At NYU Langone, our urologists treat men who have urinary dysfunction, which arises when the bladder or urethral sphincter doesn’t work properly or an enlarged prostate blocks urine flow. Causes may include conditions such as benign prostatic hyperplasia and neurogenic voiding dysfunction, both of which may be accompanied by bothersome urinary symptoms, such as the inability to empty the bladder.
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The prostate gland is a walnut-shaped gland that produces a fluid that helps the semen move during ejaculation. Benign prostatic hyperplasia is a condition in which the prostate is enlarged. It affects millions of men in the United States and is particularly common in men over age 50, because the prostate tends to grow as men age. More than half of men in their 60s and as many as 90 percent of men over age 80 have some symptoms of the condition.
The prostate surrounds the urethra, the tube that carries urine out of the body from the bladder. When the prostate grows, it can squeeze or block the urethra, causing the bladder to work extra hard to pass urine. As a result, you might experience the sensation that the bladder doesn’t completely empty when you urinate; you might need to urinate more frequently or urgently; or you might have occasional urgency incontinence, also known as overactive bladder. Other symptoms include a weak urine stream, getting up at night to urinate, or leakage of urine. Rarely, the enlarged prostate blocks the bladder, leading to infection or damage to the kidneys.
Although men with prostate cancer may also have benign prostatic hyperplasia, the condition does not cause prostate cancer.
In neurogenic voiding dysfunction, the nerves that carry messages telling the bladder muscles to contract or relax don’t work. This can lead to urine leakage, bladder or urinary tract infection, or kidney damage, caused by a backup of urine. Sometimes, the nerve damage results from pelvic or spinal surgery. The condition can also be the result of uncontrolled diabetes or central nervous system conditions such as spinal cord injury, multiple sclerosis, brain tumors, cerebral palsy, Parkinson’s disease, and stroke.
Incontinence is the accidental leakage of urine. Two of the most common types are stress incontinence and urgency incontinence. Urgency incontinence is also known as overactive bladder, because the uncontrolled contraction of the bladder leads to leakage of urine.
Stress incontinence is the term used when coughing, exercising, laughing, heavy lifting, or sneezing puts stress on the bladder and causes small amounts of urine to leak. Though uncommon in men, it can be caused by prior prostate surgery for conditions such as prostate cancer or benign prostatic hyperplasia.
Urgency incontinence is an involuntary leakage of urine accompanied by an overwhelming urge to urinate. In this condition, the bladder muscles contract at the wrong times. In men, it often results from benign prostatic hyperplasia, although it is sometimes associated with bladder inflammation, bladder stones, bladder cancer, diabetes, infection, or pelvic radiation. Conditions such as Parkinson’s disease, multiple sclerosis, and stroke are associated with overactive bladder.
All of these conditions can cause the bladder to spasm, which can lead to the urge to urinate and to incontinence.
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