An elderly man has had urinary incontinence for 10 years. How should he be managed?
Tom is 81 years old and has presented with a 10-year history of urgency and urge incontinence. He also has some mild stress incontinence and nocturia. He has been treated with prazosin (1 mg twice daily) with little effect. He takes a laxative with faecal softener to keep his constipation at bay. He underwent transurethral resection of the prostate a few years ago and abdominal aortic artery endoluminal stenting last year. A voiding diary shows small, frequent volumes in the day and small to moderate volumes overnight. He suffers incontinence four to five times a week. He lives with his elderly wife and is cognitively intact and still physically active. He has no cardiorespiratory adverse signs. His prostate is slightly enlarged but smooth, and his rectal tone is normal. How should he be managed?