Urinary Incontinence in Men

What is urinary incontinence in men?

Urinary incontinence is the accidental release of urine. It is not a disease but rather a symptom of a problem with a man's urinary tract.

Urine is produced by the kidneys and stored in a muscular sac called the urinary bladder. A tube called the urethra, which is surrounded by a special ring of muscles called the urinary sphincter, leads from the bladder through the prostate and penis to the outside of the body. As the bladder becomes filled with urine, complex nerve signals ensure that the sphincter stays contracted and the bladder stays relaxed. This interaction between nerves and muscles prevents urine from leaking out of the body.

During urination, nerve signals cause the muscles in the walls of the bladder to contract, forcing urine out of the bladder and into the urethra. At the same time the bladder contracts, nerve signals cause the muscles surrounding the urethra to relax, allowing urine to pass through and out of the body.

Incontinence may occur if the bladder suddenly contracts or if it doesn't contract when it should, leading to a buildup of too much urine in the bladder, which can cause leakage. Incontinence may also occur if the muscles around the urethra are damaged or suddenly relax or if the urethra is blocked, keeping urine from draining properly and causing eventual leakage around the blockage.

Incontinence affects 13 million Americans and occurs twice as often in women as in men.¹ Although incontinence occurs more often in older men than in young men, it is not considered a normal part of the aging process.

How is urinary incontinence in men classified?

Urinary incontinence may occur for only a short time (acute) or may become an ongoing problem (chronic). Acute incontinence is often related to other medical problems and treatments. This topic will focus on types of chronic urinary incontinence.

• Stress incontinence occurs when you sneeze, cough, laugh, lift objects, or do other activities that increase stress on your bladder.
• Urge incontinence is an urge to urinate that is so strong that you often cannot make it to the toilet in time. Urge incontinence occurs when your bladder contracts when it shouldn't. This can happen even when you only have a small amount of urine in your bladder. Overactive bladder is a kind of urge incontinence. Overactive bladder is a kind of urge incontinence. But not everyone with overactive bladder leaks urine.
• Overflow incontinence is leakage that occurs when the bladder fails to empty properly, due to a blockage or weak bladder muscle contractions. Obstruction is usually related to either enlargement of the prostate or narrowing of the urethra from scar tissue.
• Total incontinence is a continual leakage of urine due to loss of sphincter function.

Functional incontinence is a rare form of urinary incontinence related to physical or mental limitations that restrict a man's ability to reach the toilet in time.

What causes urinary incontinence in men?

Urinary incontinence occurs when the muscle (sphincter) that holds your bladder's outlet closed is not strong enough to hold back the urine. This may happen if the sphincter is too weak, if the bladder muscles contract too strongly, or if the bladder is overfull. In men, urinary incontinence often is related to a problem or a treatment involving the prostate gland, such as enlargement of the prostate (benign prostatic hyperplasia, or BPH).

• Stress incontinence may develop when a man's prostate gland is removed and there has been dysfunction of or damage to the nerves or the sphincter, resulting in inadequate support for the lower bladder (bladder neck). The sphincter must then do all the work of maintaining continence, and the extra pressure (stress) of sneezing, coughing, or straining forces urine past the sphincter and through the urethra.
• Urge incontinence is caused by bladder contractions that are too strong to be stopped by the sphincter, causing an irresistible need to urinate. In many cases, the cause of urge incontinence and overactive bladder cannot be determined, but sometimes it can be traced to urinary tract infections, early BPH, interstitial cystitis, or early bladder cancer.
• Overflow incontinence is usually caused by a blockage of the urethra that forces urine to build up in the bladder. Often the blockage stems from an enlarged prostate gland (benign prostatic hyperplasia) or a narrowing of the urethra. Eventually the pressure from the full bladder forces excess urine past the obstruction. Overflow incontinence may also occur because of muscle weakness of the bladder.

Urinary incontinence can sometimes be aggravated by drinking alcohol or by taking diuretics, antidepressants, sedatives, narcotics, or nonprescription cold or diet medicines.

What are the symptoms?

The main symptom of urinary incontinence is the accidental release of urine. Additional symptoms will vary depending on the type of urinary incontinence.

• Stress incontinence: Unintentional release of a small amount of urine occurs with coughing, straining, lifting, or changing posture.
• Urge incontinence: The need to urinate is so strong that you cannot reach the toilet in time.
• Overflow incontinence: You have uncontrolled dribbling of urine, or you have the urge to urinate but can only release a small volume of urine.

