Urinary incontinence in men is a condition in which involuntary urination occurs periodically (incontinence).

The likelihood of this disease increases with age, but there is no direct relationship. Urinary incontinence in men, as a rule, is not a separate disease, but a consequence of various pathological processes. With virtually no effect on physical well-being, this disease significantly reduces the quality of life, complicates domestic, family, professional and social adaptation, inducing a number of psychological problems.

The main types of urinary incontinence in men are:

• Stressful. Urine excretion can provoke physical activity, coughing, laughter. The excreted amount of urine is usually insignificant;
• Urgent (imperative). The excretion of urine occurs due to an unbearable urge to urinate. As a rule, a large amount of urine is excreted.

Urinary incontinence in men: causes

The main causes of urinary incontinence in men are the result of:

• Age-related changes in the tissues of the prostate gland, pelvic muscles, organs of the genitourinary system;
• Cancer or adenoma (benign hyperplasia) of the prostate;
• Side effects of surgical treatment of the prostate gland;
• Damage to the brain or spinal cord, resulting in loss of bladder control;
• Infectious diseases in the lower urinary tract and bladder;
• Deposits of stones in the bladder, in the kidneys;
• neurological diseases such as stroke, Parkinson's disease, multiple sclerosis;
• taking certain medications, such as antihistamines and decongestants;
• Stress, mental illness.

Urinary incontinence in men: treatment

Treatment of urinary incontinence in men is prescribed depending on the type of disease.

• Special exercises to strengthen the muscles of the small pelvis;
• Special exercises to strengthen the muscles of the perineum and sphincter apparatus - the Kegel complex;
• Certain medications.

Treatment of urinary incontinence in men with an urgent type of disease is prescribed after determining the causes that cause it. Effective therapy of prostate adenoma or prostatitis, in case of their disease, can be a solution to the problem of urgent incontinence.

In diseases of the neurogenic or unidentified nature of urinary incontinence in men, treatment is reduced to drug relaxation of the bladder muscle, removal of its involuntary contractions and an increase in the functional capacity of the bladder.

Male urinary incontinence should not be treated folk methods and means, since this can only aggravate the course of the disease.

To prevent incontinence, you should limit the use of alcohol, coffee, stop smoking and stop taking drugs that have diuretic properties. It is necessary to control your weight, because extra pounds can create an additional burden on the bladder and provoke urinary incontinence in men.

Bedwetting in men

Bedwetting in men - enuresis, a fairly common phenomenon, especially in age category over 45 years old. More than half of all manifestations of enuresis in adult men are the result of untreated childhood diseases. In other cases, doctors ascertain acquired or so-called secondary nocturnal urinary incontinence in men.

Specialists qualify the following types of enuresis in men:

• Constant;
• recurrent;
• Acquired.

At the first manifestations of bedwetting, a man should immediately go to the doctor to get qualified medical care. Enuresis is not only a psychological problem, it can cause various diseases of the genitourinary system, such as inflammation of the bladder (cystitis).

Urinary incontinence in men: medications

When conservative therapy does not lead to a decrease in the frequency of urinary incontinence in men, drugs can only be prescribed by the attending physician.

In modern medicine, there are the following types of drugs for urinary incontinence in men:

• Alpha blockers (drugs based on terazosin, doxazosin, tamsulosin, alfuzosin). They stimulate relaxation of the smooth muscles of the bladder neck and prostate gland, normalize the outflow of urine and prevent disruption of bladder contractions leading to urgent incontinence. In general, alpha-blockers are used if urinary incontinence in men is a consequence of benign prostatic hyperplasia;
• 5-alpha reductase blockers (drugs based on finasteride, dutasteride). Drugs for inhibiting the production of dihydrotestosterone, which is the cause of benign prostatic hyperplasia. They are taken to reduce the frequency of urinary incontinence or retention in the bladder by reducing the size of the prostate gland;
• Tricyclic antidepressants (drugs based on imipramine). The drugs relax the muscles and block the nerve impulses that cause bladder spasms;
• Antispasmodics (drugs based on active ingredients: propanteline, tolterodine, oxybutynin, darifenacin, trospium chloride, solifenacin succinate). A class of drugs that relax muscles and reduce bladder spasms.

