Table 1.
Evidence of the Association Between Risk Factors and Male Incontinence
| Tested Association | Studies | Level of Evidence | Conclusions |
| Age on UI | 69 studies of prevalence30–38,41,43,46,48,49,51–53,55,57–107 8 studies of odds ratio37,42,67,91,120,122,126,128 | High | Prevalence of UI increases with age; urge UI is the most common type of UI in men. |
| Ethnicity on UI | 1 study120 | Low | Odds of UI were the same in nonwhite vs white race (odds ratio 0.88; 95% CI, 0.72–1.07). |
| Physical activity on UI | 1 study89 | Low | Men with physical activity 1 or more times per week had 51% lower relative risk of UI (relative risk 0.49; 95% CI, 0.25–0.96). |
| Education on UI | 2 studies35,89 | Low | Men with secondary or higher education had the same odds of UI as men with primary education. |
| Marital status on UI | 1 study90 | Low | Single or never-married men had the same odds of UI as married men. |
| Body weight on UI | 4 studies35,89,90,93 | Low | 1 study reported that obese men had 220% increased odds of UI compared with men with normal weight (OR 3.2; 95% CI, 1.2–9); other studies did not find a significant association. |
| Coffee intake on UI | 1 study35 | Low | Men who regularly consumed 2 cups per day had 70% reduction in odds of UI (OR 0.3; 95% CI, 0.1–0.7). |
| Alcohol intake on UI | 3 studies35,89,90 | Low | Alcohol intake did not demonstrate consistent association with UI. |
| Smoking on UI | 2 studies35,89 | Low | Smoking did not demonstrate consistent association with UI. |
| Self-reported general health on UI | 2 studies67,90 | Moderate | Self-reported poor general health was associated with 200%–300% increase in odds of UI in both studies. |
| Comorbidities on UI | 6 studies35,42,49,58,93,117 Cardiovascular, cardiorespiratory, joint, and gastrointestinal diseases, 9 studies35,37,38,42,49,54,58,89,117 | Low | Inconsistent evidence of positive association with comorbidities on UI. Protracted coughing was associated with higher odds of UI in men >75 years of age in 1 study (OR 1.33; 95% CI, 1.04–1.69). Arthritis was associated with increased odds of UI by 59%–80% in 2 studies. Men with back problems had increased odds of UI by 110% (OR 2.10; 95% CI, 1.5–2.93) in 1 study. Men with fecal incontinence had increased odds of UI in 1 study (OR 17; 95% CI, 7.5–40), with nonsignificant changes in another. |
| Social and psychological factors on UI | 4 studies58,67,89,90 | Low | Depressive mood was associated with increased odds of UI in 1 study (OR 2.69; 95% CI, 1.14–6.34). Increased stress level and low social activity did not demonstrate significant association with UI. |
| Impaired glucose metabolism and diabetes on UI | 6 studies35,42,54,67,89,117 | Moderate | Increased borderline fasting glucose was not associated with UI. Pooled analysis of 5 studies found a consistent significant increase in odds of UI in men with diabetes (pooled OR 1.36; 95% CI, 1.14–1.61, heterogeneity NS). |
| Medication use on UI | 2 studies54,58 | Low | Antibiotics, antidepressants, asthma medication, blood pressure medications, heart medication, hypnotics, pain medications, polypharmacy, sleep medications, and tranquilizers were not associated with UI. Use of diuretics (OR 2.11; 95% CI, 1.28–3.47), laxatives (OR 2.34; 95% CI, 1.46–3.75), and narcotics (OR 2.03; 95% CI, 1.28–3.20) was associated with increased odds of UI. |
| Mental and neurologic diseases on UI | 7 studies35,42,49,54,67,101,117 | Moderate | Cognitive impairment, memory problems, and presence of any neurologic diseases were associated with increased odds of UI; dementia, depression, transient ischemic attack, and Parkinson’s disease did not demonstrate a significant association. Pooled analysis of 5 studies found a significant increase in odds of UI in men after stroke (pooled OR 2.7; 95% CI, 1.3–5.5; heterogeneity significant). |
| Physical dependency and limitation in daily activities on UI | 4 studies42,49,58,93 | Moderate | Severe physical limitations were associated with increased odds of UI in daily in 1 study (OR 3.34; 95% CI, 1.52–7.34). Men who reported difficulty talking and walking had higher odds of UI. Impaired activities of daily living were associated with increased odds of UI in a dose-response manner. |
