Editing Urinary incontinence (section)

==Management==
Treatment options include conservative treatment, behavioral therapy, bladder retraining,<ref>{{cite web | title = Bladder retraining |url = http://www.ichelp.org/page.aspx?pid=368#how | archive-url = https://web.archive.org/web/20120301182023/http://www.ichelp.org/page.aspx?pid=368#how | archive-date = 1 March 2012 | work = Interstitial Cystitis Association | access-date = 13 July 2012 }}</ref> [[Interstitial cystitis#Pelvic floor treatments|pelvic floor therapy]], collecting devices (for men), fixer-occluder devices for incontinence (in men), medications, and surgery.<ref>{{cite journal | vauthors = Price N, Jackson SR | title = Clinical audit of the use of tension-free vaginal tape as a surgical treatment for urinary stress incontinence, set against NICE guidelines | journal = Journal of Obstetrics and Gynaecology | volume = 24 | issue = 5 | pages = 534–538 | date = August 2004 | pmid = 15369935 | doi = 10.1080/01443610410001722590 | s2cid = 10473508 }}</ref> Both nonpharmacological and pharmacological treatments may be effective for treating UI in non-pregnant women.<ref name="auto" /> All treatments, except hormones and [[Periurethral gland|periurethral]] bulking agents, are more effective than no treatment in improving or curing UI symptoms or achieving patient satisfaction.<ref name="auto"/><ref name="auto2"/> For urinary incontinence in women, it is typical in clinical practice to begin with behavioral therapy, then move on to oral medication if behavioral therapy is ineffective. If both behavioral therapy and oral medication are ineffective, the patient may be given bladder botox or neuromodulation therapy.<ref name="auto" />

=== Behavioral therapy, physical therapy and exercise ===
Behavioral therapy involves the use of both suppressive techniques (distraction, relaxation) and learning to avoid foods that may worsen urinary incontinence. This may involve avoiding or limiting consumption of caffeine and alcohol. Behavioral therapies, including bladder training, biofeedback, and pelvic floor muscle training, are most effective for improving urinary incontinence in women, with a low risk of adverse events.<ref>{{cite journal | vauthors = Balk EM, Adam GP, Corsi K, Mogul A, Trikalinos TA, Jeppson PC | title = Adverse Events Associated with Nonsurgical Treatments for Urinary Incontinence in Women: a Systematic Review | journal = Journal of General Internal Medicine | volume = 34 | issue = 8 | pages = 1615–1625 | date = August 2019 | pmid = 31062225 | pmc = 6667523 | doi = 10.1007/s11606-019-05028-0 }}</ref><ref name="auto2">{{cite journal | vauthors = Todhunter-Brown A, Hazelton C, Campbell P, Elders A, Hagen S, McClurg D | title = Conservative interventions for treating urinary incontinence in women: an Overview of Cochrane systematic reviews | journal = The Cochrane Database of Systematic Reviews | volume = 2022 | issue = 9 | pages = CD012337 | date = September 2022 | pmid = 36053030 | pmc = 9437962 | doi = 10.1002/14651858.CD012337.pub2 | collaboration = Cochrane Incontinence Group }}</ref><ref>{{cite journal | vauthors = Imamura M, Williams K, Wells M, McGrother C | title = Lifestyle interventions for the treatment of urinary incontinence in adults | journal = The Cochrane Database of Systematic Reviews | volume = 2015 | issue = 12 | pages = CD003505 | date = December 2015 | pmid = 26630349 | pmc = 8612696 | doi = 10.1002/14651858.CD003505.pub5 | collaboration = Cochrane Incontinence Group }}</ref><ref name="auto" /> Behavioral therapy is not curative for urinary incontinence, but it can improve a person's quality of life. Behavioral therapy has benefits as both a monotherapy (behaviorial therapy alone) and as an adjunct to medications (combining different therapies) for symptom reduction.<ref name="Elavsky DrugTopics">{{cite journal| vauthors = Elavsky M |title=Urinary Incontinence: What Pharmacists Should Know|journal=DrugTopics|date=February 2018|volume=162|issue=2|page=24}}</ref> Time voiding while urinating and bladder training are techniques that use biofeedback. In time voiding, the patient fills in a chart of voiding and leaking. From the patterns that appear in the chart, the patient can plan to empty his or her bladder before he or she would otherwise leak.<ref name="auto" /> Biofeedback and muscle conditioning, known as bladder training, can alter the bladder's schedule for storing and emptying urine. These techniques are effective for urge and overflow incontinence.<ref>{{cite web |author=Beaumont Health |title=Treatment for Incontinence |url=https://www.beaumont.org/treatments/incontinence-treatment |access-date=19 October 2018 |website=www.beaumont.org}}</ref>

