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RehabilitationView Articles

Volume 11, Number 3Review Articles

Male Urinary Incontinence: Prevalence, Risk Factors, and Preventive Interventions

Systematic Review

Tatyana A ShamliyanJean F WymanRyan PingTimothy J WiltRobert L Kane

Urinary incontinence (UI) in community-dwelling men affects quality of lifeand increases the risk of institutionalization. Observational studies and randomized,controlled trials published in English from 1990 to November 2007on the epidemiology and prevention of UI were identified in several databasesto abstract rates and adjusted odds ratios (OR) of incontinence, calculateabsolute risk difference (ARD) after clinical interventions, and synthesizeevidence with random-effects models. Of 1083 articles identified, 126 wereeligible for analysis. Pooled prevalence of UI increased with age to 21% to32% in elderly men. Poor general health, comorbidities, severe physicallimitations, cognitive impairment, stroke (pooled OR 1.54; 95% confidenceinterval [CI], 1.14-2.1), urinary tract infections (pooled OR 3.49; 95%CI, 2.33-5.23), prostate diseases, and diabetes (pooled OR 1.36; 95% CI,1.14-1.61) were associated with UI. Treatment with tolterodine alone (ARD0.17; 95% CI, 0.02-0.32) or combined with tamsulosin (ARD 0.17; 95% CI,0.08-0.25) resulted in greater self-reported benefit compared with placebo.Radical prostatectomy or radiotherapy for prostate cancer compared withwatchful waiting increased UI. Short-term prevention of UI with pelvic floormuscle rehabilitation after prostatectomy was not consistently seen acrossrandomized, controlled trials. The prevalence of incontinence increased with ageand functional dependency. Stroke, diabetes, poor general health, radiation, andsurgery for prostate cancer were associated with UI in community-dwellingmen. Men reported overall benefit from drug treatments. Limited evidence ofpreventive effects of pelvic floor rehabilitation requires future investigation.[Rev Urol. 2009;11(3):145-165 doi:10.3909/riu0416]© 2009 MedReviews, LLC

Risk factorsUrinary incontinenceRehabilitationDrug therapy

Renal massView Articles

Volume 14, Number 1Review Articles

LHRH Agonists for the Treatment of Prostate Cancer: 2012

Management Review

Neal D ShoreHerbert Lepor

The most recent guidelines on prostate cancer screening from the American Urological Association (2009), the National Comprehensive Cancer Network (2011), and the European Association of Urology (2011), as well as treatment and advances in disease monitoring, have increased the androgen deprivation therapy (ADT) population and the duration of ADT usage as the first-line treatment for metastatic prostate cancer. According to the European Association of Urology, gonadotropin-releasing hormone (GnRH) agonists have become the leading therapeutic option for ADT because they avoid the physical and psychological discomforts associated with orchiectomy. However, GnRH agonists display several shortcomings, including testosterone (T) surge (“clinical flare”) and microsurges. T surge delays the intended serologic endpoint of T suppression and may exacerbate clinical symptoms. Furthermore, ADT manifests an adverse-event spectrum that can impact quality of life with its attendant well-documented morbidities. Strategies to improve ADT tolerability include a holistic management approach, improved diet and exercise, and more specific monitoring to detect and prevent T depletion toxicities. Intermittent ADT, which allows hormonal recovery between treatment periods, has become increasingly utilized as a methodology for improving quality of life while not diminishing chronic ADT efficacy, and may also provide healthcare cost savings. This review assesses the present and potential future role of GnRH agonists in prostate cancer and explores strategies to minimize the adverse-event profile for patients receiving ADT. [ Rev Urol. 2012;14(1/2):1-12 doi:10.3909/riu0547 ] © 2012 MedReviews®, LLC

Wilms’ tumorRenal massOpen radical nephrectomyMultimodal therapy