| Urinary tract infection and urinary symptoms on UI | 9 studies35,37,42,49,58,73,89,91,115 | Moderate | Pooled analysis of 5 studies demonstrated consistent increase in odds of UI by 260% (pooled OR 3.6; 95% CI, 2.2–6; heterogeneity NS) among men with urinary tract infections. Men with lower urinary symptoms had increased odds of UI in 2 studies, with random changes in 1 study. |
| Prostate diseases and treatments for prostate cancer on UI | 4 studies of association with prostate diseases71,93,117,126 7 observational studies of different treatments for prostate cancer35,36,71,89,122,124,126 13 RCT of behavioral interventions for prostat diseases142–154 | Moderate | Men with prostate diseases had a 520% increase in odds of UI (OR 6.2; 95% CI, 3.6–10.6), men with prostate cancer had a 100% increase in odds of UI (OR 2; 95% CI, 1.5–2.8). History of any previous prostate surgery was associated with a 110% increase in odds of UI (OR 2.1; 95% CI, 1.2–3.7), history of radical prostatectomy was associated with a 330% increase in relative risk of UI (RR 4.3; 95% CI, 2.6–7.3), and a e history of previous transurethral resection of prostate at time or following radical prostatectomy was associated with a 80% increase in relative risk of UI (RR 1.8; 95% CI, 1.1–3). Transurethral resection of prostate compared with watchful waiting (1 RCT) did not result in higher rates of persistent UI. Radical prostatectomy compared with watchful waiting (1 RCT) resulted in a significant increase in UI of moderate or greater severity that caused distress and affected sexual life. Radical prostatectomy compared with external beam radiation increased the risk of UI (1 RCT). Radiotherapy for prostate cancer compared with watchful waiting (1 RCT) resulted in a significant increase in UI that required use of pads. Adjuvant external beam radiation compared with radical prostatectomy alone (1 RCT) did not increase relative risk of UI and severe UI that would require implantation of artificial sphincter. Different doses and regimes of radiotherapy resulted in the same rates of UI (2 RCTs). Bladder neck preservation techniques resulted in the same rates of UI (2 RCTs). Artificial urethral sphincter implantation compared with macroplastique injection above or around the striated sphincter region of the urethra (1 RCT) increased rates of continence. Different methods of transurethral resection of prostate (3 RCTs) resulted in the same rate of UI. |
| Pelvic floor muscle training and physical rehabilitation on UI | 9 RCTs129–137 | Low | Inconsistent prevention of UI after pelvic floor muscle training with biofeedback and support group. |
| Medical devices on UI | 2 RCTs140,141 | Low | UroLume sphincteric stent compared with conventional external sphincterotomy did not prevent UI (1 RCT). C3 penile compression device, Cunningham clamp, and U-Tex Male Adjustable Tension resulted in the same UI (1 RCT). |
| Pharmacologic treatments of UI | Corticosteroids, 2 RCTs155,156 | Low | Betamethasone cream applied locally to both neurovascular bundles or methylprednisolone orally beginning on the day of radical prostatectomy did not prevent UI compared with placebo. |
| Antidepressants, 1 RCT158 | Low | Duloxetine 40 mg daily combined with pelvic floor muscle training compared with pelvic floor muscle training alone increased continence rates at 16 but not 24 wk of treatment. | |
| Muscarinic antagonists compared with placebo or adrenergic α-antagonists, 2 RCTs159–162 | Moderate | Tolterodine ER 4 mg daily alone and combined with tamsulosin resulted in greater self-reported overall benefit of the treatment compared with placebo. The most commonly reported adverse effects compared with placebo included dry mouth (16% vs 7%), constipation (4% vs 9%), dyspepsia (4% vs 1%), dizziness (5% vs 1%), and somnolence (3% vs 1%). |
Evidence was rated as follows: high = further research is very unlikely to change our confidence in the estimates; moderate = further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate; low = further research is likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. UI, urinary incontinence; OR, odds ratio; CI, confidence interval; NS, nonsignificant; RR, relative risk; RCT, randomized controlled trial.