Johns Hopkins Health Alert
Are my Urinary Problems Caused by LUTS, BPH or LOO?
How can you tell if your urinary frequency problems are caused by a condition in the bladder or the prostate – and what should you do about it? In this excerpt from a recent Johns Hopkins Prostate Bulletin, Dr. Jacek Mostwin explains how to differentiate LUTS, BPH and LOO.
Q. I am confused. I’m 52, and for the past three years I have had urinary frequency and urgency problems. I finally decided to go to a urologist. After taking my history, the doctor gave me a DRE (I had a “large” prostate, he said) and then took blood for a PSA test.
A week later, the doctor called to say that he wanted me to have a prostate biopsy. My PSA test had come back at 6 ng/ml. Long story, short: My prostate biopsy was negative. I was given Proscar and Flomax for my urinary problems and the doctor said to come back to see him in about six months.
I assume that he gave me this vague time frame because it may take that long for the drugs to work. I can accept that. However, what if the urinary problems are not caused by my prostate, but by my bladder? I don’t want to embarrass my doctor by second-guessing him, but can any urologist really ascertain whether urination complaints arise from the bladder or prostate, or is the diagnosis made by exclusion? Bronxville, NY
Dr. Mostwin: You are right to be concerned about the source of your lower tract urinary symptoms (LUTS) being either the prostate or bladder. LUTS can be caused by benign prostatic hyperplasia (BPH), bladder outlet obstruction (BOO) and other conditions. LUTS are only rarely caused by prostate cancer in early stages.
Urinary cytology and cystoscopy are often sufficient to exclude these conditions, but sometimes a transurethral (as opposed to a transrectal) biopsy may be needed. The most common situation is the man with LUTS and BPH. Formerly, all LUTS in men were attributed to prostatic enlargement, and prostatectomy was frequently the recommended treatment.
More recently, it has become clear that both men and women suffer from a similar age-related increase in LUTS, and that LUTS may be complicated by BPH, but may not always be caused by it. LUTS, BPH and BOO may all co-exist, but may not be directly related, so that LUTS may be improved by medications affecting the bladder or the sensory nerves to the bladder, or it may be affected by reducing prostatic volume, or both.
Sound complicated? Welcome to the world of urology! If prostate cancer is excluded and there is no blood in the urine at the time of initial evaluation, it is reasonable to offer combined medical therapy for LUTS in the setting of BPH. There should be some sign of improvement within the first few weeks from the Flomax alone; the improvement from Proscar takes a good six months to kick in. If there is no improvement in the first month, it is reasonable to re-assess the situation and decide whether the patient should wait a full six months for further improvement, or if invasive testing is required.
Posted in Enlarged Prostate on September 23, 2008
Reviewed June 2011
Medical Disclaimer: This information is not intended to substitute for the advice of a physician. Click here for additional information: Johns Hopkins Health Alerts Disclaimer
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MEDICAL IGNORANCE ABOUNDS
I have LUTS diagnosed as BPH but have had difficulty with urgency and "shy bladder syndrome". I've suffered (pain and embarassment) for 40 years and seen 5 specialists over about 20 years. The first wanted to do TURP or TULIP(?) procedures to remove the organ - 20 years ago - a procedure fraught with hazzards! While under his care, I took CARDURA until it was discovered to be a risk factor for heart failures. I also suffered several hospital visits to empty my bladder via a catheter - lots of pain, lost time and embarrasment. My GP also was *no help*, not even providing a catherization when I visited him.
Another office: the nurse was puzzled when I confessed that, tho my bladder was NOT empty, I could not pass any urine for analysis. Why did she think that I was there?
None of these had offers that would bring improvement, so I visited the JHH Brady Urological Clinic and got better understanding but no home runs until one of the specialists there, a Dr Chan, had the nurse give me directions on how to catherize myself. A GREAT RELIEF!
Since then I've found a specialist who shared the same blockage symptoms and simply monitors my gland texture for growths and provides prescriptions for my Flowmax (1.5 daily) and finasteride (1 daily). These supress my blood PSA which is very low.
I watch my diet (avoiding irritating food and drink) and plan my activities so as to avoid being in a situation in which toilet facilities are unavailable when I expect to need to void. Until this becomes inadequate, I'll defer the surgical solution.
Posted by: Ed_z23 | December 28, 2008 1:48 PM
I heard that cranberry juice is good a preventing urinary tract infections. http://www.ionmeds.com/
Posted by: esco198025 | March 17, 2009 5:26 PM
My mother has an urinary tract infection that keeps on recouring. Everytime she is giving medicine from our doctor and it goes away for a while them comes back. I guess my question is is there some typr of operation or procedure to prevent this from keep on coming back?
http://www.ionmeds.com/Adult%20Diapers%20Home.htm
Posted by: esco198025 | March 17, 2009 5:29 PM
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i'm 68 & have had problems with increasing psa readings over a period of a few years. as i get older psa seems to be increasing. i have had 2 negative biopys because of this. my most recent psa went up 2 points & uroligist wants to do a turp biopsy is this a recommended procedure.my first psa was 2.9 probably near 20 years back and has been on increase for the last approx 10 years, it is now 9.23. thanks nelson
Posted by: nelson | November 5, 2008 4:45 PM