Avoiding heavy lifting and preventing constipation may help with uncontrollable urine leakage. Stopping smoking is also recommended as it is associated with improvements in urinary incontinence in men and women.<ref>{{cite journal | vauthors = Wyman JF, Burgio KL, Newman DK | title = Practical aspects of lifestyle modifications and behavioural interventions in the treatment of overactive bladder and urgency urinary incontinence | journal = International Journal of Clinical Practice | volume = 63 | issue = 8 | pages = 1177–1191 | date = August 2009 | pmid = 19575724 | pmc = 2734927 | doi = 10.1111/j.1742-1241.2009.02078.x }}</ref> Weight loss may also be helpful for people who are overweight to improve symptoms of incontinence.<ref name="Qa2014" /><ref>{{cite journal | vauthors = Sheridan W, Da Silva AS, Leca BM, Ostarijas E, Patel AG, Aylwin SJ, Vincent RP, Panagiotopoulos S, El-Hasani S, le Roux CW, Miras AD, Cardozo L, Dimitriadis GK | display-authors = 6 | title = Weight loss with bariatric surgery or behaviour modification and the impact on female obesity-related urine incontinence: A comprehensive systematic review and meta-analysis | journal = Clinical Obesity | volume = 11 | issue = 4 | pages = e12450 | date = August 2021 | pmid = 33955687 | doi = 10.1111/cob.12450 | hdl-access = free | s2cid = 233869987 | hdl = 10044/1/89229 | url = https://pure.ulster.ac.uk/en/publications/0730378b-974c-4c2d-bb92-2dc159a27548 }}</ref><ref name="auto2" />

Physical therapy can be effective for women in reducing urinary incontinence.<ref>{{cite journal | vauthors = López-Liria R, Varverde-Martínez ML, Padilla-Góngora D, Rocamora-Pérez P | title = Effectiveness of Physiotherapy Treatment for Urinary Incontinence in Women: A Systematic Review | journal = Journal of Women's Health | volume = 28 | issue = 4 | pages = 490–501 | date = April 2019 | pmid = 30575448 | doi = 10.1089/jwh.2018.7140 | s2cid = 58590966 }}</ref> [[Pelvic floor physical therapy|Pelvic floor physical therapists]] work with patients to identify and treat underlying pelvic muscle dysfunction that can cease urinary incontinence. They may recommend exercises to strengthen the muscles, [[electrostimulation]], or [[biofeedback]] treatments.<ref>{{cite journal | vauthors = Wallace SL, Miller LD, Mishra K | title = Pelvic floor physical therapy in the treatment of pelvic floor dysfunction in women | journal = Current Opinion in Obstetrics & Gynecology | volume = 31 | issue = 6 | pages = 485–493 | date = December 2019 | pmid = 31609735 | doi = 10.1097/GCO.0000000000000584 | s2cid = 204703488 }}</ref><ref>{{cite journal | vauthors = Rosenbaum TY | title = Pelvic floor involvement in male and female sexual dysfunction and the role of pelvic floor rehabilitation in treatment: a literature review | journal = The Journal of Sexual Medicine | volume = 4 | issue = 1 | pages = 4–13 | date = January 2007 | pmid = 17233772 | doi = 10.1111/j.1743-6109.2006.00393.x }}</ref> Exercising the muscles of the pelvis such as with [[Kegel exercise]]s are a first line treatment for women with stress incontinence.<ref name="Qa2014">{{cite journal | vauthors = Qaseem A, Dallas P, Forciea MA, Starkey M, Denberg TD, Shekelle P | title = Nonsurgical management of urinary incontinence in women: a clinical practice guideline from the American College of Physicians | journal = Annals of Internal Medicine | volume = 161 | issue = 6 | pages = 429–440 | date = September 2014 | pmid = 25222388 | doi = 10.7326/m13-2410 | s2cid = 15004955 | doi-access =  }}</ref> Efforts to increase the time between urination, known as [[bladder training]], is recommended in those with urge incontinence.<ref name="Qa2014" /> Both these may be used in those with mixed incontinence.<ref name="Qa2014" />