For simple urination disorders, the doctor may recommend treatment with homeopathic and phytotherapeutic preparations Urilan, Enuran, etc. For the treatment of age-related incontinence, homeopathic injections for men Super Optimal are practiced.

All drugs are prescribed by the attending physician after a comprehensive examination and the establishment of an accurate diagnosis.

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Urinalysis is the most common test. In this article, you will learn how to properly prepare for the test, what are the normal indicators of the content of structural elements in the urine.

A general urinalysis is one of the simplest and at the same time effective studies of a person’s health status.

According to its results, if the decoding is correct, a medical specialist can timely determine the development of diseases of the urinary system and other internal organs and prescribe appropriate treatment. What are the normal indicators of the content of structural elements in a urine sample? Let's try to figure this out further.

How to pass a urine test?

In order to eliminate the influence of external factors as much as possible and obtain the most reliable analysis result with the least error, some measures should be taken:

• A urine sample for analysis is taken in the morning, since morning urine contains the correct information about the state of health of a man;
• Before carrying out the biomaterial sampling procedure, it is necessary to take care of the hygiene of the genital organs so that foreign microorganisms do not get into the biomaterial - otherwise the decoding of the results will be inaccurate;
• Women should not conduct a urine test during the opening of menstrual bleeding - in this case, it is better to postpone the study;
• A biomaterial sample must reach the laboratory within two hours after collection - over time, the urine darkens and the content of elements in it changes, so it is important to deliver the urine sample still fresh.
• For research, an average portion of urine is taken. The first portion is drained into the toilet, and the second portion is collected in a pre-prepared sterile container.

For analysis, it is convenient to use a special laboratory container - a plastic sterile container with a hermetically sealed lid. It is easiest to store and transport biomaterial in it. Such a container is sold in any pharmacy in our country.

For a general urine test, you need to collect about 50 milliliters of biomaterial.

Determination of the physical properties of the urine sample

The first step in examining a urine sample is visual. The specialist evaluates deviations in shade, smell, transparency, density and acidity. Medical science has defined standards for all these indicators for a healthy person. Comparing the sample with reference indicators, the specialist draws conclusions about deviations.

The color of the urine should be light yellow. The presence of pathologies of the urinary system or other factors, for example, taking certain tablets (antipyrine, amidopyrine, santonin) or products with rich pigment (carrots, beets) can affect the change in shade. Menstrual bleeding also changes the color of urine.

Urine turns scarlet if it contains red blood cells. This happens with glomerulonephritis, renal colic, the formation of stones and tumors in the kidneys, as well as domestic injuries.

Read also related

How much urine is needed for an adult analysis, how long can it be stored

Greenish-yellow dark-colored urine acquires if pus accumulates in it during hepatitis, which often provokes complications of liver and kidney diseases.

Intoxication of the body with all kinds of poisons or an overdose of pharmaceuticals can provoke a change in the color of urine to Brown color.

If hemoglobin, which is contained in unchanged red blood cells, enters the urine, urine turns black. This indicates hemolytic anemia.

A urinometer is a standard instrument used by a laboratory technician to determine the density of urine. The urinometer, which has a printed scale, is immersed in a container with a sample of the material. Density is determined by the degree of immersion. The normal rate for an adult male is about 1020 grams per liter.

A foreign smell of urine can also indicate diseases. urinary organs or completely other diseases. Thus, diabetes mellitus causes a sharp smell in urine, similar to acetone.

Also, the laboratory assistant compares the transparency of the sample with the standard by eye. Cloudy urine is a symptom of kidney malfunction., since in such urine there are protein compounds that should not be present in a healthy urinary system.

The level of acidity is determined by the indicator. A small paper stick coated with a reagent is dipped into the urine sample. A chemical reaction occurs and the indicator changes color - this means that the result of the acidity test is normal.

The content of structural elements in the analysis of urine.

