cancer tend to have a new lease on life, but you seem down. Are you experiencing complications from your surgery?
4. A woman I know was recently telling me about how her husband has been cured from incontinence. I’m so excited for them.
5. I know you don’t want anyone to know about your bladder control issues, but I recently heard about some treatments that could help.
6. Have you been to your urologist for a follow-up?

1. Cooperberg M, Master V, Carroll P. Health related quality of life significance of single pad urinary incontinence following radical prostatectomy. J Urol. 2003;170(2 Pt 1):512-515.

Insurance Coverage

Most insurers cover the diagnosis and medical treatment of male incontinence. Medicare has a national coverage policy for incontinence, which includes implants (sling or artificial urinary sphincter). Most commercial health insurers also cover male slings or the AUS when it is deemed medically necessary for the patient. Contact the insurer to verify coverage under a specific plan.

Symptoms

Types of Incontinence

Stress incontinence is the involuntary leakage of urine when coughing, sneezing, straining, or doing anything that puts stress on the abdomen. Some people with severe stress incontinence have nearly constant urine loss (sometimes referred to as total incontinence). In adults, this usually occurs because the urinary sphincter does not close adequately.2,3,4

Urge incontinence is characterized by an abrupt and intense urge to urinate immediately followed by uncontrollable urine release.2,3,4

Mixed incontinence involves more than one type of incontinence, typically from bladder malfunction and sphincter damage. Men with this combined problem usually experience “mixed incontinence” symptoms with a combination of both urge and stress incontinence.2,3,4

Continuous incontinence is constant leakage, usually associated with a fistula (an abnormal connection or pathway); it occurs only rarely in males. Enuresis refers to any involuntary loss of urine and should be distinguished from nocturnal enuresis, or urinary loss during sleep.4

Overflow incontinence is the uncontrollable dribbling of small amounts of urine from an overfilled bladder that does not empty well.2

Functional incontinence is the urine loss resulting from the inability to get to a toilet. Typically due to a physical or mental impairment, unrelated to the control of urination. For example, a person with dementia due to Alzheimer disease may not recognize the need to urinate or not be able to locate a toilet in time. People who are bedridden may be unable to walk to the toilet or reach a bedpan.2

Diagnosis

The inability to control one’s bladder can be a common side effect of prostate cancer surgery, when the muscles that control urination can be damaged.

Treatments

Your doctor may recommend limiting liquids, avoiding caffeine and alcohol, and kegel exercises to strengthen your pelvic floor muscles and improve bladder control.⁴  These strategies may provide some temporary relief of SUI, but there are also surgical treatment options such as the sling implant and the artificial urinary sphincter that can be considered.

Behavioral techniques often include bladder training, which consists of scheduled bathroom trips at specific times to retrain the bladder. In addition, fluid and diet management may be considered; which may involve the limitation of caffeine and alcohol, as well as avoiding consumption of liquids within a few hours of bedtime.

Physical therapy often includes Kegel exercises, designed to help strengthen the muscles that support the bladder. In addition, biofeedback, or electrical stimulation, may help gain awareness and control of urinary tract muscles.

Medication may be prescribed to decrease involuntary bladder contractions. However, medication is not typically effective for severe cases or stress incontinence.¹¹

Absorbent products may be considered when incontinence is inconsistent, persistent, or both. These undergarment solutions can be used alone, or in combination with other broad treatment options as needed. Absorbent products may be disposable or reusable, and are often recognized as liners, pads, or collection devices.

Collagen injections add bulk to the bladder neck and provide increased resistance to prevent urine leakage.

