[Epidemiology and etiology of male urinary incontinence]

Compared to female urinary incontinence, the prevalence and socioeconomic impact of male urinary incontinence has not gained much attention from epidemiologists. Moreover, the few available epidemiological surveys vary in their use of definitions and methodology, which are known to have great impact on the resulting prevalences. Therefore, the interpretation of the findings is difficult. Depending on definitions and methods, the prevalence of male urinary incontinence ranges between 5.4 and 15%. Urgency incontinence is the predominant subtype in all age groups, although the relative proportion shifts towards stress incontinence with rising age. Neurological and posttraumatic causes for male stress incontinence become less important as the frequency of iatrogenic interventions (radiation, prostate surgery) increase. Additional risk factors for male urinary incontinence are age, immobility, and neurological diseases. Surgery of the prostate (TURP, radical prostatectomy) is especially associated with postoperative urinary incontinence if bladder and/or sphincter dysfunctions are preexisting, if the patient is particularly old, and the surgeon's experience is limited. The etiology of male urgency incontinence comprises detrusor instability caused by obstruction, age-related detrusor degeneration, insufficient inhibitory CNS control over afferent detrusor overstimulation, and neurological diseases. The pathophysiological key factors of male continence are functional urethral length and maximum closure pressure, the preservation of which should receive the unrestricted attention of every prostate surgeon.