Dr. Jonathan Beilan, a urologist at BayCare’s Morton Plant Hospital, discusses different types of urinary incontinence and the treatment options available.
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Male Urinary Incontinence
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Dr. Beilan completed his general surgery internship and urologic residency at the University of South Florida in Tampa, Florida. Throughout his training, he received surgical and clinical teaching in all aspects of modern urology, including extensive training in procedures for Peyronie’s Disease and erectile dysfunction. Early in residency, Dr. Beilan developed a strong interest in sexual medicine and male fertility. He completed a clinical fellowship in Male Reproductive Medicine and Surgery at Baylor College of Medicine. Here, Dr. Beilan learned the complexities of male infertility and the intricacies of microsurgical procedures such as varicocele repairs and vasectomy reversals.
Dr. Beilan joined AUI Clearwater in September 2019. He specializes in erectile dysfunction and other sexual problems such as Peyronie’s disease and low testosterone, as well as infertility and the microsurgical procedures involved in assisting males father biologic children. Dr. Beilan has authored or co-authored many peer-reviewed publications in the field of urology, and presented dozens of posters, podiums, and abstracts at national and international meetings.
Learn more about Jonathan Beilan, MD
Jonathan Beilan, MD
Dr. Jonathan Beilan was born and raised on the Gulf Coast of Florida in New Port Richey. Dr. Beilan received his undergraduate degree in Molecular Biology and Microbiology from the University of Central Florida. In 2009, he was selected to be part of the UCF College of Medicine’s inaugural class in Orlando, Florida.Dr. Beilan completed his general surgery internship and urologic residency at the University of South Florida in Tampa, Florida. Throughout his training, he received surgical and clinical teaching in all aspects of modern urology, including extensive training in procedures for Peyronie’s Disease and erectile dysfunction. Early in residency, Dr. Beilan developed a strong interest in sexual medicine and male fertility. He completed a clinical fellowship in Male Reproductive Medicine and Surgery at Baylor College of Medicine. Here, Dr. Beilan learned the complexities of male infertility and the intricacies of microsurgical procedures such as varicocele repairs and vasectomy reversals.
Dr. Beilan joined AUI Clearwater in September 2019. He specializes in erectile dysfunction and other sexual problems such as Peyronie’s disease and low testosterone, as well as infertility and the microsurgical procedures involved in assisting males father biologic children. Dr. Beilan has authored or co-authored many peer-reviewed publications in the field of urology, and presented dozens of posters, podiums, and abstracts at national and international meetings.
Learn more about Jonathan Beilan, MD
Transcription:
Male Urinary Incontinence
Intro: This is BayCare HealthChat. Another podcast from BayCare Health System.
Scott Webb: Welcome to BayCare HealthChat. I'm Scott Webb, and I invite you to listen as we discuss male incontinence, a condition that's not as common in men as it is in women, but one that can affect quality of life and overall health. And joining me today is Dr. Jonathan Beilan. He's a urologist in the BayCare Health System.
Doctor, thanks so much for your time today. We're talking about urinary incontinence and the different forms and treatments that are available. As we get rolling here, how common is urinary incontinence in men?
Dr. Jonathan Beilan: Urinary incontinence statistically is not as common in men as it is in women. I think in men, it's roughly about 8%. And certainly more common would be just generalized urinary tract symptoms or perhaps overactive bladder. And that does creep up closer to the 45% to 50% range for the urinary tract symptoms. But incontinence itself is a little bit more rare of a problem.
Scott Webb: Yeah, that's interesting to know. Eight percent seems pretty low, you know. I guess that's why we have the experts on, because I assumed it's going to be much higher, but good to know that it's relatively low. And when we talk about the kinds of evaluation that you do, what kind of evaluation can a patient expect during the workup of his incontinence?
Dr. Jonathan Beilan: Easily, you got to start with the history and physical, get the patient's story, do an exam and really get their medical and surgical history. Certainly, more common amongst men with incontinence would be a surgical history regarding their prostate, particularly a prostatectomy. And this is largely for cancer survivors. So that subset of men has a much higher risk of urinary incontinence, usually stress urinary incontinence.
Also, in the initial evaluation, when they come into the office, I'll be considering things like an ultrasound to make sure they empty their bladder successfully, perhaps a renal bladder ultrasound or even a cystoscopy, which is a camera up the urethra where the male pees out of to evaluate the prostate and the bladder and the anatomy there.
We also have some things to do the physiology rather than the anatomy. And in terms of physiology and the function, that would be a urodynamics test to kind of tell me the interplay between the brain function and the bladder function and really what's going on with that bladder function.
