The management of urinary incontinence in the   male neurological patient.
OBJECTIVE
Urinary incontinence in male neurological patients is a very frequent problem but treatment remains challenging. Thus, we summarize and highlight the latest developments in the management of urinary incontinence in this specific patient population.


RESULTS
Intermittent self-catheterization, antimuscarinics, intradetrusor injections with onabotulinumtoxinA, augmentation cystoplasty, urinary diversion, and artificial urinary sphincter are the cornerstones of the armamentarium for treating neurogenic urinary incontinence. However, with the exception of onabotulinumtoxinA intradetrusor injections, level of evidence is often low and male-specific outcomes are virtually not available. Alternative conservative and/or minimally invasive procedures such as neuromodulation techniques and suburethral suspension devices provide promising data with apparently good safety and tolerability but still insufficient evidence lacking randomized control trials.


CONCLUSIONS
Standard options for treatment of urinary incontinence in neurological patients remain largely unchanged. Alternative treatment options, especially of conservative or minimally invasive character, have the potential to further broaden the therapeutic spectrum. While a higher level of evidence is needed to assess the potential of such therapeutic approaches, randomized controlled trials in the male neurological population present a challenge. To truly advance treatment of urinary continence in male neurological patients, well-designed, multicenter studies are warranted.
Ulrich
U
Mehnert
Thomas M
TM
Kessler
D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D019468:Disease Management; D006801:Humans; D007273:Injections, Intramuscular; D008297:Male; D018727:Muscarinic Antagonists / Q000627:therapeutic use*; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D001750:Urinary Bladder, Neurogenic / Q000628:therapy*; D053201:Urinary Bladder, Overactive / Q000628:therapy*; D014546:Urinary Catheterization; D014549:Urinary Incontinence / Q000628:therapy*; D016741:Urinary Sphincter, Artificial
D018727:Muscarinic Antagonists; D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A