The second stage of the study of urine is the identification of the elements contained in it. Standard organic analysis includes determination of the presence of protein compounds and sugar. physician in case of suspected specific disease has the right to send the patient for an in-depth study to determine the content of bilirubin, bile acids, indican.

First, using the indicator, the specialist determines the presence of a substance in the sample: if the indicator changes color, it means that a chemical reaction has occurred, that is, the desired substance is contained in the sample. Next, using a microscope, the specific content of each element in the field of vision is calculated.

Urine sediment analysis. Decryption

The urine sample is placed in a centrifuge, where, under the action of centrifugal force, solid particles are separated from the liquid - a precipitate forms.

Microscopic analysis reveals the concentration of such elements:

• epithelial cells;
• mucous fluid;
• erythrocytes;
• leukocytes;
• cylinders;
• crystalline salt;
• microbes.

There are several types of epithelium: flat, transitional and renal. In a healthy body, a small number of squamous epithelial cells (up to five units) is necessarily present. The content of the renal epithelium in the patient's urine is a bad symptom, signaling diseases of the urinary system.

Also, in a healthy body, mucus and microbes should not be present in the urine sediment. The number of bacteria is approximately calculated and marked on the form according to gradations from one to four crosses, where four means numerous content.

Detection in the urine sediment of salts of urates, scalates and phosphates is considered normal, their concentration is noted in the same way as microbes - with crosses.

The number of leukocytes in the urine of a healthy man should be no more than 3 units. An elevated level of leukocytes indicates inflammation of the urinary organs.

Deciphering the indicators of a general urine test

General urine analysis refers to mandatory diagnostic procedures that are assigned to all patients who apply to a healthcare institution.

Here we will tell you what indicators of urine are measured in a general urine test, and what diseases are indicated by certain deviations of these indicators from the norm. And also about how to properly collect urine for general analysis, analysis of daily urine and for urine analysis according to Nechiporenko.

In the general analysis of urine, parameters such as specific gravity (relative density), color, transparency, odor, pH (acidity), protein content, glucose content, content of ketone bodies and bile pigments and some other indicators are examined.

The results of the urine test are given to the patient in the form of a table with incomprehensible letters, which can only be read by a specialist. Below is a transcript of those very "incomprehensible letters", as well as the norms and possible deviations for individual indicators.

Deciphering the indicators of a general urine test

BLd - erythrocytes,
Bil- bilirubin,
Uro - urea,
KET ketones,
PRO protein,
NIT - nitrites (in the usual sense - bacteriuria),
GLU - glucose,
pH - acidity,
S.G - density,
LEU - leukocytes,
UBG - urobilinogen.

The table shows the main indicators of the general analysis of urine in the norm. Some of them will be discussed in more detail below:

The norm of a general urine test (table)

Interpretation of urinalysis indicators

The rate of urine analysis in adults and children (table)

Normal values ​​(in the field of view)

Acid-base reaction of urine is normal

The urine reaction (pH) of urine in a healthy person on a mixed diet is acidic or slightly acidic.

Table: Urine acidity in children and adults is normal

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The specific gravity of urine (g / l) is normal

The specific gravity of the urine of a healthy person during the day can fluctuate in a fairly wide range, which is associated with periodic food intake and loss of fluid through sweat and exhaled air.

Table: The specific gravity of urine in adults and children is normal

The specific gravity of urine depends on the amount of substances dissolved in it: urea, uric acid, creatinine, salts.

• A decrease in the specific gravity of urine (hypostenuria) to 1005-1010 g / l indicates a decrease in the concentration ability of the kidneys, an increase in the amount of urine excreted, and drinking plenty of water.
• An increase in the specific gravity of urine (hyperstenuria) more than 1030 g / l is observed with a decrease in the amount of urine excreted, in patients with acute glomerulonephritis, systemic diseases, cardiovascular insufficiency, may be associated with the appearance or increase edema, large fluid loss (vomiting, diarrhea), toxicosis of pregnant women.

