Ehab A. Elzayat, MD, Urology Fellow, Dalhousie University, Halifax, NS.
Ali Alzahrani, MD, Urology Fellow, Dalhousie University, Halifax, NS.
Jerzy B. Gajewski, MD, FRCSC, Professor of Urology and Pharmacology, Department of Urology, Dalhousie University, Halifax, NS.

Urinary incontinence is a common symptom among older adults that is often marginalized and not properly addressed. It is, however, often associated with potentially treatable conditions. Concurrent chronic medical problems add more challenges in this patient population. Comprehensive assessments and evaluations are necessary because of the multifactorial underlying pathology. The selection of the best treatment option is challenging. This article reviews the effect of age on lower urinary tract symptoms, mainly incontinence, and describes the evaluation and management of urinary incontinence in older men.
Key words: urinary incontinence, aging male, older adults, men’s health.

Peter J. Pommerville, BA, MD, FRCS(C), Consultant Urologist, Vancouver Island Health Authority, Victoria, BC; Principal Investigator, Can-Med Clinical Research Inc., Victoria, BC.

Introduction
Erectile Dysfunction is a significant and common medical problem. The National Institutes of Health has defined erectile dysfunction as "the persistent inability to achieve or maintain an erection sufficient for satisfactory sexual performance."¹ The nature of sexual dysfunction is more precisely defined by the term erectile dysfunction (ED) than by the term impotence.¹

ED is a clearly defined problem that the medical practitioner must differentiate from premature ejaculation, orgasmic dysfunction and Peyronie's disease.

Prevalence of Erectile Dysfunction
According to the NIH Consensus Development Panel, ED may affect as many as 30 million males in the U.S.¹ Data collected by Statistics Canada indicate that as many as three million Canadian men may suffer from ED. However, it is estimated that fewer than 20% seek treatment.²

Epidemiological studies conducted in the U.S. provide the most extensive information on the prevalence of ED. One such study that is often referred to is the Massachusetts Male Aging Study (MMAS).³ This study demonstrated a combined prevalence of minimal, moderate and severe ED in 52% of non-institutionalized men aged 40 to 70 (Figure 1). Of these, 10% reported complete ED, 25% reported moderate ED and 17% minimal ED.