Physical therapy, both by itself and in combination with anticholinergic drugs, was found to be more successful in reducing urinary incontinence in women than anticholinergics by themselves.<ref name="auto"/>

Small vaginal cones of increasing weight may be used to help with exercise.<ref>{{cite web|title=How to Use Vaginal Weights|url=http://www.nationalincontinence.com/blog/how-to-use-vaginal-weights/ | archive-url = https://web.archive.org/web/20130329212916/http://www.nationalincontinence.com/blog/how-to-use-vaginal-weights/ | archive-date = 29 March 2013 |publisher=National Incontinence|access-date=10 October 2012 |date=September 4, 2012 |author=Chelsea|work=Incontinence Blog - NationalIncontinence.com }}</ref><ref name="Herb2013">{{cite journal | vauthors = Herbison GP, Dean N | title = Weighted vaginal cones for urinary incontinence | journal = The Cochrane Database of Systematic Reviews | issue = 7 | pages = CD002114 | date = July 2013 | volume = 2013 | pmid = 23836411 | pmc = 7086390 | doi = 10.1002/14651858.CD002114.pub2 }}</ref> They seem to be better than no active treatment in women with stress urinary incontinence, and have similar effects to training of pelvic floor muscles or [[electrostimulation]].<ref name="Herb2013" />

[[Biofeedback]] uses measuring devices to help the patient become aware of his or her body's functioning. By using electronic devices or diaries to track when the bladder and urethral muscles contract, the patient can gain control over these muscles. Biofeedback can be used with pelvic muscle exercises and electrical stimulation to relieve stress and urge incontinence. The evidence supporting the role for biofeedback devices in treating urinary incontinence is mixed.<ref name="Leonardo_2022">{{cite journal | vauthors = Leonardo K, Seno DH, Mirza H, Afriansyah A | title = Biofeedback-assisted pelvic floor muscle training and pelvic electrical stimulation in women with overactive bladder: A systematic review and meta-analysis of randomized controlled trials | journal = Neurourology and Urodynamics | volume = 41 | issue = 6 | pages = 1258–1269 | date = August 2022 | pmid = 35686543 | doi = 10.1002/nau.24984 | s2cid = 249545181 }}</ref> There is some very weak evidence that electrical stimulation that is low in frequency may be helpful in combination with other standard treatments for women with overactive bladder condition,<ref>{{cite journal | vauthors = Stewart F, Berghmans B, Bø K, Glazener CM | title = Electrical stimulation with non-implanted devices for stress urinary incontinence in women | journal = The Cochrane Database of Systematic Reviews | volume = 2017 | issue = 12 | pages = CD012390 | date = December 2017 | pmid = 29271482 | pmc = 6486295 | doi = 10.1002/14651858.CD012390.pub2 | collaboration = Cochrane Incontinence Group }}</ref> however, the evidence supporting a role for biofeedback combined with pelvic floor muscle training is very weak and likely indicates that biofeedback-assistance is not helpful when included with conservative treatments for overactive bladder.<ref name="Leonardo_2022" />

Preoperative pelvic floor muscle training in men undergoing radical prostatectomy was not effective in reducing urinary incontinence.<ref name="Wang" />

Alternative exercises have been studied for stress urinary incontinence in women.<ref name="Bø_2013">{{cite journal | vauthors = Bø K, Herbert RD | title = There is not yet strong evidence that exercise regimens other than pelvic floor muscle training can reduce stress urinary incontinence in women: a systematic review | journal = Journal of Physiotherapy | volume = 59 | issue = 3 | pages = 159–168 | date = September 2013 | pmid = 23896331 | doi = 10.1016/S1836-9553(13)70180-2 | quote = There is not yet strong evidence that alternative exercise regimens can reduce urinary leakage in women with stress urinary incontinence. | doi-access = free }}</ref> Evidence was insufficient to support the use of [[Paula method]], [[abdominal muscle]] training, [[Pilates]], [[Tai chi]], [[breathing exercises]], postural training, and generalized fitness.<ref name="Bø_2013" />

