“It is a myth that incontinence is only a women’s problem; it’s more common in men than we appreciate.”
These are the words of Dr Darren Katz, a urologist, and the medical director of Men’s Health Melbourne. He specialises in continence issues, voiding dysfunction, erectile dysfunction, and male infertility.
There are two types of incontinence commonly experienced: urge incontinence (including overactive bladder), and stress incontinence (including leakage brought on by physical activity, coughing or straining). Overactive bladder symptoms can often be treated successfully with conservative measures such as exercises prescribed by pelvic floor physiotherapists, and/or certain medications.
Many of Dr Katz’s patients are part of the small percentage of men who experience incontinence after prostate surgery. “Incontinence after having the prostate out due to prostate cancer is often termed a ‘social cancer’ because patients are often reluctant to go out and socialise and can become isolated,” he says. The good news is that through medical, surgical, or allied health mechanisms, men experiencing incontinence after a prostate operation can get back to the life they want. Incontinence often gives rise to embarrassment which can cause a decline in mental health. It is therefore important for men to also have a mental health plan, which can be supported by their general practitioner or a psychologist.
Dr Katz says men experiencing stress incontinence don’t generally respond to medical interventions. Mild cases sometimes respond to pelvic floor muscle training, but if this does not work, then surgery should be considered. There are different surgical devices to help men, depending on their degree of incontinence, and if they have had other therapies such as radiation.
The options include different types of slings or an artificial urinary sphincter. It is important to get a complete assessment by your urologist to work out if you are a candidate for these anti-incontinence implants and if so, which one. All these devices can be implanted by minimally invasive incisions, and patients usually only require one night in hospital after the operation.
When men are first referred to a urologist, they are asked to complete objective measures. A 24-hour pad weight helps to determine the amount of leakage which occurs under different conditions and therefore which targeted treatment is best. Additionally, urologists will do a cough test to see how much leakage there is during coughing, a urinary flow test, an ultrasound to ensure the bladder is being properly emptied, and tests to check for infection. The results of these will determine the next steps, for example whether a cystoscopy or urodynamics study may be required. Dr Katz’s passion for his work is driven by the opportunity to dramatically improve quality of life. “The men, and often their partners who have their loved one back, are incredibly grateful. After treatment their demeanor and outlook on life changes,” he says.
Dr Katz developed and is the director of the only Australian Prosthetic and Micro-surgical Fellowship which trains urologists in world leading procedures and operations. He has trained urologists from the USA, Canada, Israel, and England. These urologists spend a year with Dr Katz and his colleagues learning the latest treatments and operations in his sub-specialty field.
WHAT IS A CYSTOSCOPY?
A cystoscopy is a medical procedure used to look inside the urinary bladder. It utilises a cystoscope, a thin tube with a light, microscopic lenses, and a small camera at the end. It is used to help diagnose conditions affecting the bladder and urinary system.
WHAT IS A URODYNAMICS STUDY?
A urodynamics study is any procedure that tests how well parts of the lower urinary tract, the bladder, sphincters, and urethra, work to store and release urine. Most urodynamic tests focus on how well the bladder can hold and empty urine and can also show whether your bladder is contracting when it’s not supposed to, causing urine to leak.