A urologist evaluates incontinence by identifying the type you have, measuring how well your bladder functions, and then matching you with treatments that range from simple office procedures to implanted devices. The specific path depends on whether you’re dealing with stress incontinence (leaking when you cough, sneeze, or lift), urge incontinence (a sudden, overwhelming need to go), or a combination of both. Here’s what to expect at each stage.
The Initial Evaluation
Your first visit typically involves a detailed conversation about your symptoms: when leaking happens, how often, what triggers it, and how much it affects your daily life. You’ll likely be asked to keep a bladder diary for a few days, recording how much you drink, how often you urinate, and when leaks occur. A physical exam checks the pelvic floor muscles and, in women, looks for signs of pelvic organ prolapse. In men, the prostate is assessed.
One of the simplest initial tests is a post-void residual measurement. After you urinate, an ultrasound or a thin catheter checks how much urine is still sitting in your bladder. Anything over 300 mL suggests urinary retention, and over 400 mL is generally diagnostic of it. This matters because retention can cause overflow incontinence, which looks like other types but requires a completely different treatment approach.
Urodynamic Testing
If the cause of your incontinence isn’t obvious from the initial workup, urodynamic testing gives a much more detailed picture of what’s happening inside your bladder. This is a series of measurements done in the office, and while not everyone needs them, they’re especially useful when symptoms don’t fit a clear pattern or when previous treatments haven’t worked.
Uroflowmetry measures how fast urine comes out and creates a graph of your flow rate over time. A cystometric test fills your bladder with water through a small catheter and records three things: how much your bladder can hold, how much pressure builds inside it during filling, and how full it is when you first feel the urge to go. Leak point pressure testing measures the exact bladder pressure at which leaking occurs. A pressure flow study then tracks how much pressure your bladder generates to push urine out and how quickly it flows at that pressure.
Together, these tests tell a urologist whether your bladder muscle is overactive, whether the outlet (urethra or sphincter) is weak, or whether there’s a coordination problem between the two. That distinction drives every treatment decision that follows.
Treatments for Stress Incontinence
Stress incontinence happens when physical pressure on the bladder overwhelms a weakened pelvic floor or urethral sphincter. In women, this commonly follows childbirth or menopause. In men, it most often develops after prostate surgery or radiation therapy.
Urethral Bulking
For mild stress incontinence, a urologist can inject a bulking agent around the urethra to help it seal more tightly. The most commonly used material in the U.S. is a polyacrylamide hydrogel (Bulkamid), which received FDA approval in 2020. The procedure is done in the office or as a short outpatient visit, requires no general anesthesia, and has a low complication rate. It’s a particularly good option for older patients, those on blood thinners, or anyone who isn’t a candidate for surgery. The trade-off is durability: over 60% of patients need a second injection to maintain results.
Mid-Urethral Sling Surgery
The mid-urethral sling has been the standard surgical treatment for stress incontinence in women for 25 years. A strip of synthetic mesh or the patient’s own tissue is placed beneath the urethra to provide support. A large systematic review comparing surgical options found that slings using the patient’s own tissue and retropubic mesh slings had the highest cure rates, around 89%. Transobturator slings, which use a slightly different placement angle, showed five-year cure rates ranging from 43% to 92% depending on the study. Recovery typically takes a few weeks, and groin discomfort, when it occurs, usually resolves within six months.
Artificial Urinary Sphincter
For men with significant incontinence after prostate cancer treatment, a urologist may recommend an artificial urinary sphincter. This implanted device has three parts: a cuff that wraps around the urethra and keeps it closed, a small pump placed in the scrotum, and a fluid-filled balloon in the abdomen. When you’re ready to urinate, you squeeze the pump, which moves fluid out of the cuff and opens the urethra for about three minutes. It then closes automatically. It requires some manual dexterity but provides reliable control for men whose sphincter was damaged by surgery or radiation.
Treatments for Urge Incontinence
Urge incontinence involves an overactive bladder muscle that contracts when it shouldn’t, creating sudden, intense urgency and leaking before you can reach a bathroom. Urologists typically start with behavioral strategies and medication before moving to procedures.
Bladder Botox Injections
When medications don’t control urge incontinence well enough, or when side effects like dry mouth and constipation are intolerable, a urologist can inject botulinum toxin directly into the bladder muscle. The procedure is done through a small scope in the office and takes about 15 minutes. For non-neurological overactive bladder, the standard dose is 100 units. For patients with neurological conditions like spinal cord injury or multiple sclerosis, the dose ranges from 200 to 300 units.
In a randomized controlled trial of women with stubborn urge incontinence, 60% of those who received the injections reported meaningful improvement, and the effect lasted an average of 373 days compared to 62 days or less with placebo. The injections need to be repeated when symptoms return, but many patients get close to a year of relief per treatment.
Sacral Neuromodulation
Sacral neuromodulation uses a small implanted device to send gentle electrical pulses to the nerves that control the bladder. Think of it as a pacemaker for your bladder. The process starts with a trial phase: a temporary lead is placed near the sacral nerves in your lower back and connected to an external stimulator. For basic testing, the lead stays in place for up to seven days. An advanced evaluation can extend up to two weeks. If your symptoms improve by at least 50% during the trial, you proceed to permanent implantation of a small pulse generator under the skin.
This two-step approach is one of the procedure’s strengths. You get to test whether it works for you before committing to a permanent implant. It’s typically offered after behavioral therapies and medications have been tried.
Urologist vs. Urogynecologist
If you’re a woman researching incontinence treatment, you may wonder whether to see a urologist or a urogynecologist. Both can treat urinary incontinence, but their training differs. Urologists complete a surgical residency focused on the entire urinary tract in both men and women, including the kidneys, ureters, and bladder. They also handle conditions like kidney stones and urinary tract cancers. Urogynecologists start with a gynecology residency and then complete an additional three-year fellowship focused exclusively on the female pelvic floor, covering incontinence, pelvic organ prolapse, and birth injuries.
For men, a urologist is the clear choice. For women, either specialist can manage incontinence effectively. A urogynecologist may be a better fit if you also have prolapse or other pelvic floor issues alongside your incontinence, since their training specifically bridges both systems. Many patients are referred between the two specialties depending on what the evaluation reveals.