Protein in the urine, protein in the urine

Fine protein in urine missing. Appearance protein in urine is one of the most important symptoms of kidney and urinary tract disease. The appearance of protein in the urine is called proteinuria. Proteinuria is possible in healthy people after taking a large amount of food rich in proteins, after strong physical stress, emotional experiences.

Pathological proteinuria divided into renal (prerenal) and extrarenal (postrenal):

• Extrarenal proteinuriadue to the admixture of protein excreted by the urinary tract and genital organs; they are observed at cystitis, pyelitis, prostatitis, urethritis, vulvovaginitis. Such proteinuria rarely exceeds 1 g / l (except in cases of severe pyuria - the detection of a large number of leukocytes in the urine).
• Renal proteinuriamost often associated with acute and chronic glomerulonephritis and pyelonephritis, nephropathy of pregnancy, febrile conditions, severe chronic heart failure, kidney amyloidosis, lipoid nephrosis, kidney tuberculosis, hemorrhagic fevers, hemorrhagic vasculitis, hypertension.
  

Glucose (sugar) in urine (normal)

Carbohydrates (glucose) in urine a healthy person are contained in insignificant concentrations, their presence is almost always a sign diabetes. So, normally, urine contains glucose in the form of traces not exceeding 0.02%, which, like protein, is not detected by ordinary quality tests.

Urinalysis for red blood cells (normal)Source: http://med..php/%D0%B0%D0%BD%D0%B0%D0%BB%D0%B8%D0%B7%D1%8B/193-%D0%B0%D0%BD %D0%B0%D0%BB%D0%B8%D0%B7-%D0%BC%D0%BE%D1%87%D0%B8.html

Erythrocytes (red blood cells)normally, there are no urine sediments or single ones are found in the preparation. A general urine test in a healthy person should show no more than 2 erythrocytes in the microscope field of view, and no more than 3 leukocytes in men and 5 in women.

An increased number of red blood cells is characteristic of many diseases: pyelonephritis, urolithiasis, glomerulonephritis, urinary tract infections, systemic lupus erythematosus or poisoning(especially poisonous mushrooms, snake venom, benzene and aniline derivatives).

Urinalysis for leukocytes (normal)

Fine leukocytes in the urine are absent, or single ones are detected in the preparation and in the field of view. An increased content of leukocytes indicates possible pathologies of the kidneys or urinary tract: glomerulonephritis, pyelonephritis, urethritis, cystitis, prostatitis.

Leukocyturia (more than 5 leukocytes per field of view) can be infectious (bacterial inflammation of the urinary tract) and aseptic (with glomerulonephritis, amyloidosis, chronic renal transplant rejection, chronic interstitial nephritis). pyuria consider the detection in the sediment during microscopy of 10 or more leukocytes in the field of view.

Urinalysis for epithelium (normal)

squamous epithelium: in men, only single cells are normally detected, their number increases with urethritis and prostatitis. In the urine of women, squamous cells are present in greater numbers.

Transitional epithelial cells may be present in significant amounts acute inflammatory processes in the bladder and renal pelvis, intoxication, urolithiasis and neoplasms of the urinary tract.

Department of Urology, Moscow State University of Medicine and Dentistry.

Urinary incontinence in men one of the most difficult diseases in urology. There is no guaranteed method of treatment that allows you to completely get rid of this disease. , as a rule, develops as a result of a certain lifestyle, functional negative changes in the bladder, and in some cases its sphincter, the negative impact of the external environment, including complications caused by incorrect actions of the doctor or the treatment itself, as well as from a combination of these factors.

The main manifestations of urinary incontinence in men include: bedwetting, incontinence after prostatectomy, and urine leakage after urination. This may be due to detrusor overactivity, chronic urinary tract infection, infravesical obstruction, bladder cancer, or neurological disease. Unlike women, sphincter insufficiency in men is rare, but can develop as a result of trauma, after prostate surgery, or as a result of neurological disorders. All treatments for urinary incontinence in men can be divided into two large groups: conservative and surgical. Depending on this, we present generally accepted practical advice for the treatment of this condition.

Preserving methods of treatment of the disease associated with urinary incontinence in men.