How is urinary incontinence in men diagnosed?

Your medical history and a physical examination, along with some simple diagnostic tests such as a urinalysis, often provide enough information for your health professional to determine the cause of your incontinence. Additional tests called urodynamics may be needed if the incontinence is caused by more than one problem or if the cause is unclear.

How is it treated?

Incontinence is usually treatable with medicines, specific exercises, or surgery, after a health professional has determined what is causing the problem. Treatment varies based on the type of incontinence and how much it is affecting your life.

Incontinence can be an embarrassing problem, and men are sometimes reluctant to seek help. Some men might find it more of a problem than others and choose more aggressive treatment. Most men don't require surgery to treat their symptoms. All men with symptoms of urinary incontinence should see their health professional.

Frequently Asked Questions

Urinary incontinence occurs when the muscle (sphincter) that holds your bladder's outlet closed is not strong enough to hold back the urine. This may happen if the sphincter is too weak, if the bladder muscles contract too strongly, or if the bladder is overfull.

A man may have one or more types of incontinence, and each type may have a different cause.

• Stress incontinence occurs when the muscle (sphincter) surrounding the urethra opens at an inappropriate time. This can happen when you laugh, sneeze, cough, lift something, or change posture. Stress incontinence can be caused by surgery to treat an enlarged prostate or prostate cancer, radiation therapy to treat prostate cancer, or removal of the prostate. For more information, see the topics Benign Prostatic Hyperplasia (BPH) or Prostate Cancer.
• Urge incontinence is caused by bladder contractions that are too strong to be stopped by the sphincter. Often the urge is a response to something that makes you anticipate urination, such as waiting to use a toilet, unlocking the door when returning home, or even turning on a faucet. The bladder contractions can be caused by many conditions, including:
  • Urinary tract infection.
  • Bowel problems, such as constipation.
  • Prostatitis, a painful infection of the prostate gland.
  • Certain neurological conditions that affect nerve signals from the brain, such as Parkinson's disease or stroke.
  • Kidney or bladder stones.
  • Blockage due to prostate cancer or benign prostatic hyperplasia (BPH).
  Overactive bladder is a kind of urge incontinence. But not everyone with overactive bladder leaks urine. For more information, see the topic Overactive Bladder.
• Overflow incontinence usually is caused by obstruction of the urethra from BPH or prostate cancer or when the bladder muscles contract weakly or don't contract when they should. Other causes include:
  • Narrowing of the urethra (stricture).
  • Medicines, such as antihistamines, and decongestants.
  • Nerve conditions, such as diabetes or multiple sclerosis.

Functional incontinence is a rare form of incontinence caused by physical or mental limitations that restrict a man's ability to reach the toilet in time.

Your symptoms will depend upon the type of urinary incontinence you have.

Symptoms of stress incontinence may include loss of urine while:

• Coughing.
• Laughing.
• Lifting.
• Straining.
• Changing posture.

Symptoms of urge incontinence may include:

• A sudden, urgent need to urinate.
• Sudden accidents in which you lose a large amount of urine.
• The need to urinate frequently, often at night.

Symptoms of overflow incontinence may include:

• A urine stream that starts and stops during urination.
• An accidental release of a small amount of urine.
• A weak urine stream.
• A need to strain while urinating and a sense that the bladder is not empty.
• An urgent need to urinate, often at night.
• Loss of urine while asleep.

Urinary incontinence in men is often related to prostate problems. As men age, the prostate gland grows larger, squeezing the urethra and pushing the neck of the bladder out of position. These changes can lead to incontinence.

Prostate surgery is also a major cause of urinary incontinence in men.

• Stress incontinence is a common complication following prostate removal (radical prostatectomy) or radiation treatment for prostate cancer, though it is becoming less common with improving surgical techniques. For more information, see the topic Prostate Cancer.
• Some treatments for an enlarged prostate (benign prostatic hyperplasia, or BPH) can also cause incontinence, but this is uncommon. For more information, see the topic Benign Prostatic Hyperplasia.
• Short-term (acute) incontinence following prostate surgery may go away with time, especially for younger men. In some cases, the incontinence may last up to a year.
• In most cases, incontinence due to prostate enlargement can be cured by prostate surgery.