Another option that may work for some men is an Implantable Male Solutions…

Sling implants (also known as a suburethral sling) are devices that are placed within the body via surgery. Sling implants reposition the urethra and provide support to surrounding muscles for enhanced urethral closure and the reduction or elimination of unintended urine flow, especially when coughing, sneezing or lifting.¹² The implanted device works automatically, requiring no action on the patient’s part.¹⁸

• Presented at  a urologic congress and published in peer-reviewed journals, clinical studies encompassing over 500 patients, showed an average success rate (cured + improved) at 81%.^19-25
• In a study of 42 patients, 94% would recommend the procedure to a friend.¹³

Artificial urinary sphincter (AUS) is a device that is placed within the body via surgery.  The AUS device contains an inflatable cuff that fits around the urethra that mimics the function of a normal, healthy urinary sphincter. A pump is implanted inside the scrotum to control transfer of fluid between the cuff and a reservoir that is implanted in the abdomen. At rest, the cuff is filled with fluid keeping the urethra closed and preventing urine flow until the man is ready to urinate. To urinate, the pump is squeezed by hand 2-5 times, deflating the cuff, opening the urethra and allowing urine to exit the body. After urination, a button on the pump is pressed and fluid from the reservoir returns to the cuff, closing the urethra once again.¹⁴

• With over 150,000 patients treated, the AUS has been referred to as the “Gold Standard” for treating male stress urinary incontinence (SUI) following prostate surgery.^15,17
• In one study of 50 patients, 90% reported satisfaction. 92% would have an AUS placed again, and 96% would recommend it to a friend. ¹⁶

Resources

1. Anger JT, Saigal CS et al. The prevalence of urinary incontinence among community dwelling men: results from the National Health and Nutrition Examination Study. J Urol. 2006; 176:2103-2108.

2. Chapple, C, Milsom, I. Urinary incontinence and pelvic prolapse epidemiology and pathophysiology. In: McDougal WS, Wein JW, Kovoussi, AC, et al. Campbell-Walsh Urology. 10th ed. Philadelphia, PA: WB Saunders Elsevier: 2012:1871-1895.

3. Prostate Cancer, www.cancer.org/cancer/prostatecancer/index.  American Cancer Society Web site. Accessed June 20, 2013.

4. Sandhu, J. Treatment options for male stress urinary incontinence. Nat Rev Urol. 2010;7:223.

About

WHAT IS PEYRONIE’S DISEASE?

Peyronie’s disease is a condition in which a man’s erection curves and may feel painful. It may begin as a bump on the penis. The bump is scar tissue, and it’s known as Peyronie’s plaque. Some men are aware of the Peyronie’s plaque, which can feel like a small bump directly under the skin of the penis. Peyronie’s plaque is benign (noncancerous). It is not a tumor, but only a healthcare professional can make a proper diagnosis. It is not elastic, so during an erection, the penis can’t expand in the area where the plaque is located. As a result, the erection becomes curved.

It might be difficult to talk about a curved erection, but it is important to discuss this symptom with a healthcare provider.

FYI

HOW COMMON IS PEYRONIE’S DISEASE? WHO HAS IT?

The current estimate is that 5% of men have the disease although the reluctance of men to communicate with their doctors would suggest the actual rate may be higher.

The condition exists at all ages but the greatest rate is in men from 40 to 60. At least 65,000 diagnoses are expected annually, with the actual number of cases higher because of under-reporting by men reluctant to communicate with their healthcare provider and seek help for the condition. 

HOW DOES A MAN GET PEYRONIE’S DISEASE?

Although the cause of the disease is not clear in every case, healthcare providers believe that injury to the penis, possibly during sex, may result in abnormal scarring. This scarred tissue is not as elastic and subsequently results in an erection that is curved and possibly painful. It is also possible that genetic factors predispose the individual to such scarring and the subsequent affects.

CAN PEYRONIE’S DISEASE GET WORSE OVER TIME?

In the beginning stages of Peyronie’s, men have curved erections that may also be painful. With time, the pain usually goes away. But it’s most likely that the curve will remain.

There are two phases of Peyronie’s disease:

• The acute phase, which lasts up to a year, is a time when men can experience painful erections. In addition, the acute phase is characterized by an increase in plaque size, penile curvature, and pain.
• The chronic phase, which follows the acute phase, is characterized by minimal or no pain and stable penile curvature deformity. While pain usually subsides, other characteristics of the disease remain throughout the chronic phase.

