Join Dr. Lucas Wiegand as he describes the types of male incontinence and what makes male incontinence unique, familiarize with the treatments for urge and stress incontinence and how they differ, and Recognize that urologic surgery and/or radiation for prostate cancer complicate the workup and treatment of incontinence in men.
PHYSICIANS
ACCME
USF Health is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
USF Health designates this live activity for a maximum of 0.25 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Florida Board of Medicine
USF Health is an approved provider of continuing education for physicians through the Florida Board of Medicine. This activity has been reviewed and approved for up to 0.25 continuing education credits.
Target Audience: Urologists, Primary Care Physicians, Urologic Oncologists
Release Date: 2/21/2023
Expiration Date: 2/21/2024
Relevant Financial Relationships
All individuals in a position to influence content have disclosed to USF Health any financial relationship with an ineligible organization. USF Health has reviewed and mitigated all relevant financial relationships related to the content of the activity. The relevant relationships are listed below. All individuals not listed have no relevant financial relationships.
Lucas Weigand, MD: Consultant for Intuitive, Provepharm, Boston Scientific, & Coloplast
Claim CME/CEU Credit for this episode here: https://cmetracker.net/USF/Publisher?page=pubOpen#/getCertificate/355380
Incontinence in Men: Workup and Treatment
Featuring:
Lucas Wiegand, MD
Dr. Wiegand completed his undergraduate training at Jacksonville University. He earned his Doctor of Medicine degree at the University of South Florida College of Medicine. His Urology residency was completed at the University of South Florida through Tampa General Hospital, the James A. Haley VA Hospital, and the H. Lee Moffitt Cancer Center and Research Institute in Tampa, as well as the Arnold Palmer Hospital for Children in Orlando. He then went on to complete a fellowship in Reconstructive Urology at Washington University in St. Louis at the Barnes Jewish Hospital. He is board certified in Urology by the American Board of Urology. His clinical and research interests include urethral and ureteral stricture disease, radiation-related urologic dysfunction, neurogenic bladder, incontinence and voiding dysfunction, urologic fistulae, erectile dysfunction, Peyronie’s disease, and urologic trauma.
Transcription:
Scott Webb: Incontinence in men, both kinds is common and treatable, as many of you know, and joining me today to tell us about the latest treatment options and technologies at USF is Dr. Lucas Wiegand. He's an associate professor of urology and vice chair of research and outreach.
Welcome to MD Cast by Tampa General Hospital, a go-to listing location for specialized physician-to-physician content, and a valuable learning tool for world-class healthcare. I'm Scott Webb. and doctor, thanks so much for your time today. We're gonna talk about something that, maybe some men aren't always comfortable talking about, and maybe you'll be able to assure them along the way today that it's okay to talk about this. It's okay, especially to talk about it with our doctors. So as we get rolling here, what are the most common types of incontinence in men?
Dr. Lucas Wiegand: Yeah, you're right. That's one of the things I wanted to bring up is the privacy aspect and the being uncomfortable. And what I find is that many men. And are nervous. To talk about this with their primary care doctor or their urologist or the, a lot of times the surgeon that did some of their other surgeries. And they can come in and see most urologists and they're gonna be very happy with the amount of privacy that they have. And in the end, it's one of those things where most men are like, why didn't I do this sooner?
And I wanted to start off talking about that and so I'm glad you brought it up. To answer your question though the most common types of incontinence in men that we're seeing are incontinence related to prostate procedures. Most commonly having it removed for cancer or just from having their prostate being enlarged and causing an overactive bladder.
Scott Webb: Yeah, I'm a 54 years old doctor, and for all that implies with this topic, I'm somewhat familiar with this normal 54 year old guy type stuff. But I'm definitely familiar with this and had to have that conversation with my primary care doctor and yeah. You're so right. Privacy is a concern. Maybe sometimes it's a little embarrassing to talk about, but we want to encourage men even if they come in as couples, like to speak about these things. Be open and honest, and know that help is available. And is that really your sense why more men don't come in? Why they don't seek help? Is it just sort of the discomfort of it all? The embarrassment maybe. And how do you really help them through that?
