Experts urge early exploration of surgical treatments for incontinence in men

In this video, Nathan M. Shaw, MD, and Lindsay A. Hampson, MD, MAS, share notable findings from the Neurourology and Urodynamics study, “How older men live with stress urinary incontinence: Patient experience and navigation to treatment.” Shaw is an assistant professor of urology and an assistant professor of plastic and reconstructive surgery at Medstar Georgetown University Hospital in Washington, DC. Hampson is an associate professor of urology associate chair of education and Residency Program Director at the University of California, San Francisco.

Transcription:

What were some of the notable findings? Were any of them surprising to you and your coauthors?

Shaw: There were a number of findings that I'd like to highlight. I think the main one that continues to strike me working with Dr Hampson on this type of work is how different individual incontinence is for the patient who is experiencing it. Basically, we looked at some of the objective metrics around leakage for men. How many pads were they going through per day? How bothered were they on a standardized bother score? And then ultimately, what treatment [did they elect] to pursue, whether that was 1 of the 2 surgical treatment options—the artificial urinary sphincter, or the male sling, vs not pursuing a surgical management option. I think, intuitively, we can all sort of understand that the patients who are more bothered, who had more objectively severe leakage would probably pursue the surgical management options. And that just wasn't the case. So I think that was both notable and a bit surprising. The other thing that was very notable, and it certainly ties into some of the questions that arise from this research, is the number of barriers that men face as they started to begin to understand to pursue treatment. In the work, we talked about these stages of a lived experience, including hitting a breaking point. So it's often in these men's journeys, there's something, whether it's an isolated event, or just sort of an accumulation of bother and negative experiences around incontinence, that leads them to pursue, whether it's a treatment option, or just something else, a change in how they're managing their incontinence.

Hampson: I think to add to that, it was surprising hearing men's experiences, what they were told about their leakage, what options they were given or not given. There were some men who were just told there weren't treatment options for leakage; there were some who were told, "Well, consider yourself lucky, because you're better off than some other people." There were some providers who use their own measures of leakage and what they think qualified as a threshold for treatment, which led to them saying, "Oh, well, 1 pad a day or 2 pads a day, that's pretty good; you don't need treatment." Whereas for some men, as we experienced through looking at the objective data, and the quality-of-life impacts, even 1 or 2 pads a day can be really bothersome to some people. And I think that one of the big takeaways and something, honestly, that was surprising to both of us was just the difficulty in people feeling like they had in getting options for treatment. And so this led in many cases to men waiting a very long time before they even understood what treatment options looked like. And I think often, we want to give people time to recover their incontinence after a procedure, after they have problems with leakage. But the realization that actually people find a lot of benefit in actually understanding the treatment options and knowing what those options look like, even if they don't decide to pursue them at that point. So I think 1 big message to providers is, talk about treatment options early. It doesn't mean that everybody is going to go and pursue treatment for incontinence, but it does mean that you're empowering people to understand what those options look like and knowing what the path is to get there, if they want that in the future.

This transcription was edited for clarity.