If your incontinence is not related to prostate surgery and it appears suddenly, it will usually clear up after you have received treatment for whatever is causing the incontinence. For example, incontinence related to a urinary tract infection, prostatitis, or constipation will most likely disappear when the infection or condition is cured. For more information, see the topics Urinary Tract Infections and Prostatitis.

For some men, incontinence may have more than one cause.

Many factors have been associated with an increased risk of urinary incontinence in men. Incontinence may be the result of various health conditions or medical treatments, or it could be caused by family history or lifestyle. Sometimes factors from more than one of the lists below can combine to cause incontinence.

Physical conditions or lifestyle factors that may make urinary incontinence more likely include:

• Age-related changes, including decreased bladder capacity and physical frailty.²
• Smoking tobacco.
• Injury to the bladder or urethra.
• Bladder infection or prostatitis.
• Obesity.
• Structural abnormalities of the urinary tract.

Medicines and foods that may make urinary incontinence worse are those that promote more urine formation, relax the bladder muscle, or cause congestion of the prostate. These include:

• Caffeinated and carbonated drinks, such as coffee, tea, and soda pop.
• Alcoholic beverages.
• Prescription medicines that increase urine production, such as diuretics, or relax the bladder, such as anticholinergics and antidepressants.
• Other prescription medicines, such as sedatives, narcotics, and calcium channel blockers.
• Nonprescription medicines, such as diet, allergy, and cold medicines.
• Radiation therapy or surgery for prostate cancer.

Several diseases or conditions may increase your risk of developing urinary incontinence, including:

• Neurological conditions such as Alzheimer's disease, Parkinson's disease, stroke, diabetes, spinal injury, and multiple sclerosis.
• Bladder cancer.
• Chronic bronchitis.
• Interstitial cystitis.
• Anxiety and depression.

See your health professional immediately if your urinary incontinence does not go away or is accompanied by:

• Weakness or numbness in your buttocks, legs, and feet.
• Fever, chills, and abdominal or side pain.
• Blood in your urine or burning with urination.
• A change in your bowel habits.

Call your health professional if:

• You have a problem with urinary incontinence that is getting worse.
• Uncontrolled loss of urine is enough of a problem that you need to wear an absorbent pad.
• Incontinence interferes with your life in any way.

Do not be embarrassed to discuss incontinence with your health professional. Incontinence is not an inevitable result of aging. Most people with incontinence can be helped or cured.

If you have a sudden change in your ability to urinate and you are not sure if it is related to your urinary incontinence, see the topic Urinary Problems and Injuries, Age 12 and Older.

Watchful Waiting

If you have chronic urinary incontinence that begins slowly, you may be able to control the problem yourself. (See the Home Treatment section of this topic.) If home treatment does not control your problem, or if incontinence interferes with your lifestyle, ask your health professional to recommend a treatment.

If you have urinary incontinence that begins suddenly (acute), call your health professional. Acute incontinence is often caused by urinary tract problems or medicines and can be easily corrected.

Who To See

Any of the following health professionals can diagnose and treat urinary incontinence:

• Family medicine doctor
• Internal medicine doctor
• Physician assistant
• Nurse practitioner
• Urologist
• Geriatrician

If you need surgery to treat your incontinence, it is important to find a surgeon who is experienced in the type of surgery you need, usually a urologist.

To prepare for your appointment, see the topic Making the Most of Your Appointment

The first steps your health professional will take to learn the cause of your urinary incontinence are a medical history and a physical examination. The physical exam will include examination of the penis, the prostate, and the nervous system. The history and exam, along with routine diagnostic tests such as a urinalysis, often provide enough information to determine the cause of the incontinence and enable your health professional to start treatment.

Your health professional may ask you to keep a voiding log, which is a record of the amount of liquids you drink and how much and how often you urinate.