Dr. Lucas Wiegand: Yeah, I think there is the. Being uncomfortable. They realize that there's gonna be some procedures, possibly that they're worried are gonna be painful. And typically things are not painful during the workup. They don't know that anything can be done. And so that's the reason that we do these kinds of podcasts like this so that we can get the word out there that there are things available that are able to make these men have more normal lives.
Scott Webb: Yeah, and I think a lot of us in hosting a lot of these, there's a common thread, which is people get to a certain age and they just say well, I'm older, and when you get older, things don't work as well as they used to. So, you What are you gonna do? And the answer to that is, talk to your doctor, see a specialist see a urologist because there is lots that can be done. And let's talk about that. So what are some of the treatment options that are available for the urge incontinence?
Dr. Lucas Wiegand: Yeah. And to piggyback on what you were saying the natural aging process is exactly what we're fighting against a lot of times, and we don't have to accept that. It's kind of our job to find ways around it. And so like for the urge and continents, for example many times we can treat men with medications, but a lot of medications will have side effects. And despite having efficacy that these meds work pretty well, a lot of men will stop taking them because of side effects. And one of the other areas that I specialize in and that I like to talk about with my patients is some of the more advanced treatments for this incontinence, which might include Botox injections into the bladder wall.
Which is something that will deaden some of these overactive bladder sensations or a spinal stimulator, a stimulator that will actually be implanted and stimulate the nerves of the sacral spine that leads to improved bladder function.
Scott Webb: Yeah, maybe you can go in, because this is for other providers. Those who maybe, you know, even if they are experts, they can learn from you. So maybe you can roll up your sleeves a little bit and go through some of that you know, in a little more detail.
Dr. Lucas Wiegand: Yeah, sure. One of the standards before any patient is gonna get to some of these advanced therapies is that they're going to need pelvic floor physical therapy, that will help a large proportion of men, which is done by a licensed physical therapist. They will generally have tried several different medications and either not had efficacy or had to stop because of side effects. And then we move on to the other treatments I was mentioning. The bladder Botox is done either in the office or with sedation in an operating suite with injections directly into the wall of the bladder.
This is done through a cystoscope, a small scope that goes up into the bladder and the side effects are minimal from that, there's small risk of bleeding and a small risk that the man would have retention of urine where they would require period of catheterizations. Finally, the medication only lasts around six to 12 months. And so it either has to be repeated or another treatment needs to be discussed. For the sacral neuromodulation which is offered by several different companies, that is something that is done as a testing period where small wire will be placed into the S3 nerve root, under local anesthesia.
Patient wears it around for about a week to see how they respond and if they respond well, then a full implant is done in the operating room with a battery stimulating this nerve in the neighborhood of 10 to 15 years before it has to be replaced.
Scott Webb: Yeah, it's really amazing and I think we've all been there and I know of course doctors are patients too. And then it's like you, you get prescribed something and it's supposed to help the one thing and then it brings on the side effects. And then many of us, we go to reach for that pill that day and we think, all right which is worse here? Is it the thing or the side effects from this medication? And so good to note, there are some other options as well. So we talked about urge incontinence. Let's talk about stress incontinence.
Dr. Lucas Wiegand: Yeah, and so stress incontinence in men is most frequently related to prostate cancer treatments. I see a lot of it after prostate removal or radiation therapy for prostate cancer. And then further treatments on the prostate related to obstruction. And this can lead to the classic stress incontinence where the patient is having to wear diapers or pads related to their physical activity. Traditionally, the treatments for this were bulking agents, which is a, an injection around the urethra that helps to bulk it up and prevent the leakage.
But this has fallen out of favor because the longevity is very short measured in month. The other mainstay of treatments are an implantable mesh that is or an artificial urinary sphincter, which is a hydraulic device that is the gold standard for this type of incontinence.
Scott Webb: Yeah it's all good stuff and as we wrap up here and really educational for me and I'm sure for our other listeners as well give you a chance to toot your own horn a little bit there. What are you doing at USF that's unique and or new, in the treatment of incontinence?
Dr. Lucas Wiegand: One of the areas of specialty that myself and my partners have in the Reconstructive Urology Center is the treatment of the difficult or complete incontinence cases. And so usually these are related to patients that have had radiation therapy for various cancers, usually prostate cancer. And that really makes the quality of the tissue very difficult to work with. And so a lot of other providers and urologists will have a hard time dealing with these patients because of the number of complications that they have.
