On Wednesday 18 March at 15:00 hours, the first Meet the Expert session of the 24th Annual EAU Congress was held. Professor Paul Abrams was the expert in this informal session about male incontinence.

Professor Abrams: “The older men get, the more bladder problems they develop. Psychogeriatric patients are almost 100% incontinent”. He stressed that there is no association between urinary symptoms and prostate cancer at the time patients present them.
“Men do not suffer from overactive bladder often, except after radical prostatectomy”, says Abrams. What is the incidence of incontinence after radical prostatectomy, was one of the questions. “After 1 year, 5% is still incontinent”, says Abrams. “Those are the patients we wish to treat. And to do this effectively, the medical community needs to define cure and improvement objectively”.
At present, the artificial urinary sphincter is the gold standard for mild, moderate and severe male incontinence.   

The journalists especially asked about new treatments. Paul Abrams stressed that drugs do not work for stress incontinence; it is a mechanical problem in men. Placing a sphincter around the bladder is a possibility; above or below the sphincter gives different results.
A rather new minimally invasive technique is the implantation of adjustable balloons for male postoperative incontinence. Prof. Abrams: “Pignot et al show that this technique carries a low rate of morbidity. The earlier it is implanted, the more efficacious it is”.
  
“New techniques do seem to work, however, we do not know how they work in the long term compared to the ‘gold standard’. And we do not know their behaviour in the different phases mild, moderate and severe incontinence compared to the ‘gold standard’”.

Another issue that came forward was whether or not it is useful to train the pelvic floor muscles pre-operatively. “A study by Centemero et al shows that pre-operative pelvic floor muscle training (PFMT) hastens the return to continence more than post-operative PFMT alone and decreases the severity of incontinence following radical retropubic prostatectomy”, says Prof Abrams.