===Devices===
[[File:Foley Catheter Drainage.png|alt=foley catheter|thumb|279x279px|Example of a [[foley catheter]]]]
Individuals who continue to experience urinary incontinence need to find a management solution that matches their individual situation. The use of mechanical devices has not been well studied in women, as of 2014.<ref>{{cite journal | vauthors = Lipp A, Shaw C, Glavind K | title = Mechanical devices for urinary incontinence in women | journal = The Cochrane Database of Systematic Reviews | volume = 2014 | issue = 12 | pages = CD001756 | date = December 2014 | pmid = 25517397 | pmc = 7061494 | doi = 10.1002/14651858.CD001756.pub6 }}</ref>
* [[External urine collection device|Collecting systems]] (for men) – consists of a sheath worn over the penis funneling the urine into a urine bag worn on the leg. These products come in a variety of materials and sizes for individual fit. Studies<ref name="pmid20950307">{{cite journal | vauthors = Chartier-Kastler E, Ballanger P, Petit J, Fourmarier M, Bart S, Ragni-Ghazarossian E, Ruffion A, Le Normand L, Costa P | display-authors = 6 | title = Randomized, crossover study evaluating patient preference and the impact on quality of life of urisheaths vs absorbent products in incontinent men | journal = BJU International | volume = 108 | issue = 2 | pages = 241–247 | date = July 2011 | pmid = 20950307 | doi = 10.1111/j.1464-410X.2010.09736.x | doi-access = free }}</ref> show that urisheaths and urine bags are preferred over absorbent products – in particular when it comes to 'limitations to daily activities'. Solutions exist for all levels of incontinence. Advantages with collecting systems are that they are discreet, the skin stays dry all the time, and they are convenient to use both day and night.  Disadvantages are that it is necessary to get measured to ensure proper fit, and in some countries, a prescription is needed.
* Absorbent products (include [[Incontinence pad|shields]], [[incontinence pad]]s, undergarments, protective underwear, briefs, diapers, [[adult diapers]] and underpants) are the best-known product types to manage incontinence. They are widely available in pharmacies and supermarkets. The advantages of using these are that they barely need any fitting or introduction by a healthcare specialist. The disadvantages with absorbent products are that they can be bulky, leak, have odors and can cause skin breakdown due to the constant dampness.
* [[Intermittent catheterisation|Intermittent catheters]] are single-use catheters that are inserted into the bladder to empty it, and once the bladder is empty they are removed and discarded. Intermittent catheters are primarily used for urinary retention (inability to empty the bladder), but for some people they can be used to reduce or avoid incontinence.  These are prescription-only medical devices.
* [[File:Pessaries.JPG|alt=Vaginal pessaries|thumb|321x321px|Different types of pessaries. These are inserted inside the vagina for support.]]Indwelling [[catheter]]s (also known as [[Foley catheter|foleys]]) are often used in hospital settings, or if the user is not able to handle any of the above solutions himself/herself (e.g. severe neurologic injury or neurodegenerative disease). These are also prescription-only medical devices. The indwelling catheter is typically connected to a urine bag that can be worn on the leg or hung on the side of the bed. Indwelling catheters need to be monitored and changed on a regular basis by a healthcare professional. The advantage of indwelling catheters is that because the urine is funneled away from the body, the skin remains dry. However, the disadvantage is that it is very common to incur urinary tract infections when using indwelling catheters.  Bladder spasms and other problems can also occur with long-term use of indwelling catheters.<ref name="pmid10670503">{{cite journal | vauthors = Cravens DD, Zweig S | title = Urinary catheter management | journal = American Family Physician | volume = 61 | issue = 2 | pages = 369–376 | date = January 2000 | pmid = 10670503 }}</ref>
* [[Penis clamp]] (or penis compression device), which is applied to compress the [[urethra]] to compensate for the malfunctioning of the natural urinary [[sphincter]], preventing leakage from the [[Urinary bladder|bladder]].<ref>{{cite journal | vauthors = Chong JT, Simma-Chiang V | title = A historical perspective and evolution of the treatment of male urinary incontinence | journal = Neurourology and Urodynamics | volume = 37 | issue = 3 | pages = 1169–1175 | date = March 2018 | pmid = 29053886 | doi = 10.1002/nau.23429 | s2cid = 4769215 }}</ref> This management solution is only suitable for light or moderate incontinence.
* [[Pessary|Vaginal pessaries]] for women are devices inserted into the vagina. This device provides support to the urethra which passes right in front of it, allowing it to close more firmly.