And so we specialize in getting those patients optimized through various treatment regimens, and then onto the traditional treatments with equal success to the patients that don't have these significant risk factors. Additionally, patients that have had complications from prior incontinence surgery we are able to get those patients with their artificial sphincters or slings replaced when they've maybe been told that nobody should put something back into that patient or provide them with another surgery. And so we're able to offer that and offer that with a high percentage of success.
Scott Webb: Yeah. That's awesome. That's perfect. Doctor, thanks so much. As I said, this is educational for me. Folks may be listening for CME credits. Either way. All good stuff. So thanks so much. You stay well.
Dr. Lucas Wiegand: Thank you. You too.
Scott Webb: And thank you for listening to MD Cast by Tampa General Hospital, which is available on all major streaming services for free. To collect your CME, please click on the link in the description. For other CME opportunities, including live webinars, on-demand videos and local events offered to you by Tampa General Hospital, please visit cme.tgh.org.
Scott Webb: Incontinence in men, both kinds is common and treatable, as many of you know, and joining me today to tell us about the latest treatment options and technologies at USF is Dr. Lucas Wiegand. He's an associate professor of urology and vice chair of research and outreach.
Welcome to MD Cast by Tampa General Hospital, a go-to listing location for specialized physician-to-physician content, and a valuable learning tool for world-class healthcare. I'm Scott Webb. and doctor, thanks so much for your time today. We're gonna talk about something that, maybe some men aren't always comfortable talking about, and maybe you'll be able to assure them along the way today that it's okay to talk about this. It's okay, especially to talk about it with our doctors. So as we get rolling here, what are the most common types of incontinence in men?
Dr. Lucas Wiegand: Yeah, you're right. That's one of the things I wanted to bring up is the privacy aspect and the being uncomfortable. And what I find is that many men. And are nervous. To talk about this with their primary care doctor or their urologist or the, a lot of times the surgeon that did some of their other surgeries. And they can come in and see most urologists and they're gonna be very happy with the amount of privacy that they have. And in the end, it's one of those things where most men are like, why didn't I do this sooner?
And I wanted to start off talking about that and so I'm glad you brought it up. To answer your question though the most common types of incontinence in men that we're seeing are incontinence related to prostate procedures. Most commonly having it removed for cancer or just from having their prostate being enlarged and causing an overactive bladder.
Scott Webb: Yeah, I'm a 54 years old doctor, and for all that implies with this topic, I'm somewhat familiar with this normal 54 year old guy type stuff. But I'm definitely familiar with this and had to have that conversation with my primary care doctor and yeah. You're so right. Privacy is a concern. Maybe sometimes it's a little embarrassing to talk about, but we want to encourage men even if they come in as couples, like to speak about these things. Be open and honest, and know that help is available. And is that really your sense why more men don't come in? Why they don't seek help? Is it just sort of the discomfort of it all? The embarrassment maybe. And how do you really help them through that?
Dr. Lucas Wiegand: Yeah, I think there is the. Being uncomfortable. They realize that there's gonna be some procedures, possibly that they're worried are gonna be painful. And typically things are not painful during the workup. They don't know that anything can be done. And so that's the reason that we do these kinds of podcasts like this so that we can get the word out there that there are things available that are able to make these men have more normal lives.
Scott Webb: Yeah, and I think a lot of us in hosting a lot of these, there's a common thread, which is people get to a certain age and they just say well, I'm older, and when you get older, things don't work as well as they used to. So, you What are you gonna do? And the answer to that is, talk to your doctor, see a specialist see a urologist because there is lots that can be done. And let's talk about that. So what are some of the treatment options that are available for the urge incontinence?
Dr. Lucas Wiegand: Yeah. And to piggyback on what you were saying the natural aging process is exactly what we're fighting against a lot of times, and we don't have to accept that. It's kind of our job to find ways around it. And so like for the urge and continents, for example many times we can treat men with medications, but a lot of medications will have side effects. And despite having efficacy that these meds work pretty well, a lot of men will stop taking them because of side effects. And one of the other areas that I specialize in and that I like to talk about with my patients is some of the more advanced treatments for this incontinence, which might include Botox injections into the bladder wall.