If you have a curved erection or think you might have Peyronie’s, the best thing to do is discuss it with your healthcare provider.

IS PEYRONIE’S DISEASE THE SAME AS ERECTILE DYSFUNCTION?

Erectile dysfunction (ED) may be a symptom of Peyronie’s disease, but it is not the cause of Peyronie’s disease. Not all men with Peyronie’s disease have ED. A man may experience one condition and not the other.

There is an increased occurrence of ED in patients with Peyronie’s disease. Studies of patients with Peyronie’s disease have reported that between 30% and 80% of them may have ED. What remains unclear is whether this is due to psychological or physiological factors. It might be that the curvature deformity and pain of Peyronie’s disease cause distress or performance anxiety that interferes with the ability to have or maintain an erection. Or it could be that the change in fibrotic tissue affects normal blood flow during erection.

Either way, when a man expresses concern about ED it’s important to consider the possibility of Peyronie’s disease.

Symptoms

WHAT DOES PEYRONIE’S DISEASE LOOK LIKE?

Not all curved erections or penile bumps are caused by Peyronie’s disease. It is important for men to discuss their condition with their healthcare provider.

The main feature of Peyronie’s disease is the curved penis caused by a Peyronie’s plaque (lump). The location of the plaque may determine the type of curvature deformity that occurs. The most common type of curvature deformity is “dorsal” – in other words, an upward bend caused by plaques on the dorsal (top) side of the erect penis.

In addition to the Peyronie’s plaque and curved penis, many men initially experience painful erections. Further, the plaque may cause changes to the length or circumference of the penis while erect. Other physical symptoms are penile folding or collapsing during intercourse, and erectile dysfunction.

OTHER THAN PHYSICAL SYMPTOMS, HOW MIGHT A MAN BE AFFECTED BY PEYRONIE’S DISEASE?

Not all curved erections or penile bumps are caused by Peyronie’s disease. It is important for men to discuss their condition with their healthcare provider.

For men with Peyronie’s disease, the impact goes beyond the physical symptoms and may include sexual, psychological and social effects. Because the erection curves and even hurts, intercourse can become difficult and even impossible for some men. Others can become self-conscious about the appearance and limitations of their erections, causing them to avoid sex. For some men, the problem is more than just sexual. Peyronie’s can be embarrassing to talk about – even with a partner. This can lead to relationship difficulties.

Peyronie’s bothers men in different ways. For example, in one study of 92 men with Peyronie’s, 48% had clinical depression.

Peyronie’s disease can significantly impact men in many different and meaningful ways. The effects can be physical, sexual, psychological, or social. Depression, lowered self-esteem, and difficulties with relationships are common.

HOW DOES A HEALTHCARE PROVIDER EVALUATE FOR PEYRONIE’S DISEASE?

A thorough evaluation for Peyronie’s disease is essential so that the healthcare provider can fully understand the man’s condition and make an accurate diagnosis. There is not one universally accepted standardized evaluation for Peyronie’s disease, but during an initial evaluation, the patient might participate in:

• A physical exam
• Imaging analysis
• An interview

Physical exam: A healthcare provider might measure the degree of curvature of an erect penis. The healthcare provider may also look for the number and position of plaques on the penis and the degree of plaque calcification (hardening).

Imaging analysis: Penile ultrasound has gained widespread acceptance as a valuable tool for the diagnosis of Peyronie’s disease in recent years.

Patient interview: During the interview, a healthcare provider may ask questions about the degree of curvature of an erect penis, the onset and duration of symptoms, presenting signs and symptoms, and the presence or absence of pain. Patients should also plan to tell their healthcare provider about personal or family medical history of Dupuytren’s contracture and Lederhose disease as well as risk factors for erectile dysfunction including hypertension, dyslipidemia, tobacco use, and diabetes.