Scott Webb: Yeah. And it sounds like the evaluation and workup is pretty comprehensive, which is good to know. And you mentioned stress urinary incontinence there. Let's talk about the treatment options for the two main types, urgency incontinence and then, of course, stress urinary incontinence as well.
Dr. Jonathan Beilan: And I'll throw in the third one, overflow incontinence, just as something that I'm always thinking about. So for urgency incontinence, this is generally something associated with overactive bladder and what we call urgency. You know, if you're sitting in a movie theater, watching a movie and you have to go to the bathroom, generally, most of us can wait a little while before we got to run off. And some of us can't and if we try to wait, we'll end up leaking our pants and that would be classified as urgency incontinence.
So usually after the workup and we've proven that's their issue, generally we start with some medications, just oral pills, and there's a couple of different classes that we can try. And if not, then there’s second, third, fourth line treatments that can be pretty successful. Everything ranging from pelvic floor physical therapy, all the way up to procedures and surgeries. That is a whole spectrum of treatments to kind of keep it broad.
With regards to stress urinary incontinence, that's usually the stress maneuvers, the cough, the sneeze or the laugh. And, generally speaking, that's going to be some sort of procedure or surgery, whether it's a pelvic floor sling or an artificial urinary sphincter would be the most common answers for those problems.
Scott Webb: Yeah. And you mentioned the third type to be on the lookout for as well.
Dr. Jonathan Beilan: Yeah, the overflow incontinence. That's actually one of the more dangerous types. Imagine a bowl of water and you keep pouring water into it. At some point, the bowl is going to overflow and that same concept can happen with your bladder. And that's the type that can really cause kidney problems, repeat infections and worsening bladder function. So if the patient isn't emptying his bladder, that needs to be caught on the first evaluation. And then we have to talk about how you get the urine out and that's with various catheter, procedures or medications even to try to assist in that way.
When a patient first comes in and I'm collecting that story from them, I'm trying to see which category do they fall or maybe it's a mix of a couple of different ones. Sometimes you can have pieces of each type of incontinence.
Scott Webb: Yeah, I was going to ask you, you know, is there some crossover or sort of hybrid, a mixing of the different types? It sounds like there is.
Dr. Jonathan Beilan: Yeah, absolutely. And, you know, for example, a patient who had his prostate removed and now has stress incontinence can certainly develop bladder dysfunction and urinary urge incontinence as well. So then you need to kind of see which one bothers the patient more, maybe we start with medications to address the urgency. And if we're still having stress incontinence, how do we address that moving forward? So you kind of have to take it apart piece by piece.
Scott Webb: Yeah, definitely. And I want to ask you about artificial urinary sphincters. How do those work exactly?
Dr. Jonathan Beilan: Yeah. This is a pretty neat invention. It's actually prosthetic device. It's, you know, made of plastic, silicone. And you implant three different pieces all under the skin. And the most important piece is that the sphincter itself, that looks like a little, well, I don't know an inflatable donut that encircles the urethra. And it's placed kind of in the area called the perineum, which is the area between the scrotum and the anus and it encircles the urethra and will act as the external sphincter, which no longer functions in many of our stress incontinence patients. And you control the sphincter through a pump. And this goes down in the scrotum next to the testicles. And you train the patient to squeeze the pump, not their testicle, and you can inflate and deflate this sphincter based on when they need to urinate. And so when you pump it properly, their sphincter will relax and it'll now open up the urethra and you can have passage of urine. And when you want to be dry, which is the majority of your day and night, then it will stay closed.
Scott Webb: What's the relationship between prostate cancer surgery, urinary incontinence and sexual dysfunction?
Dr. Jonathan Beilan: Well, that's a good one. So the nerves to the penis and the sphincter, for that matter, are very closely related to the prostate itself. And so an individual who has prostate cancer, one of the more common treatments is complete removal of the prostate and oftentimes the nerves right next to it. And even with nerve-sparing procedures, you can still have damage to that.
So the recovery rate, for example, for erections, for erectile dysfunction ranges really anywhere from 47% to 60% at about a year. So a good subset of surgical patients still have severe or moderate to severe erectile dysfunction following surgery. And with that also goes the urinary dysfunction, meaning stress incontinence because it's really disrupting that natural sphincter, that natural urethra. So these patients can have leakage at any point in the day, but particularly with stress maneuvers or even just during sex, what we call climacturia. So that's a little bit more of a niche problem.
Scott Webb: Doctor, as we wrap up here, when it comes to incontinence, whether it's the types, treatment, you know, artificial urinary sphincters, what are your take-home messages?