Tests that may be done to determine the type and cause of your urinary incontinence include:

• Urinalysis and urine culture, which may be done to learn whether a urinary tract infection (UTI) or prostatitis are present or whether there is blood or sugar in your urine.
• Cough test to check for urine leakage while coughing.
• Urodynamic tests, which could include tests to look for hesitancy or interruptions of your urine flow, to measure the volume of urine left in your bladder after urination (post-void residual), and to measure how much urine in the bladder causes you to have a strong urge to urinate. The actual tests done vary from person to person. Urodynamic testing may include:
  • Uroflowmetry. The uroflowmetry test measures the rate of urine flow during urination. During the test, a flow curve will be charted to determine the peak flow rate. A low peak flow rate may be suggestive of an obstruction or a weak bladder causing the incontinence.
  • Pressure flow studies, which measure pressures produced in the bladder as the flow changes. Pressure studies may help distinguish between urinary symptoms caused by obstruction and those caused by a problem affecting the bladder muscles or nerves. This test is often used when the cause of a man's symptoms is uncertain.
• Residual urine determination. Your health professional may measure your post-void residual volume by inserting a thin tube (catheter) into your bladder or by using a bladder ultrasound scan immediately after you have urinated.
• Cystometrogram (CMG). This test evaluates your bladder's ability to store and release urine.
• Electromyogram (EMG), which is used to record the electrical activity of muscles.

Your health professional may conduct a cystoscopic exam (a test that allows your health professional to see inside the urinary tract) to rule out other causes of incontinence.

Further tests may be required if initial treatment for incontinence has failed. Other tests may also be needed if you have had previous prostate surgery, radiation therapy, or frequent urinary tract infections or if a catheter cannot be easily placed into your bladder.

Tests such as cystourethrogram, an X-ray taken of your bladder and urethra while you are urinating, are not often used to evaluate incontinence, but they may be helpful. If your health professional wants to do one of these tests, ask whether the test is necessary to diagnose your type of incontinence.

The treatment you and your health professional choose will depend upon what type of urinary incontinence you have and how much you are bothered by your symptoms.

Assuming there is no underlying infection or cancer or other cause that could only be cured by surgery, treatment for incontinence proceeds in stages.

• Behavioral strategies are tried first for all types of incontinence. These include reducing the amount of liquids you drink, eliminating caffeinated and carbonated drinks, and establishing a schedule for urinating. See the Home Treatment section of this topic for more information.
• Exercise on a regular basis is important for physical and emotional health. Some men with urinary incontinence stop exercising because they fear that it will cause leakage. However, regular exercise is important and can help you manage stress and keep your muscles in tone. Specifically, pelvic floor (Kegel) exercises can reduce symptoms of urge or stress incontinence.²
• Absorbent materials such as pads or diapers may be used if you are progressing through a different treatment and are waiting to see whether your incontinence goes away or if other methods of treatment have failed. However, pads or diapers should only be used along with a more specific treatment, since they can hide a more serious condition that may be curable.
• Medicines may be prescribed, depending on the cause of your incontinence.
  • Antispasmodics and anticholinergics may be prescribed to relax the bladder (for urge incontinence).
  • Antibiotics may be prescribed for incontinence caused by infection.
  • You may need to avoid medicines that can cause incontinence, such as diet, cold, and allergy medicines.
• Self-catheterization may be tried if you have overflow incontinence from a weak bladder or blockage or if surgery is not the best option for you.
• Surgery is usually considered when it is the only treatment that can cure the incontinence, such as when the condition is caused by a bladder obstruction.

What To Think About

Many men who have urge incontinence or overflow incontinence also have an enlarged prostate gland (benign prostatic hyperplasia). They may want to talk to their health professional about medicine, surgery, or other treatment to relieve their symptoms. For more information, see the topic Benign Prostatic Hyperplasia (BPH).

Urinary incontinence can be a problem following treatment for prostate cancer, including radiation therapy and removal of the prostate. For more information, see the topic Prostate Cancer.

Treatment will be different for men who have total incontinence or who cannot comply with or tolerate specific treatments because of a serious illness or disease.

You may reduce your chances of developing urinary incontinence by:

• Limiting caffeine and alcohol.
• Keeping your weight down. (For more information, see the topic Healthy Weight.)
• Quitting smoking. (For more information, see the topic Quitting Tobacco Use.)
• Avoiding constipation by eating a healthy, high-fiber diet.
• Doing Kegel exercises to strengthen the muscles that control the flow of urine.

In many cases, behavioral changes, including changes to your diet, lifestyle, and urinary habits, can be enough to control urinary incontinence.