WHAT ROLE CAN PARTNERS PLAY IN RECOGNIZING THE SIGNS AND SYMPTOMS OF PEYRONIE’S DISEASE AND ENCOURAGING MEN TO SPEAK WITH A HEALTHCARE PROVIDER?

It is important to keep in mind that Peyronie’s disease and some of its related symptoms may be very difficult for men to speak about openly. If you recognize any of the signs and symptoms of Peyronie’s disease in your partner offer him support and understanding and encourage him to visit his healthcare provider to see if he may have Peyronie’s disease.

Keep in mind that Peyronie’s disease, in addition to impacting a man physically, may lead to sexual, psychological and social issues. If he is comfortable with the idea of seeing a healthcare provider, offer to go along with him to visit his healthcare provider or offer support by doing research on the condition.

Questions to Ask Your Health Care Provider

HOW SHOULD A MAN INITIATE THE CONVERSATION ABOUT PEYRONIE’S DISEASE WITH HIS HEALTHCARE PROVIDER?

A man with a curved penis may find it hard to start a conversation with his healthcare provider. But seeing a healthcare provider, such as a urologist, is an important step to take. A man should feel free to ask the urologist whatever questions come to mind using whatever words are most comfortable. First, it is important for a man to find out from a healthcare professional whether or not he has Peyronie’s disease.

Ask your healthcare provider:

• Why do I have a curved penis?
• What causes a curved penis?
• What can I do about the pain I have?
• Will this problem go away on its own?
• What are my treatment options?
• Is it normal to feel the way I do about this?
• How can I make sex more comfortable?

WHAT KINDS OF QUESTIONS WILL A HEALTHCARE PROVIDER ASK?

Since each man’s experience with Peyronie’s disease is unique, your healthcare provider might ask a number of questions to better understand your condition. Some questions might include:

• When did this problem start?
• Do you have any bumps on your penis?
• Do you have a palpable plaque (a bump you can feel on your penis)?
• Do you have a curved erection?
• How severe is the curvature (how much does your erection bend)?
• Are your erections painful?
• Does this interfere with sex?
• On a scale of 1 to 10, what kind of impact is this having on your day-to-day well-being?
• How else does this bother you?

A healthcare provider might ask more than just basic physical questions to better understand how Peyronie’s disease is affecting a man’s life. Some questions he or she might ask are:

• On a scale of 1 to 10, what kind of impact is this having on your relationship with your partner?
• Do you find you’re thinking about this when you should be focusing on other matters?
• What kind of impact is this having on your day-to-day well-being?
• Do you find it easy to talk to your partner about what’s happening physically?
• How easy is it to talk to your partner about Peyronie’s disease?
• How is this affecting your social life?

Treatments

DOES PEYRONIE’S DISEASE LAST FOREVER?

For some men, Peyronie’s disease may go away on its own – this is called “spontaneous resolution.” However, just as it is unclear how many men have Peyronie’s disease; it is unclear how often spontaneous resolution occurs. One study in 2001 suggested that “spontaneous resolution” was a rare occurrence.

In a 1990 study, among 97 patients with Peyronie’s disease, 13% experienced a resolution of their symptoms. They further noted that 40% of respondents perceived that their disease had progressed, and 48% considered that their condition had remained unchanged at follow up.

Surgery

Surgery is the only treatment guaranteed to have a beneficial effect on Peyronie’s disease but it would only be offered to you once the changes caused by the condition had settled down. This normally takes 12-18 months.  You doctor may perform surgery using  one of these available options:

• Extracorporeal shock wave therapy: This uses vibrations from sound waves to break down the tough fibrous plaques. The sound waves are delivered by a device outside the body. You may be offered sedation during the procedure. The technique is safe but its effects are uncertain.
• ‘Cold steel’ surgery: This means surgery involving conventional surgical instruments. Several operations are available including:
• The Nesbitt tuck procedure: this involves removing some tissue from the side of the penis opposite the plaque. This has the effect of straightening but shortening the penis.
• Plication:  this involves folding the normal tissue on itself rather than removing it completely.
• Cutting out the plaque : this sometimes is combined with the insertion of a plastic rod (prosthesis) to counteract any shortening.
• Laser surgery – a carbon dioxide laser is used to thin the plaque.