Which is something that will deaden some of these overactive bladder sensations or a spinal stimulator, a stimulator that will actually be implanted and stimulate the nerves of the sacral spine that leads to improved bladder function.
Scott Webb: Yeah, maybe you can go in, because this is for other providers. Those who maybe, you know, even if they are experts, they can learn from you. So maybe you can roll up your sleeves a little bit and go through some of that you know, in a little more detail.
Dr. Lucas Wiegand: Yeah, sure. One of the standards before any patient is gonna get to some of these advanced therapies is that they're going to need pelvic floor physical therapy, that will help a large proportion of men, which is done by a licensed physical therapist. They will generally have tried several different medications and either not had efficacy or had to stop because of side effects. And then we move on to the other treatments I was mentioning. The bladder Botox is done either in the office or with sedation in an operating suite with injections directly into the wall of the bladder.
This is done through a cystoscope, a small scope that goes up into the bladder and the side effects are minimal from that, there's small risk of bleeding and a small risk that the man would have retention of urine where they would require period of catheterizations. Finally, the medication only lasts around six to 12 months. And so it either has to be repeated or another treatment needs to be discussed. For the sacral neuromodulation which is offered by several different companies, that is something that is done as a testing period where small wire will be placed into the S3 nerve root, under local anesthesia.
Patient wears it around for about a week to see how they respond and if they respond well, then a full implant is done in the operating room with a battery stimulating this nerve in the neighborhood of 10 to 15 years before it has to be replaced.
Scott Webb: Yeah, it's really amazing and I think we've all been there and I know of course doctors are patients too. And then it's like you, you get prescribed something and it's supposed to help the one thing and then it brings on the side effects. And then many of us, we go to reach for that pill that day and we think, all right which is worse here? Is it the thing or the side effects from this medication? And so good to note, there are some other options as well. So we talked about urge incontinence. Let's talk about stress incontinence.
Dr. Lucas Wiegand: Yeah, and so stress incontinence in men is most frequently related to prostate cancer treatments. I see a lot of it after prostate removal or radiation therapy for prostate cancer. And then further treatments on the prostate related to obstruction. And this can lead to the classic stress incontinence where the patient is having to wear diapers or pads related to their physical activity. Traditionally, the treatments for this were bulking agents, which is a, an injection around the urethra that helps to bulk it up and prevent the leakage.
But this has fallen out of favor because the longevity is very short measured in month. The other mainstay of treatments are an implantable mesh that is or an artificial urinary sphincter, which is a hydraulic device that is the gold standard for this type of incontinence.
Scott Webb: Yeah it's all good stuff and as we wrap up here and really educational for me and I'm sure for our other listeners as well give you a chance to toot your own horn a little bit there. What are you doing at USF that's unique and or new, in the treatment of incontinence?
Dr. Lucas Wiegand: One of the areas of specialty that myself and my partners have in the Reconstructive Urology Center is the treatment of the difficult or complete incontinence cases. And so usually these are related to patients that have had radiation therapy for various cancers, usually prostate cancer. And that really makes the quality of the tissue very difficult to work with. And so a lot of other providers and urologists will have a hard time dealing with these patients because of the number of complications that they have.
And so we specialize in getting those patients optimized through various treatment regimens, and then onto the traditional treatments with equal success to the patients that don't have these significant risk factors. Additionally, patients that have had complications from prior incontinence surgery we are able to get those patients with their artificial sphincters or slings replaced when they've maybe been told that nobody should put something back into that patient or provide them with another surgery. And so we're able to offer that and offer that with a high percentage of success.
Scott Webb: Yeah. That's awesome. That's perfect. Doctor, thanks so much. As I said, this is educational for me. Folks may be listening for CME credits. Either way. All good stuff. So thanks so much. You stay well.
Dr. Lucas Wiegand: Thank you. You too.
Scott Webb: And thank you for listening to MD Cast by Tampa General Hospital, which is available on all major streaming services for free. To collect your CME, please click on the link in the description. For other CME opportunities, including live webinars, on-demand videos and local events offered to you by Tampa General Hospital, please visit cme.tgh.org.