Bringing the conditions and features of everyday life back to normal.

To date, selective, specialized studies have not been conducted on the influence of the conditions and characteristics of everyday life on the specific activity of the body to retain urine in men. The data below was obtained in the process of collecting information from other researchers.

1. Slimming.

Unfortunately, studies on the effect of male body weight on urinary retention have not yet been conducted. According to the available information, mass, index and body weight do not have a pronounced effect on the male lower urinary tract (LUTS).

2. Refusal of tobacco smoking.

In smokers, the intensity of LUTS is significantly, one and a half times, increased, in comparison with non-smokers or those who have given up tobacco.

3. Reducing the amount of fluid consumed.

Several studies conducted have provided reasoned information about the absence of a pronounced dependence of incontinence (incontinence) on the volume of fluid consumed.

4. Alcohol and caffeine containing liquids.

Reducing the consumption of alcohol and caffeine-containing fluids does not affect the severity of incontinence (incontinence) in men.

Treatment of bedwetting (enuresis).

Bedwetting in adult men is not only a cause of severe discomfort, but can also affect a career, family relationships and social adaptation. There are primary and secondary nocturnal urinary incontinence.

1. Treatment of primary nocturnal urinary incontinence in men.
Urinary incontinence is primary if the patient has a lifetime of involuntary urination at night. According to various data, this category of patients includes from 0.3% to 0.6% of all men. Most of these patients have detrusor overactivity. The main treatments for this type of incontinence include:

• Nighttime awakenings to urinate
• Taking desmopressin at night
• Antimuscarinic drugs (oxybutynin)

2. Treatment of secondary (acquired) nocturnal urinary incontinence in men.
Bedwetting in men is called secondary if the patient has not had episodes of bedwetting at night for at least a year before the onset. This condition is characteristic of a number of pathologies, and the tactics of treatment depend on it.

a) Diabetic cystopathy
Develops in patients with diabetes second type. Clinical manifestations are associated with the development of detrusor hyperactivity. Treatment consists of correcting blood sugar levels and taking drugs that suppress detrusor overactivity.
b) Infravesical obstruction
A typical example is chronic urinary retention with the development of paradoxical ischuria in elderly patients with prostatic hyperplasia. It can be cured after the causes of the obstruction are removed.
c) Diseases of the endocrine system
Bedwetting can develop in men with thyrotoxicosis and is cured after normalization of thyroid hormone levels.
d) Sleep apnea syndrome
This syndrome can be the cause of urinary incontinence at night. in the best way treatment is to eliminate the cause of the disease.

Treatment of urinary incontinence after prostate surgery.

Urinary incontinence in men most often occurs after radical prostatectomy, but can also develop after open surgery for benign prostatic hyperplasia, after transurethral resection of the prostate, as well as any other interventions on the prostate gland and male urethra. There is a set of measures aimed at the conservative elimination of urinary incontinence that developed in the postoperative period. Minimum period conservative therapy ranges from 6 months to 1 year.

1. Patient selection.
Detrusor overactivity is one of the main causes of urinary incontinence in men in the postoperative period. In patients with hyperactive symptoms, a urodynamic study should be performed prior to surgical treatment. Patients with severe parkinsonism are also at risk and, if possible, should be treated conservatively.

2. Improvement of surgical technique.
During radical prostatectomy, careful anatomical dissection of the apical part of the prostate gland with the maximum possible preservation of the length and ligamentous apparatus of the urethra are the most important factors in reducing the severity of incontinence in the postoperative period. Preservation of the puboprostatic ligaments leads to a faster recovery of urinary continence in the postoperative period. This result is achieved due to the preservation of the elements of the external sphincter of the bladder.

3. Pelvic floor muscle training.
It has been proven that pelvic floor muscle training combined with electrical stimulation, biofeedback exercises, or transcutaneous electrical stimulation leads to faster resolution of incontinence in the postoperative period. The disadvantages of all studies were: the absence of control groups of comparison, a small number of patients, and a short duration of observation. A possible placebo effect was also not assessed.