In some cases, your healthcare provider may choose to treat Peyronie’s disease using one or a combination of the following.

• Stretching: the technical name for this is external penile traction. It involves wearing a device which stretches the penis. It has shown some effect in improving the length of the penis and lessening deformity.
• Vacuum devices: these work in a similar way to traction devices by creating a vacuum around the penis, which stretches the shaft.
• Medicines taken orally: medicines tried in the past for this condition include para-aminobenzoate, colchicine, propoleum, pentoxifylline, vitamin E, tamoxifen and acetyl-L carnitine. Only para-aminobenzoate has the backing of European guidelines and a UK licence to be used for this condition.
• Medicines injected into the plaques: various medicines have been tried and research studies have reported some improvement in pain, the size of the plaques and the amount of bend of the penis after these injections.
• Surgery

Resources

For more information about Peyronie’s Disease visit:

Ask About the Curve
American Urological Association
Sexual Medicine Society of North America
Association of Peyronie’s Disease Advocates
Association of Peyronie’s Disease Advocates – Support Community
Mayo Clinic
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), a Division of the National Institutes of Health (NIH)
WebMD

About

STDs are widespread—19 million new cases are diagnosed every year—with over 20 different varieties. STDs often have no early symptoms, meaning they can unknowingly be passed on to a partner.

FYI

Your sex life changes as you age

As you get older your sex life will change. You may not respond to sexual stimulation as quickly as you once did. You may lose your erection after sex sooner and it may take longer for you to get another erection. But none of this means that you can’t have an active sex life. The key is to keep it going. Without regular workouts, your sexual muscles will get weaker. So you can help combat this natural occurrence with exercise to help maintain your sexual strength. As men, having a positive self-image is a very important part of our sex life. But the two are connected in a kind of loop: the more attractive and desirable we feel, the better we’ll perform. At the same time, the better we perform sexually, the more attractive and desirable we feel. For this reason, do not hesitate to discuss any sexual related problems with your health care provider as most conditions are easily treatable.

Symptoms

Here are some of the most common STDs, their symptoms, and how to prevent them. If you suspect that you are infected, see your healthcare provider immediately and tell your partner so she or he can get checked as well.

• Chlamydia is the most common STD in the US. Thirty percent of women who get it and are not treated become sterile and are unable to have children. It can also cause sterility in men. About three-quarters of infected women and about one-half of infected men have no symptoms. If symptoms do occur, they usually appear within one to three weeks after exposure. Signs are a thin, clear discharge of fluid from the penis and a burning feeling in the penis or scrotum. Chlamydia is easily diagnosed with a urine test and treatments are widely available.
• Gonorrhea is one of the most common infectious diseases in the world. It’s also one of the easiest to cure—as long as it’s caught early. Ignored, it can cause infertility, and spread to other parts of the body. Symptoms can appear two to 30 days after the infection, and include a burning feeling when urinating and a yellowish or greenish discharge from the penis. If the fluid gets into the eyes, it can cause blindness. Gonorrhea is treated with antibiotics.
• Syphilis is a serious bacterial infection. Symptoms begin with bumps or sores on the penis, mouth, or anus that last anywhere from one to five weeks. These sores sometimes leak fluid that is highly contagious. Fever, rash, and flu-like symptoms follow. Detected early, syphilis can be treated with antibiotics. But ignored, it can damage the brain, heart and spinal cord—and even cause death.
• Herpes is caused by a virus. Symptoms begin to appear within a week of infection. They start with tingling and itching, followed by small, painful blisters that can appear on the penis, mouth, anus, buttocks or thighs. Herpes can be confirmed by examining a sample from the sores under a microscope. There is no cure and outbreaks can happen several times a year. However, it can be controlled with special anti-viral medication. Herpes can be contagious even when there are no sores present, so if you’re diagnosed, take steps to protect your partner.
• Genital warts are growths or bumps caused by a viral infection. Symptoms are itching and irritation, beginning within a month after infection. The warts appear soon afterwards and they spread quickly. They can be treated with prescription medication or surgically removed. Genital warts can lead to cancer in women.
• Acquired Immunodeficiency Syndrome (AIDS) develops from exposure to the HIV virus. The HIV virus lives in body fluids such as semen, breast milk, vaginal secretions, blood, saliva and even tears. AIDS is a fatal disease. But identified early and aggressively treated, HIV can sometimes be kept from developing into AIDS. Drug therapy is the most common treatment.

