Overactive Bladder in Men

You've all probably seen ads on television showing women rushing to the bathroom because of a severe or sudden urge to urinate. That's overactive bladder (OAB). You've also seen ads of men rushing to the bathroom at football games. Those ads say it's a prostate or 'growing problem' - the prostate is getting too big or causing a blockage. Whether you are a man or a woman, though, if you have to rush to get to the bathroom to urinate, you have overactive bladder. Most of the time, there are other symptoms that accompany OAB -- frequency of urination, loss of urine control on the way to the bathroom, difficulty starting urination, having to push or strain and having a weak stream. Sometimes things can get so bad that you cannot urinate at all and a tube (catheter) needs to be inserted to let the urine out.

The causes of the overactive bladder are different in men and women; in men, about 2/3rds of the time, a blockage to the flow of urine by the prostate is the culprit, but there are other causes as well including weakness of the muscles of the bladder, infection of the bladder or prostate (prostatitis), bladder stones and even bladder cancer. Neurologic conditions such as Parkinson's disease, stroke, multiple sclerosis and diabetes can also cause symptoms of OAB.

So, if you're a man and you have OAB, what should you do? The first step is to see your doctor.

Should I see my primary care doctor or should I go right to a urologist?

That's for you decide. I think you are better off seeing a urologist, but here are the pros and cons to seeing a urologist:

Pros
- He knows all of the potential causes of OAB in men
- He can begin the evaluation on the first visit
- He can begin treatment on the first visit
- He can rule out serious causes of OAB on the first visit
- If a serious cause is suspected, he can begin the evaluation and treatment right away
Cons
- He might make a 'bigger deal' of your condition and order more tests
- It may be more expensive

What should the urologist do?

Here is what we do and recommend on the first visit:

Take a history
Examine you
Obtain a urine specimen - The purpose of the urine test is to make sure that you do not have a urinary tract infection (UTI) and that you don't have blood in your urine. A UTI commonly causes overactive bladder symptoms and requires antibiotics. If you have a UTI, you should get better within a matter of days after starting treatment. Once you are better though, we may suggest that you have more tests to determine why you got the infection in the first place. Blood in the urine is common in UTI's, but it can also be due to kidney stones, bladder or kidney cancer, and a number of other medical conditions.
Make sure that you are not retaining too much urine in your bladder after you urinate. That is called post-void residual urine or PVR. The best check of PVR is to obtain an ultrasound of the bladder which is a simple, non-invasive, non-painful test done in the office. An elevated PVR is usually due to a blockage by the prostate or a weak bladder.
Obtain a uroflow -- Uroflow measures how fast the urine comes out during urination. You simply urinate into a specialized urinal and if it comes out to slow, you may have a blockage, but it can also be due to a weak bladder.
Ask you to complete a 24 bladder diary -- You will be given a preprinted diary form, an instruction sheet and a folding measuring device to measure the amount of each urination. In the diary you will record the time and amount of each urination and record your symptoms.
Begin treatment (in most cases) or recommend further tests.
- If you are not emptying your bladder completely and/or if there are other signs of a blockage by the prostate, you will probably be treated with a medication called an alpha-blocker (Avodart, Flomax or Uroxatrol). An alpha-blocker is a medication that helps to relax the muscles in the wall of the prostate and that helps to relieve the blockage.
- If there are no signs of a blockage we may recommend a behavior modification approach or prescribe an anticholinergic medication that relaxes the muscles in the walls of the bladder and diminishes the strong urge to urinate. Common anticholinergic medications include Gelnique, Detrol, oxybutinin, Oxytrol, Sanctura, Toviaz and Vesicare.

These treatments are effective in the majority of men and often have long lasting results. When they are not effective or if the effect wears off, further treatment may be provided depending on the cause. At this point, we may recommend further testing to determine the cause. The two most common tests are cystoscopy and videourodynamic study. Both are usually done at one sitting in the office and require only local anesthesia applied through a gel. When there is a blockage by the prostate, surgical treatment is effective in the vast majority of men and those results are long lasting too. The two best operations are transurethral resection of the prostate (TURP) and laser ablation of the prostate. Both operations are done by passing a surgical instrument through the penis and cutting out (TURP) or vaporizing (laser) the prostate. The operations are very safe, require no incisions and either no hospital stay or a very short one. There are very few serious complications.

If there is no blockage and overactive bladder symptoms persist, then there are three surgical treatments available -- injections of Botox into the bladder, neuromodulation and enterocystoplasty. Botox is short for botulinim toxin and, despite its name, it is a very safe treatment that is done in the office with local anesthesia. Neuromodulation is a minor operation done in the operating room under local anesthesia that is similar to a pacemaker for the heart. Enterocystoplasty is a major operation done under general anesthesia using part of the intestine to reconstruct the bladder.