Dr. Jonathan Beilan: You know, with regard to urination in general, no matter what your degree of bother is or your personal situation or your medical history, I think it's important to remember that there is a treatment that's appropriate for you. And this is not to mean that you're going to go into the doctor and all he's going to say is, "You need surgery." What I'm saying is there's a wide range of minimally invasive to completely noninvasive treatments to more aggressive options that can help your urinary symptoms and your incontinence. So don't give up hope. You know, talk to your doctor, talk to your primary care specialist or see your urologist, specifically one familiar with the treatment of male urinary incontinence and talk through the options and see which one is right for you.
Scott Webb: I mean, that's just great advice because I think we all as patients and doctors and nurses of patients, of course, as well, you know, we all want options. So we want to know that there's a thorough evaluation and workup being done, that we’re in the hands of professionals, experts who specialize in these types of things. And then of course, ultimately, we want to know that we have options and we pick the right option, you know, working with our doctors, the right option for us. So doctor, thanks so much for your time today. This was educational and fun and you stay well.
Dr. Jonathan Beilan: All right. Thanks for having me. I appreciate it.
Scott Webb: And to learn more about men's health services and all the services of BayCare, please visit BayCare.org.
And that wraps up this episode of BayCare HealthChat. Always remember to subscribe, rate, and review this podcast and all the other BayCare podcasts, so we can share the wealth of information from our experts together. I'm Scott Webb. Stay well.
Male Urinary Incontinence
Intro: This is BayCare HealthChat. Another podcast from BayCare Health System.
Scott Webb: Welcome to BayCare HealthChat. I'm Scott Webb, and I invite you to listen as we discuss male incontinence, a condition that's not as common in men as it is in women, but one that can affect quality of life and overall health. And joining me today is Dr. Jonathan Beilan. He's a urologist in the BayCare Health System.
Doctor, thanks so much for your time today. We're talking about urinary incontinence and the different forms and treatments that are available. As we get rolling here, how common is urinary incontinence in men?
Dr. Jonathan Beilan: Urinary incontinence statistically is not as common in men as it is in women. I think in men, it's roughly about 8%. And certainly more common would be just generalized urinary tract symptoms or perhaps overactive bladder. And that does creep up closer to the 45% to 50% range for the urinary tract symptoms. But incontinence itself is a little bit more rare of a problem.
Scott Webb: Yeah, that's interesting to know. Eight percent seems pretty low, you know. I guess that's why we have the experts on, because I assumed it's going to be much higher, but good to know that it's relatively low. And when we talk about the kinds of evaluation that you do, what kind of evaluation can a patient expect during the workup of his incontinence?
Dr. Jonathan Beilan: Easily, you got to start with the history and physical, get the patient's story, do an exam and really get their medical and surgical history. Certainly, more common amongst men with incontinence would be a surgical history regarding their prostate, particularly a prostatectomy. And this is largely for cancer survivors. So that subset of men has a much higher risk of urinary incontinence, usually stress urinary incontinence.
Also, in the initial evaluation, when they come into the office, I'll be considering things like an ultrasound to make sure they empty their bladder successfully, perhaps a renal bladder ultrasound or even a cystoscopy, which is a camera up the urethra where the male pees out of to evaluate the prostate and the bladder and the anatomy there.
We also have some things to do the physiology rather than the anatomy. And in terms of physiology and the function, that would be a urodynamics test to kind of tell me the interplay between the brain function and the bladder function and really what's going on with that bladder function.
Scott Webb: Yeah. And it sounds like the evaluation and workup is pretty comprehensive, which is good to know. And you mentioned stress urinary incontinence there. Let's talk about the treatment options for the two main types, urgency incontinence and then, of course, stress urinary incontinence as well.
Dr. Jonathan Beilan: And I'll throw in the third one, overflow incontinence, just as something that I'm always thinking about. So for urgency incontinence, this is generally something associated with overactive bladder and what we call urgency. You know, if you're sitting in a movie theater, watching a movie and you have to go to the bathroom, generally, most of us can wait a little while before we got to run off. And some of us can't and if we try to wait, we'll end up leaking our pants and that would be classified as urgency incontinence.
So usually after the workup and we've proven that's their issue, generally we start with some medications, just oral pills, and there's a couple of different classes that we can try. And if not, then there’s second, third, fourth line treatments that can be pretty successful. Everything ranging from pelvic floor physical therapy, all the way up to procedures and surgeries. That is a whole spectrum of treatments to kind of keep it broad.
With regards to stress urinary incontinence, that's usually the stress maneuvers, the cough, the sneeze or the laugh. And, generally speaking, that's going to be some sort of procedure or surgery, whether it's a pelvic floor sling or an artificial urinary sphincter would be the most common answers for those problems.
Scott Webb: Yeah. And you mentioned the third type to be on the lookout for as well.
