When you have to go…

Symptoms may differ from the fairer sex and largely consists of nocturnal frequency, increased dribble after urination and commonly accompanied by urgency symptoms.

Commonly the “old-prostate” is to blame, yet more often the bladder does contribute or may even be the sole perpetrator.

Conditions such as BPH (benign prostate enlargement/hypertrophy), prostatitis, cystitis and an overactive bladder may be the cause.

Less common causes are bladder cancer, bladder stones and neurological conditions.

It is also pertinent to exclude prostate cancer, by means of a DRE (dreaded rectal examination) and a PSA blood test.

Brisbane has taken the lead with MRI screening of suspicious prostates, an advance to the initial blinded multiple prostate biopsies of the past.

An enlarged obstructing prostate is probably the most common cause of lower urinary tract symptoms.
You may already have tried some of the self-help medications.

Most phyto-therapies (natural remedies) are good for that initial management.  

If this fails, your GP can start you off on an alpha-blocker.

If there’s no success after four to six weeks, you may require Step-Up therapy with a combination drug. This should be initiated by an urologist as this is not suitable for everyone, and the indications and side effects will be discussed with you.

The next tier in therapy is surgical. The new gold standard” in treatment is laser therapy. This enables removal of the adenoma by means of vaporisation.

The benefits of this would be a reduced hospital stay, minimal blood loss and reduced catheterisation time.
It’s a major improvement on the traditional techniques and can even be done while on anti-coagulants.

Now for the more tricky diagnosis of an overactive bladder (OAB).

You would probably be able to say that you have “FUUN” symptoms - Frequency, Urgency, Urge incontinence and Nocturia.

What a misnomer. Having these symptoms is definitely not fun!  

About 65 per cent of men (or women) may experience a satisfactory improvement in symptoms on a 60-90 day trial of medication.

Commonly used medications are the anticholinergic drugs.

A newcomer drug is the B3-adrenergic agent, which has made a huge improvement in the battle against the leak.
Further advances have been made in the resistant overactive bladder.

Sacroneuromodulation and Intra-vesical botox can provide up to a 70-80 per cent improvement in these cases.
Both are done as day procedures.

It’s all a far cry from a few years ago when you would have been doomed to a life of seclusion, isolation and embarrassment.

Dr Jo Schoeman is a urologist at St Andrews Hospital, Brisbane.