The following changes to diet and lifestyle may help reduce incontinence:

• Reduce or eliminate caffeinated and carbonated drinks—such as coffee, tea, and soda pop—from your diet.
• Do not drink more than one alcoholic drink per day.
• Try to identify any foods that might irritate your bladder—including citrus fruits, chocolate, tomatoes, vinegars, spicy foods, dairy products, and aspartame—and eat less of those foods.
• If you smoke, quit. For more information, see the topic Quitting Tobacco Use.
• If constipation is a problem, increase the amount of fiber in your diet. You can do this easily by adding a small amount of wheat bran, even a spoonful, to dishes you normally eat. See your health professional if your constipation continues. For more information, see the Home Treatment section of the topic Constipation, Age 12 and Older.
• If you are overweight, try to lose some weight. Remember that effective weight-loss programs depend on a combination of diet and exercise. For more information, see the topics Healthy Weight and Fitness.
• Try pelvic floor (Kegel) exercises to strengthen pelvic muscles.

The following changes to urinary habits may help reduce incontinence:

• Establish a schedule of urinating every 3 to 4 hours, regardless of whether you feel the need.
• Practice “double voiding” by urinating as much as possible, relaxing for a few moments, and then urinating again.
• If you have trouble reaching the bathroom before you urinate, consider making a clearer, quicker path to the bathroom and wearing clothes that are easily removed (such as those with elastic waistbands or Velcro closures), or keep a urinal close to your bed or chair.

Talk with your health professional about all medicines you take, including nonprescription medicines, to see whether any of them may be making your incontinence worse. Medicines that may cause urinary incontinence in men include certain antidepressants, sedatives, and even some allergy and cold medicines.

If your urinary incontinence is caused by prostatitis, a painful inflammation of the prostate gland, your health professional will prescribe antibiotics. When the infection is cured, your incontinence should be cured as well.

If your incontinence is caused by medicine you are taking, stopping or changing that medicine may be sufficient. However, be sure to talk to your health professional before stopping or changing medicines.

Although some types of long-term (chronic) incontinence may be treated with medicine, the likelihood that medicines will improve your incontinence depends on the severity and cause of the problem. Some medicines that are used to treat incontinence may actually make the condition worse in men whose incontinence is caused by an enlarged prostate gland (benign prostatic hyperplasia, or BPH). Therefore, consultation with a urologist is an important part of incontinence care.

Medication Choices

• For overflow incontinence: If your overflow incontinence is caused by an enlarged prostate, medicines to treat benign prostatic hyperplasia may be prescribed. However, these medicines do not always improve incontinence. For more information, see the topic Benign Prostatic Hyperplasia (BPH).
• For urge incontinence:
  • Anticholinergic and antispasmodic medicines such as oxybutynin and tolterodine calm the nerves that control bladder muscles and increase bladder capacity.
  • Imipramine is a tricyclic antidepressant, which is usually used to treat depression but may also be used to treat urge incontinence. Imipramine causes the bladder muscle to relax while causing the muscles at the bladder neck to contract.

Anticholinergic and tricyclic medicines may also be used to treat stress incontinence, especially if you have both stress and urge incontinence.

What To Think About

For men with stress incontinence or urge incontinence, behavioral methods of treatment such as bladder training techniques are used in combination with medicine.

Some of the medicines may cause side effects, and some may cause problems by interacting with other medicines you are taking.

If your urinary incontinence has not improved after trying behavioral methods and medicine and your health professional feels surgery will be an effective treatment, you may choose to have surgery rather than live with your symptoms. In some cases, such as when a bladder outlet obstruction is affecting kidney function, surgery may be the only way to treat the problem that is causing the incontinence.

Surgery may be appropriate for men who:

• Have ongoing (chronic) incontinence.
• Have severe symptoms and total incontinence.
• Are extremely bothered by their symptoms.
• Have problems with urinary retention.
• Have moderate to severe recurrent bleeding.
• Have recurrent urinary tract infections.

Overflow incontinence caused by enlargement of the prostate (benign prostatic hyperplasia, or BPH) is the form of incontinence most often treated with surgery. For more information, see the topic Benign Prostatic Hyperplasia (BPH).

Stress incontinence caused by removal of the prostate gland because of prostate cancer or an enlarged prostate may also be treated with surgery, if the incontinence isn't cured after a period of watchful waiting. Surgery for an enlarged prostate (BPH) can interfere with or damage the structures involved in holding urine, leading to incontinence.

Surgery Choices

If overflow incontinence is caused by benign prostatic hyperplasia (BPH), prostate surgery may relieve the incontinence. For more information about surgery options and treatment for BPH, see the topic Benign Prostatic Hyperplasia (BPH).

