In extremely rare cases, when incontinence does not get better over time, your doctor may do cystometry to determine the state of the bladder. If you have urgency incontinence, anticholinergic drugs can dampen the involuntary bladder contractions. If you have stress incontinence, drugs that cause smooth muscle contractions, including decongestants or antidepressants (imiprimine, for instance, is an antidepressant drug that also inhibits urination), may be helpful. If incontinence persists for more than a year, or is severe, your doctor may suggest further treatment, possibly placement of an artificial sphincter. In this procedure, a rubbery cuff is positioned around the urethra and connected by tubing to a reservoir for fluid that’s installed in the abdomen, and to a small pump, placed in the scrotum. The pump transfers fluid from the reservoir to inflate the cuff (and block the urethra), and a valve next to the pump can be released to deflate the cuff and allow urine to pass through the urethra.

The artificial sphincter is an elaborate device, but there are several simpler solutions that involve the injection of material (collagen) into the urethra or bladder neck. It’s possible that with further refinements, these techniques will be sufficient for managing incontinence in almost all men who develop it.

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