===Medications===
A number of medications exist to treat urinary incontinence including: [[fesoterodine]], [[tolterodine]] and [[oxybutynin]].<ref name=Med2012>{{cite journal | vauthors = Shamliyan T, Wyman JF, Ramakrishnan R, Sainfort F, Kane RL | title = Benefits and harms of pharmacologic treatment for urinary incontinence in women: a systematic review | journal = Annals of Internal Medicine | volume = 156 | issue = 12 | pages = 861–74, W301-10 | date = June 2012 | pmid = 22711079 | doi = 10.7326/0003-4819-156-12-201206190-00436 | s2cid = 29778547 }}</ref> These medications work by relaxing [[smooth muscle]] in the bladder.<ref>{{Cite web|url=https://www.drugs.com/monograph/oxybutynin-chloride.html|title=Oxybutynin Chloride Monograph for Professionals|website=Drugs.com|language=en|access-date=2019-08-05}}</ref><ref>{{Cite web|url=https://www.drugs.com/pro/tolterodine-tartrate-tablets.html|title=Tolterodine Tartrate Tablets - FDA prescribing information, side effects and uses|website=Drugs.com|language=en|access-date=2019-08-05}}</ref><ref>{{Cite web|url=https://www.drugs.com/pro/fesoterodine-tablets.html|title=Fesoterodine Tablets - FDA prescribing information, side effects and uses|website=Drugs.com|language=en|access-date=2019-08-05}}</ref> While some of these medications appear to have a small benefit, the risk of side effects are a concern.<ref name=Med2012/> Medications are effective for about one in ten people, and all medications have similar efficacy.<ref name="Med2012"/>

Medications are not recommended for those with stress incontinence and are only recommended in those with urge incontinence who do not improve with bladder training.<ref name=Qa2014/> While medications have been shown to be helpful with treating urinary incontinence, studies have shown that the first line treatment that's most effective against urinary incontinence is behavioral therapy.<ref name=":0" />

Injectable bulking agents may be used to enhance urethral support, however, they are of unclear benefit.<ref>{{cite journal | vauthors = Kirchin V, Page T, Keegan PE, Atiemo KO, Cody JD, McClinton S, Aluko P | title = Urethral injection therapy for urinary incontinence in women | journal = The Cochrane Database of Systematic Reviews | volume = 2017 | issue = 7 | pages = CD003881 | date = July 2017 | pmid = 28738443 | pmc = 6483304 | doi = 10.1002/14651858.cd003881.pub4 }}</ref><ref>{{cite journal | vauthors = Matsuoka PK, Locali RF, Pacetta AM, Baracat EC, Haddad JM | title = The efficacy and safety of urethral injection therapy for urinary incontinence in women: a systematic review | journal = Clinics | volume = 71 | issue = 2 | pages = 94–100 | date = February 2016 | pmid = 26934239 | pmc = 4760362 | doi = 10.6061/clinics/2016(02)08 }}</ref>

===Surgery===
Women and men that have persistent incontinence despite optimal conservative therapy may be candidates for surgery. Surgery may be used to help [[Stress incontinence|stress]] or [[overflow incontinence]].<ref name=Mayo2008/> Common surgical techniques for stress incontinence include [[Urethral sling|slings]], tension-free vaginal tape, bladder suspension, artificial urinary sphincters, among others.<ref name=Mayo2008/> It is not clear if [[antibiotic]]s taken [[prophylactically]] after surgery are helpful at decreasing the risk of an infection after surgery.<ref>{{cite journal | vauthors = Temtanakitpaisan T, Buppasiri P, Lumbiganon P, Laopaiboon M, Rattanakanokchai S | title = Prophylactic antibiotics for preventing infection after continence surgery in women with stress urinary incontinence | journal = The Cochrane Database of Systematic Reviews | volume = 2022 | issue = 3 | pages = CD012457 | date = March 2022 | pmid = 35349162 | pmc = 8962651 | doi = 10.1002/14651858.CD012457.pub2 | collaboration = Cochrane Incontinence Group }}</ref>

The use of transvaginal mesh implants and bladder slings is controversial due to the risk of debilitating painful side effects such as vaginal erosion.<ref>{{Cite news|url=https://www.lieffcabraser.com/injury/devices/vaginal-mesh/|title=Vaginal Mesh & Bladder Sling Complications and Lawsuits|work=[[Lieff Cabraser]]|access-date=2018-05-10}}</ref> In 2012 transvaginal mesh implants were classified as a high risk device by the US Food and Drug Administration.<ref>{{Cite web|url=https://www.theguardian.com/society/2017/aug/31/vaginal-pelvic-mesh-explainer|title=What does pelvic mesh do and why are women suing over it? – explainer | vauthors = Davey M |date=2017-08-31 |website=the Guardian |access-date=2018-05-10}}</ref> [[Urodynamic testing]] seems to confirm that surgical restoration of vault prolapse can cure motor urge incontinence.