Surgery for severe stress incontinence that does not improve with behavioral methods includes:

• Artificial sphincter, which is a device made of silicone rubber that fits around the urethra (the tube that carries urine from your bladder to the outside of your body) and can be inflated or deflated to control urination.
• Urethral bulking, which involves injecting material around the urethra to control urination by either closing a hole in the urethra or building up the thickness of the wall of the urethra.

A new procedure called the bulbourethral sling is being studied as a treatment for urinary incontinence that results from prostate surgery. In this procedure, a sling is placed beneath the urethra to support it and is attached to either muscle tissue or the pubic bone. The sling compresses and elevates the urethra, giving the urethra greater resistance to pressure from the abdomen. Early studies indicate that this procedure may show promise in the treatment of urinary incontinence, but further study is necessary to determine its long-term effectiveness.

What To Think About

Surgery is usually not considered for urinary incontinence unless it is the only reasonable way to cure it or until after attempts to treat the problem with conservative measures or other treatment have failed. The decision to have surgery must always be based on an accurate diagnosis and realistic expectations for the surgery.

Most surgical failures are due to incorrect diagnoses. Other reasons for failure include healing problems, additional causes of incontinence that aren't apparent before the surgery, and a lack of experience or skill on the part of the surgeon performing the procedure.

Factors that increase the chances that surgical treatment will fail to correct incontinence include obesity, long-term (chronic) cough, radiation therapy, age, poor nutrition, and strenuous physical activity.

Treatment other than surgery or medicine may be used to treat urinary incontinence.

For stress incontinence

Biofeedback, a technique that helps you learn to control a specific body function, may be an option for some men who have stress incontinence or urge incontinence.

For urge incontinence

Behavioral therapies such as biofeedback and bladder training can be used to treat urge incontinence.

For overflow incontinence

Some men may require intermittent self-catheterization. During this procedure, a catheter is inserted into the bladder, usually 3 to 4 times a day.

Other Treatment Choices

• Catheterization may be used to treat severe incontinence that cannot be managed with medicines or surgery. Catheters do not cure incontinence but rather allow you or a caregiver to manage incontinence.
  • Intermittent self-catheterization is done with a thin, flexible, hollow tube (catheter) that is inserted through the urethra into the bladder, allowing the urine to drain out.
  • Indwelling catheterization uses a catheter that remains in place continuously. For more information, see the topic Care for an Indwelling Urinary Catheter.
  • Condom or Texas catheter uses a special condom that can be attached to a tube for short-term use. The condom, placed over the penis, keeps the tube in place. The tube allows the urine to drain out.
• Behavioral therapies, including biofeedback and pelvic muscle exercises, are used to treat urge incontinence.
• Absorbent products, items that absorb urine, may be used to manage any form of incontinence.

What To Think About

Men often use absorbent products, such as pads or diapers, when other methods of treating incontinence have failed or cannot be used. Some men may prefer to use absorbent products rather than taking medicines or having surgery. They may also use absorbent products after surgery for prostate cancer, while they are waiting to see if their incontinence goes away. This method does not treat the incontinence but manages the problem instead. In general, absorbent products should only be used along with a more specific treatment, because use of absorbent products can hide a more serious condition that may be curable.

Organizations

• Benign Prostatic Hyperplasia (BPH)
• Fitness
• Healthy Weight
• Overactive Bladder
• Prostate Cancer
• Prostatitis
• Quitting Tobacco Use
• Urinary Problems and Injuries, Age 12 and Older
• Urinary Tract Infections in Teens and Adults

Citations

1. Payne CK (2002). Urinary incontinence: Nonsurgical management. In PC Walsh et al., eds., Campbell's Urology, 8th ed., vol. 2, pp. 1069–1091. Philadelphia: W.B. Saunders.

2. Johnson TM II, Ouslander JG (1999). Urinary incontinence in the older man. Medical Clinics of North America, 83(5): 1247–1266.

Other Works Consulted

• Carlson KV, Nitti VW (2001). Prevention and management of incontinence following radical prostatectomy. Urologic Clinics of North America, 28(3): 595–612.

• Shekarriz B, et al. (2001). Intraoperative, perioperative, and long-term complications of radical prostatectomy. Urologic Clinics of North America, 28(3): 639–653.