After TURP, bladder sphincter function returns spontaneously within one month. Training the pelvic floor muscles leads to a reduction in this period to one to two weeks.

In patients undergoing radical prostatectomy after an initial, relatively rapid recovery period, urinary retention slowly returns over the next three months. In a relatively small group of patients, the continence recovery period lasts from 6 to 12 months. Given the above data, conservative therapy aimed at eliminating incontinence in the postoperative period should be carried out for at least three months. The best methods of conservative therapy are the implementation of a set of exercises aimed at training the muscles of the pelvic floor and electrical myostimulation.

In the clinic of urology of MSMSU in last years Urinary incontinence is treated using a myostimulator - a Neocontrol chair. The method of extracorporeal magnetic influence was presented for the treatment of urinary incontinence as an alternative to electrical stimulation. The Neocontrol system is intended for the treatment of diseases associated with dysfunction of the pelvic floor muscles. The basis of the therapeutic effect is the mechanism of magnetic induction. In the clinic of urology of the Moscow State Medical University, this type of therapy is widely used for the treatment various forms urinary incontinence in both women and men.

4. Pharmacotherapy.
Detrusor overactivity is one of the main factors in the development of urinary incontinence after prostate surgery. However, it is very difficult to predict the development of detrusor overactivity in this particular patient after TURP or prostatectomy. According to the results of urodynamic studies, 34% of patients with incontinence have sphincter insufficiency, 26% suffer from detrusor overactivity, and 33% have a mixed form of urinary incontinence. Medical elimination of the hyperactive component can lead to the elimination of urinary incontinence, or to a significant relief of symptoms.

Treatment of leakage of urine after urination.

Leakage after urination is a common complaint in men with urethral stricture or other cause of urethral obstruction. A rare cause is the presence of a urethral diverticulum. Pathology is associated with urinary retention in the bulbous urethra, followed by the release of the latter during movement or under the influence of gravity. These symptoms are present in 17% of healthy adult men and in 67% of patients with LUTS. Leakage of urine after urination does not threaten the life of patients, but leads to a sharp deterioration in its quality. To combat leakage, it is recommended that the urethra be carefully "chipped off" and/or a series of rhythmic pelvic movements be performed before the penis is placed in the underpants. They may also be beneficial exercises for training the pelvic floor muscles.

Medical products for collection and storage of urine.

For patients with urinary incontinence that is not amenable to the available treatments, the main goals of therapy are:

• Skin protection
• Protecting clothes and bed
• Fight bad odor

There are three groups of devices for solving these problems. These include: absorbents(pads, disposable and reusable diapers, diapers); urine collection devices(urinals fixed to the penis); occlusive type devices(penile clips). Absorbents are effective but expensive devices for permanent use. Urine bags are most widely used in everyday practice. Given that the number of patients with urinary incontinence is increasing every year, it is necessary to fight to reduce the complications from the use of such devices (dermatitis, penile ischemia/necrosis, urethral erosions and urinary infection).

Operative methods of treatment of urinary incontinence in men.

Surgical treatment of urinary incontinence in men is becoming increasingly important due to the sharp increase in operations for prostate cancer. At the same time, the possibility of developing urinary incontinence after open and endoscopic operations for BPH remains, which may also require surgical treatment. Below is a classification of diseases and pathological conditions that lead to urinary incontinence, which may require surgical correction, depending on the etiology.

• Associated with violation of the sphincter apparatus.
  • Postoperative
    • After radical prostatectomy
    • After surgery for BPH
    • TURP and radiotherapy for PCa
    • After cystoprostatvesiculectomy with ileocystoplasty for bladder cancer
  • Post-traumatic
    • After reconstruction of the posterior urethra
    • pelvic injury
  • Congenital
    • Exstrophy and epispadias
• Associated with bladder pathology
  • Incontinence due to severe detrusor overactivity
  • Shriveled bladder
• Fistulas
  • Urethral-rectal
  • urethro-dermal

Surgical methods of treatment can be used only after the use of complex conservative treatment for at least 6 months after surgery. There are several ways to surgically correct urinary incontinence in men associated with the pathology of the sphincter apparatus.