Dr. Jonathan Beilan: Yeah, the overflow incontinence. That's actually one of the more dangerous types. Imagine a bowl of water and you keep pouring water into it. At some point, the bowl is going to overflow and that same concept can happen with your bladder. And that's the type that can really cause kidney problems, repeat infections and worsening bladder function. So if the patient isn't emptying his bladder, that needs to be caught on the first evaluation. And then we have to talk about how you get the urine out and that's with various catheter, procedures or medications even to try to assist in that way.
When a patient first comes in and I'm collecting that story from them, I'm trying to see which category do they fall or maybe it's a mix of a couple of different ones. Sometimes you can have pieces of each type of incontinence.
Scott Webb: Yeah, I was going to ask you, you know, is there some crossover or sort of hybrid, a mixing of the different types? It sounds like there is.
Dr. Jonathan Beilan: Yeah, absolutely. And, you know, for example, a patient who had his prostate removed and now has stress incontinence can certainly develop bladder dysfunction and urinary urge incontinence as well. So then you need to kind of see which one bothers the patient more, maybe we start with medications to address the urgency. And if we're still having stress incontinence, how do we address that moving forward? So you kind of have to take it apart piece by piece.
Scott Webb: Yeah, definitely. And I want to ask you about artificial urinary sphincters. How do those work exactly?
Dr. Jonathan Beilan: Yeah. This is a pretty neat invention. It's actually prosthetic device. It's, you know, made of plastic, silicone. And you implant three different pieces all under the skin. And the most important piece is that the sphincter itself, that looks like a little, well, I don't know an inflatable donut that encircles the urethra. And it's placed kind of in the area called the perineum, which is the area between the scrotum and the anus and it encircles the urethra and will act as the external sphincter, which no longer functions in many of our stress incontinence patients. And you control the sphincter through a pump. And this goes down in the scrotum next to the testicles. And you train the patient to squeeze the pump, not their testicle, and you can inflate and deflate this sphincter based on when they need to urinate. And so when you pump it properly, their sphincter will relax and it'll now open up the urethra and you can have passage of urine. And when you want to be dry, which is the majority of your day and night, then it will stay closed.
Scott Webb: What's the relationship between prostate cancer surgery, urinary incontinence and sexual dysfunction?
Dr. Jonathan Beilan: Well, that's a good one. So the nerves to the penis and the sphincter, for that matter, are very closely related to the prostate itself. And so an individual who has prostate cancer, one of the more common treatments is complete removal of the prostate and oftentimes the nerves right next to it. And even with nerve-sparing procedures, you can still have damage to that.
So the recovery rate, for example, for erections, for erectile dysfunction ranges really anywhere from 47% to 60% at about a year. So a good subset of surgical patients still have severe or moderate to severe erectile dysfunction following surgery. And with that also goes the urinary dysfunction, meaning stress incontinence because it's really disrupting that natural sphincter, that natural urethra. So these patients can have leakage at any point in the day, but particularly with stress maneuvers or even just during sex, what we call climacturia. So that's a little bit more of a niche problem.
Scott Webb: Doctor, as we wrap up here, when it comes to incontinence, whether it's the types, treatment, you know, artificial urinary sphincters, what are your take-home messages?
Dr. Jonathan Beilan: You know, with regard to urination in general, no matter what your degree of bother is or your personal situation or your medical history, I think it's important to remember that there is a treatment that's appropriate for you. And this is not to mean that you're going to go into the doctor and all he's going to say is, "You need surgery." What I'm saying is there's a wide range of minimally invasive to completely noninvasive treatments to more aggressive options that can help your urinary symptoms and your incontinence. So don't give up hope. You know, talk to your doctor, talk to your primary care specialist or see your urologist, specifically one familiar with the treatment of male urinary incontinence and talk through the options and see which one is right for you.
Scott Webb: I mean, that's just great advice because I think we all as patients and doctors and nurses of patients, of course, as well, you know, we all want options. So we want to know that there's a thorough evaluation and workup being done, that we’re in the hands of professionals, experts who specialize in these types of things. And then of course, ultimately, we want to know that we have options and we pick the right option, you know, working with our doctors, the right option for us. So doctor, thanks so much for your time today. This was educational and fun and you stay well.
Dr. Jonathan Beilan: All right. Thanks for having me. I appreciate it.
Scott Webb: And to learn more about men's health services and all the services of BayCare, please visit BayCare.org.
And that wraps up this episode of BayCare HealthChat. Always remember to subscribe, rate, and review this podcast and all the other BayCare podcasts, so we can share the wealth of information from our experts together. I'm Scott Webb. Stay well.