Prevention

BIRTH CONTROL/CONTRACEPTION

Abstinence (avoiding all sexual contact, including oral sex) is the best way to avoid STDs. But for most people, that is not a practical solution. If you’re sexually active, you should protect yourself and your partner. The best form of protection is a latex condom which can reduce or eliminate becoming infected or spreading an STD. Do not defeat the purpose of the condom by using lubricants like Vaseline which can weaken the condom.

When having sex, there are other things to protect yourself from as well. You and your partner are equally responsible for doing what is necessary to prevent an unplanned pregnancy. Here are a few of the most safe and reliable methods for doing so:

• The pill. When taken as prescribed, birth control pills are nearly 100% effective.
• Implants and injections. A woman can have certain hormones implanted under her skin that are effective for as long as five years. Pregnancy-preventing hormones can also be injected, but they are only effective for three months.
• Condoms. Worn properly and used with a contraceptive foam or jelly, condoms can prevent pregnancy up to 99% of the time.
• Vasectomy. This is a surgical procedure that involves severing the tubes that carry sperm from the testicles to the penis. A successful vasectomy is virtually 100% effective in preventing pregnancy, but it won’t protect you against STDs. If you later decide you want children the tubes can be joined again but there is no guarantee of success.
• Patches, pills, injections, and implants for men. While not yet available, they will soon be on the market. Remember, both partners are equally responsible for preventing an unwanted pregnancy. So make sure you and your partner talk about birth control and take the matter seriously.

Questions to Ask Your Health Care Provider

1. What are sexually transmitted diseases (STDs) or sexually transmitted infections (STIs)?
2. What type(s) of STD do I have?
3. I have STD symptoms that come and go. Should I be tested?
4. Should I be tested for HIV/AIDS?
5. When will the results of these diagnostic tests be available? Will someone contact me or should I call for the results of my STD testing?
6. Do you recommend that I avoid sexual activity until my test results are available? If not, what types of precautions can I take to reduce the risk for infecting my sexual partner?
7. Should my partner also be tested for sexually transmitted diseases?
8. Is this infection caused by bacteria, parasites, fungus, or a virus?
9. How is this infection transmitted?
10. Is this sexually transmitted disease treatable? Is it curable?
11. Does having this sexually transmitted disease increase my risk for other health problems, including other STDs?
12. Are there long-term risks or complications associated with this type of sexually transmitted disease? If so, what are these risks?
13. What does treatment for this STD involve? Which medication(s) will be used to treat my condition?
14. What are the benefits, risks, side effects, and possible complications associated with this STD treatment?
15. Should I avoid sexual activity during treatment? If not, what types of precautions can I take to reduce the risk for infecting my sexual partner?
16. How will you determine if treatment is working? Will I undergo additional STD testing?
17. If this STD is not curable, how can I reduce the risk for transmitting the disease to my future sexual partners?
18. What types of sexual activity increase the risk for STDs?

Treatments

There are many STDs and the types of STD treatment will depend on the STD you have and its symptoms. Treatment is discussed between you and your healthcare provider and takes into account your overall physical health. Talk to your healthcare provider about which treatment option is best for you.

Resources

For more information visit:

Centers for Disease Control
NIH Medline Plus