1. Implantation of an artificial sphincter of the bladder.
Implantation of an artificial bladder sphincter is successful in 75-80% of cases in patients who have undergone radical prostatectomy and in about 70% of patients who have undergone surgery for BPH. Implantation of an artificial sphincter is the operation of choice for patients with insufficiency of the internal sphincter of the bladder with its normal function, and this operation is also indicated in cases of urinary incontinence due to pelvic trauma. Complications of sphincter implantation include: urinary incontinence; erosion; periprosthetic infection; damage to the components of the prosthesis.

2. Injection therapy.
Periurethral injections of collagen can achieve success in 40-50% of cases in patients undergoing surgery for benign and malignant diseases of the prostate. The main problem of this type of treatment is the temporality of the effect due to the migration and resorption of collagen. Injection therapy is not a reliable treatment for urinary incontinence in men.

3. Sling operations.
In connection with the development of new technologies, sling operations in various modifications began to be used in the treatment of urinary incontinence in men. The operation is based on the creation of a mechanism for urinary retention due to compression of the bulbous urethra. The first publications gave encouraging results. There are two approaches for installing the loop: retropubic and perineal with fixation of the synthetic mesh to the bones of the pubic joint. The last modification using the InVanceTM loop allows to achieve a positive effect in 55 - 76% of cases. The experience of the Urology Clinic of Moscow State University of Medicine and Dentistry in the treatment of stress urinary incontinence in men using the InVanceTM loop allows us to speak about the good results of using this method.

Treatment of other forms of urinary incontinence in men.

Incontinence associated with radiation therapy, cryosurgery, pelvic surgery and pelvic trauma is a particularly difficult problem to treat, since the damaging factor does not directly affect the urethra. In this situation, the implantation of an artificial sphincter is most preferable, however, complications of implantation in such conditions are more likely.

Problems associated with incontinence due to detrusor overactivity that does not respond to conservative treatment may require reconstructive surgery. Rare conditions such as urethro-cutaneous and urethro-rectal fistulas require surgical treatment by an experienced surgeon.

Conclusion.

Summing up, I would like to emphasize again that the problem of urinary incontinence in men is difficult to treat. Only a whole range of measures can make it possible to successfully fight this disease. It is necessary to carry out further work aimed at the development of new conservative and surgical methods of treatment. It is also necessary to conduct many multicenter randomized trials to select the optimal tactics for the treatment of urinary incontinence in men.

Men often have problems with urination, especially in older late age. One of the main problems is that a man does not pass urine well. In medical terms, this condition is called ischuria.

Urinary retention is usually caused primarily by psychological difficulties and physical discomfort. Moreover, in a man with such congestion, the general condition of the body worsens. If timely measures are not taken to eliminate the problem, complications may occur. That is why the treatment of pathologies that cause urinary retention should be timely.

Urinary retention in men: types of pathology

Ischuria is a disease that can develop at different rates. As a rule, depending on this symptom, pathology is divided into two main types

acute form

As a rule, acute urinary retention in men is quite unexpected for a man. At the same time, he experiences a number of symptoms that accompany the disease. These signs include pain in the lower abdomen and the urge to go to the toilet more often than usual.

In addition, a man may feel an unpleasant feeling that the bladder is not completely empty. At the beginning of the development of the disease, the patient's urine is excreted in small portions, however, over time, even with stress, urine ceases to be excreted at all. At the same time, urine accumulates in the bladder, causing an increase in the abdomen in a man, which becomes very noticeable externally. This condition is dangerous for the body, and therefore it is necessary to urgently consult a doctor..

Chronic form

The chronic form, in which urine is poorly discharged in a man, usually proceeds for a long time. In this case, a man may not notice the signs of the disease and not pay attention to the difficulties that have arisen when urinating. However, sooner or later the urinary canals will narrow so much that it will begin to cause a certain discomfort to the man. Chronic urinary retention in men can, under the influence of external factors, turn into acute.

