From the Guidelines
Male urinary incontinence can be effectively managed with medications such as alpha-blockers, 5-alpha-reductase inhibitors (5-ARIs), muscarinic receptor antagonists, and phosphodiesterase type 5 inhibitors, with the choice of medication depending on the underlying cause and severity of symptoms.
Medication Options
- Alpha-blockers, such as tamsulosin, are recommended for men with moderate-to-severe lower urinary tract symptoms (LUTS) 1.
- 5-ARIs, such as finasteride, are recommended for men with moderate-to-severe LUTS and an increased risk of disease progression, such as a prostate volume greater than 40 ml 1.
- Muscarinic receptor antagonists, such as tolterodine, are recommended for men with moderate-to-severe LUTS who mainly have bladder storage symptoms 1.
- Phosphodiesterase type 5 inhibitors, such as tadalafil, are recommended for men with moderate-to-severe LUTS with or without erectile dysfunction 1.
Combination Therapy
- Combination treatment with an alpha-blocker and a 5-ARI is recommended for men with moderate-to-severe LUTS and an increased risk of disease progression 1.
- Combination treatment with an alpha-blocker and a muscarinic receptor antagonist is recommended for patients with moderate-to-severe LUTS if relief of storage symptoms has been insufficient with monotherapy with either drug 1.
Lifestyle Modifications
- Lifestyle modifications, such as timed voiding, fluid management, and pelvic floor exercises, should accompany medication treatment to help manage symptoms.
Monitoring and Follow-up
- Patients should be monitored regularly to assess the effectiveness of treatment and to adjust the treatment plan as needed.
- If symptoms do not improve after 4-6 weeks, dosage adjustments or medication changes may be necessary.
- For severe or persistent incontinence, additional treatments like botulinum toxin injections or surgical interventions might be considered.
From the FDA Drug Label
Mirabegron extended-release tablets are indicated for the treatment of OAB in adult patients with symptoms of urge urinary incontinence, urgency, and urinary frequency. The recommended starting dosage of mirabegron extended-release tablets is 25 mg orally once daily. If needed, increase to the maximum dosage of mirabegron extended-release tablets 50 mg orally once daily after 4 to 8 weeks.
- Key points:
- Indication: Treatment of Overactive Bladder (OAB) in adult patients with symptoms of urge urinary incontinence, urgency, and urinary frequency.
- Dosage: 25 mg orally once daily, increasing to 50 mg orally once daily if needed. 2
From the Research
Male Incontinence Treatment with Medications
- Medications such as antimuscarinic drugs and α1-adrenoceptor blockers can be useful for treating male lower urinary tract symptoms, including overactive bladder syndrome 3.
- Combination of antimuscarinic drugs and α1-adrenoceptor blockers may offer additional benefits over monotherapy with either agent, but may also increase postvoid residual urine volume 3.
- Mirabegron, alone or in combination with solifenacin, is a treatment alternative for male overactive bladder syndrome 3.
- Monotherapy with phosphodiesterase 5 inhibitors seems to be as effective as α1-adrenoceptor blockers in male lower urinary tract symptoms 3.
- Duloxetine has a modest positive effect in men with postprostatectomy incontinence, but may be recommended in some patients 3, 4.
Treatment Options for Male Urinary Incontinence
- First-line treatment for male urinary incontinence usually involves conservative management, such as lifestyle interventions, pelvic floor muscle training, and bladder retraining 4, 5.
- Medical therapy, including anticholinergic drugs and α-receptor antagonists, can be effective for treating male urinary incontinence, particularly for overactive bladder symptoms 3, 6.
- Surgical options, such as male slings and artificial urinary sphincter surgery, may be considered for men with persistent stress urinary incontinence 4.
- Intravesical botulinum toxin, sacral neuromodulation, or surgery may be considered for refractory cases of overactive bladder or urge urinary incontinence 4.