Rigi10™ Malleable Penile Prosthesis
Also Known As
Chronic urinary retention with overflow, Overflow urinary incontinence, Paradoxical incontinence, Retention with overflow, Chronic retention incontinence, Ischuria paradoxa
Definition
Overflow incontinence is a type of urinary incontinence characterized by the involuntary leakage of urine due to an overfilled bladder that cannot empty completely¹. This condition occurs when the bladder becomes distended beyond its normal capacity, resulting in frequent or constant dribbling of small amounts of urine². The primary pathophysiological mechanism involves either impaired detrusor muscle contractility, bladder outlet obstruction, or both, leading to urinary retention and subsequent overflow³.
Unlike other forms of urinary incontinence, overflow incontinence is more common in men than women, primarily due to the prevalence of prostatic enlargement as a causative factor⁴. The condition represents approximately 5% of all chronic urinary incontinence cases⁵. Patients may experience paradoxical symptoms of both urinary frequency and incomplete emptying, often without sensing bladder fullness⁶.
The clinical presentation typically includes frequent or constant dribbling, difficulty initiating urination, interrupted urine stream, and a sensation of incomplete bladder emptying⁷. Diagnosis requires comprehensive evaluation including measurement of post-void residual volume, which is characteristically elevated in these patients⁸. Management strategies range from behavioral techniques and pharmacotherapy to catheterization and surgical interventions depending on the underlying etiology⁹.
Clinical Context
Overflow incontinence occurs in clinical settings where there is impaired bladder emptying, resulting in urinary retention and subsequent overflow1. The condition requires careful differential diagnosis from other forms of incontinence, as management strategies differ significantly2.
The most common cause in men is benign prostatic hyperplasia (BPH), which creates mechanical obstruction at the bladder outlet3. In women, causes include pelvic organ prolapse, urethral stricture, or neurogenic bladder dysfunction4. Neurological conditions such as multiple sclerosis, Parkinson’s disease, diabetic neuropathy, and spinal cord injuries can affect both genders by impairing the neural control of bladder function5.
Patient selection for treatment depends on the underlying etiology, symptom severity, and comorbidities6. Initial management typically involves addressing reversible causes and may include alpha-adrenergic blockers for prostatic obstruction or intermittent catheterization for neurogenic bladder7. Surgical interventions such as transurethral resection of the prostate (TURP) may be indicated for obstructive causes8.
Expected outcomes vary based on the underlying pathology and intervention chosen. Patients with mechanical obstruction often experience significant improvement following surgical correction, while those with neurogenic causes may require long-term management strategies9. Complications of untreated overflow incontinence include recurrent urinary tract infections, bladder stones, and potential kidney damage from chronic back-pressure7.