Incomplete urinary retention allows a man for a long time not to notice the appearance of a problem at all. With the full form of pathology, a man feels a sharp deterioration in well-being, and therefore, as a rule, urgently seeks medical help. In such cases, when a man cannot urinate outside on his own, the doctor uses a catheter.

It is possible to determine the development of ischuria by a characteristic feature - the need to strain to go to the toilet. In this case, urination often occurs intermittently. Sometimes in men there is a so-called paradoxical ischuria, in which the patient is not able to empty the bladder voluntarily, but drops of urine are involuntarily released from the urethra. In any case, the pathology requires medical intervention, and therefore it is highly not recommended to delay the problem.

Causes of urinary retention in men

Ischuria can develop in a man under the influence of many factors. The most common reasons are the following:

Urinary obstruction in men can occur due to various reasons and in different ages. Even some disturbances in the central nervous system injury or damage to the brain or spinal cord. Frequent violations in urination after operations on the spine or abdominal organs.

1. Sometimes the abuse of alcohol or drugs leads to ischuria in men.
2. In some cases, urinary retention appears as a result of prolonged use of drugs, for example, sleeping pills or sedatives, antidepressants have a strong effect.
3. Sometimes urine can stop being excreted after severe hypothermia of the body, after serious stress or heavy physical exertion.

The chronic form of the disease, as a rule, appears in elderly men.. If for a long time a man has experienced various or problems with the organs of the genitourinary system, pathology may appear over time.

One of the most dangerous causes of ischuria is neoplasms in the prostate, including benign hyperplasia. As a rule, in most cases, urination becomes difficult due to the enlargement of the prostate gland. In this case, the gland on both sides squeezes the urethra, making the urethra narrower, which is why the urine does not pass completely, or does not come out at all.

In addition, diseases that occur in other organs near the genitourinary system can cause urinary retention. For example, fibrosis and sclerosis, as well as inflammatory processes in the intestines, can affect. In older men, neurogenic dysfunction in the bladder is sometimes observed.

Signs of ischuria in a man

The main symptom of ischuria is, of course, a violation of the normal process of urination. At acute form such symptoms are more noticeable, because due to the accumulation of urine in the bladder, its walls are greatly stretched, which causes quite severe pain and a lot of discomfort.

Sometimes, if the cause of urinary retention is a blockage of the urinary canal, then a man may also feel pain in the urethra due to stones that linger there. If the cause of urinary retention is an injury to the penis, then discharge in the form of blood clots from the urethra is possible.

The acute form of ischuria can be seen even with the naked eye, since the man's belly increases significantly in size. In addition, the man experiences, but no urine is excreted. If the cause of urinary retention lies in inflammatory processes, the man will feel sharp pains in the lower abdomen and lower back.

If the chronic form of ischuria is caused by prostate adenoma, then the man will experience the following signs of the disease:

• Frequent urge to go to the toilet.
• Constant feeling that the bladder is not completely emptied. As a rule, only a small portion of urine is excreted during urination.
• The stream of urine is sluggish.
• Frequent urination at night.

In the absence of proper medical care intoxication can occur in the body due to harmful substances that are in the urine. In addition, due to the strong overflow of the bladder with urine, rupture of its walls may occur. At the same time, the man has symptoms of an "acute abdomen", in which irritation occurs in the abdominal cavity.

In order to make a correct diagnosis, the doctor may additionally prescribe a urinalysis, ultrasound, cystoscopy or computed tomography. These studies help to determine the presence of neoplasms in the organs of the genitourinary system, as well as other disorders and pathologies.

Poor urine output - how to treat

With an acute form of urinary retention in order to alleviate the patient's condition and prevent intoxication or rupture of the bladder. However, the use of a catheter to remove urine is a one-time procedure that cannot be used on an ongoing basis. Therefore, to improve the patency of urine, complex therapy is needed to eliminate the cause of the disease:

There are also folk recipes, which help to improve the process of urination and get rid of diseases. However, if symptoms of ischuria are detected, the first thing to do is to consult a doctor and conduct an examination.