Traditional suburethral sling operations are probably slightly better than open abdominal retropubic colposuspension and are probably slightly less effective than mid-urethral sling operations in reducing urinary incontinence in women, but it is still uncertain if any of the different types of traditional suburethral sling operations are better than others.<ref name="Saraswat2020">{{cite journal | vauthors = Saraswat L, Rehman H, Omar MI, Cody JD, Aluko P, Glazener CM | title = Traditional suburethral sling operations for urinary incontinence in women | journal = The Cochrane Database of Systematic Reviews | volume = 1 | issue = 1 | pages = CD001754 | date = January 2020 | pmid = 31990055 | pmc = 7027385 | doi = 10.1002/14651858.CD001754.pub5 }}</ref> Similarly, there is insufficient long term evidence to be certain about the effectiveness or safety of single-incision sling operations for urinary incontinence in women.<ref>{{cite journal | vauthors = Carter E, Johnson EE, Still M, Al-Assaf AS, Bryant A, Aluko P, Jeffery ST, Nambiar A | display-authors = 6 | title = Single-incision sling operations for urinary incontinence in women | journal = The Cochrane Database of Systematic Reviews | volume = 2023 | issue = 10 | pages = CD008709 | date = October 2023 | pmid = 37888839 | pmc = 10604512 | doi = 10.1002/14651858.CD008709.pub4 }}</ref> Traditional suburethral slings may have a higher risk of surgical complications than minimally invasive slings but the risk of complications compared with other types of operation is still uncertain.<ref name="Saraswat2020" />

[[Laparoscopy|Laparoscopic]] colposuspension (keyhole surgery through the abdomen) with sutures is as effective as open colposuspension for curing incontinence in women up to 18 months after surgery, but it is unclear whether there are fewer risk of complications during or after surgery.<ref name="Freites_2019">{{cite journal | vauthors = Freites J, Stewart F, Omar MI, Mashayekhi A, Agur WI | title = Laparoscopic colposuspension for urinary incontinence in women | journal = The Cochrane Database of Systematic Reviews | volume = 2019 | issue = 12 | pages = CD002239 | date = December 2019 | pmid = 31821550 | pmc = 6903454 | doi = 10.1002/14651858.CD002239.pub4 | collaboration = Cochrane Incontinence Group }}</ref> There is probably a higher risk of complications with traditional suburethral slings than with open abdominal retropubic suspension.<ref name="Freites_2019" />
[[File:Artificial urinary sphincters.jpg|alt=artificial urinary sphincter|thumb|250x250px|AMS 800 and ZSI 375 artificial urinary sphincters]]
The [[artificial urinary sphincter]] is an implantable device used to treat stress incontinence, mostly in men. The device is made of 2 or 3 parts: The pump, cuff, and balloon reservoir connected to each other by specialized tubes.  The cuff wraps around the urethra and closes it. When the person wants to urinate, he presses the pump (implanted in the scrotum), to deflate the cuff, and allow the urine to pass. The cuff regains pressure within a few minutes to regain continence.<ref>{{cite journal | vauthors = Downey A, Inman RD | title = Recent advances in surgical management of urinary incontinence | journal = F1000Research | volume = 8 | pages = 1294 | date = 2019-07-31 | pmid = 31448082 | pmc = 6676503 | doi = 10.12688/f1000research.16356.1 | doi-access = free }}</ref> The [[European Association of Urology]] considers the artificial urinary sphincter as the gold standard in surgical management of [[Stress incontinence|stress urinary incontinence]] in men after [[prostatectomy]].<ref>{{Cite journal| vauthors = Burkhard FC, Bosch JL, Cruz F, Lemack GE, Nambiar AK, Thiruchelvam N, Tubaro A, Ambühl D, Bedretdinova DA, Farag F |title=EAU Guidelines on Urinary Incontinence in Adults|url=https://uroweb.org/wp-content/uploads/EAU-Guidelines-on-Urinary-Incontinence-2018-large-text.pdf|journal=European Association of Urology}}</ref>