Urinary incontinence in men: current and developing therapy options

ABSTRACT

Introduction: Urinary incontinence in men is a significant and often underappreciated problem. Men can have urgency and or stress incontinence. Urgency incontinence as part of the overactive bladder (OAB) syndrome and can often coexist with benign prostatic obstruction (BPO) in men and the initial treatment of this is conservative lifestyle changes and then medical therapy.

Areas covered: This literature review aims to cover synthetic drugs currently utilised to treat urinary incontinence in men that are phase III and onwards. Neurological incontinence and surgical treatment options for male urinary incontinence are beyond the scope of this review.

Expert opinion: The most common form of urinary incontinence in men is urgency incontinence secondary to an OAB, which often co-exists in men, with bladder outflow obstruction (BOO). The pharmacotherapy options to treat OAB include antimuscarinics, β3 agonists and phosphodiesterase inhibitors. Antimuscarinics and β3 agonists are effective in treating OAB, and have been found to have no increased urinary retention risk in the group of patients with co-existing BPO. Emerging medications include the alternative β3 agonists – solabegron and ritobegron. The future may include novel combinations of these therapies.

KEYWORDS:

• Urinary incontinence
• male
• antimuscarinic
• overactive bladder

Article highlights

• Male incontinence can be urgency or stress incontinence in type. A detailed and thorough history and examination, validated questionnaires, and appropriate investigations (such as urodynamics) are essential to developing a diagnosis, and ruling out significant pathologies (urinary tract infection or malignancy).

• The medications that may be used to treat urinary urgency incontinence secondary to an OAB in men include antimuscarinics, β3 agonists, and phosphodiesterase 5 inhibitors. The noradrenaline serotonin reuptake inhibitor duloxetine is sometimes used to treat SUI.

• Antimuscarinics are effective and safe in treating urgency incontinence in men.

• Trospium, tolterodine, and solifenacin have specifically been investigated in the cohort of men with coexisting BPO and OAB and are effective, with no increased risk of urinary retention.

• The β3 agonist mirabegron is safe and efficacious in treating urgency incontinence in men and data are emerging to suggest good efficacy in men with coexisting BPO and OAB symptoms. Long-term data are still awaited.

• Future treatment of urinary incontinence in men is likely to include combinations of medications affecting different pathways.

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Declaration of interest

P Abrams has received consultancy fees from Astellas, Pfizer, Ferring, Ipsen and Proctor & Gamble; lecturer fees from Astellas, Pfizer, Ferring and Sanofi; and investigator fees from Astellas. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed