Johns Hopkins Health Alert
Overactive Bladder Concerns
In this Grand Rounds column from a recent Prostate Bulletin, a reader writes: Early this year I had the TURP surgery (transurethral prostatectomy) for BPH (benign prostatic hyperplasia). Before the surgery, I would take one 5 mg tablet of Ditropan XL or oxybutynin each evening and I did not have to get up to urinate during the night. Now, after the TURP procedure, I am back to getting up to go to the bathroom. I tried taking Ditropan XL and oxybutynin, but they no longer worked. I tried taking one pill in the morning and another at night, and that didn't work either. In addition, I am careful not to drink anything after 6 P.M. ...
At my urologist's suggestion, I tried a new prescription drug, VesiCare, and when that didn't work, I tried Detrol LA. I still have to get up four, sometimes five times a night to urinate. I've now noticed that during the daytime I have to urinate more often before, sometimes in a panic.
Do you have any idea why this is happening? Any recommendations about what I can do to get a better night's sleep? It seems like my bladder is just not functioning properly anymore. Novato, CA
Dr. Jacek L. Mostwin answers: A few things that can be considered as possible causes of your symptoms could be easily treated. Is there a urinary tract infection? A urinalysis and a urine culture would answer that question. Is there a bladder stone? An ultrasound or a cystoscopic examination would answer that question. Is there a scar or a bladder neck contracture in the area where the prostatic surgery was performed? Cystoscopic examination or a flow rate would help to answer that question.
If the suggestions described above don't lead to a diagnosis, your overactive bladder symptoms may be due to changes in spinal reflexes that took place over the many years during which the prostate was blocking your bladder. These reflexes improve partially after prostatectomy, but in some cases they do not improve completely. We generally expect about 15% of patients to continue to have significant overactive bladder symptoms, and some of them may get worse.
Again, if none of the suggestions made in the previous paragraph provide an answer, and there is no other explanation for your severe overactive bladder symptoms, you may require more decisive intervention. It all depends on how bothersome your symptoms are.
A device called the Interstim is approved for the treatment of your problem. It is more commonly described as a spinal cord stimulator, although the electrodes used to stimulate the bladder nerves do not actually enter the spinal cord at all. It is a safe device and has been used in many thousands of patients with good results. This would be one possible solution to consider if your symptoms are very disruptive and they have not responded to any other medications or conservative fluid management.
Posted in Enlarged Prostate on March 2, 2010
Reviewed September 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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Johns Hopkins doctors and other physicians have stated that many men (14-35% of male Americans, depending upon source) suffer from prostatitis (inflamation or bacterial). However, little hope is extended to those of us who are so afflicted. From the age of 22 I have had my life darkened by this misearble condition (I am now almost 70). Virtually every aspect of existence is affected. Is any meaningful remedy available or in the offing? All of the emphasis seems to be on BPH or carcinoma---undeniably serious and signicicant problems, but not the only ones related to that wretched little gland. Often I feel that I may as well have lived in the 14th Century as far as useful medical care is concerned!
Posted by: Ed Greding | March 7, 2010 1:47 AM
I had radiation therapy (gold seeds implant and external beam) about 17 years ago. My cancer returned after 5 years and I have been on hormonal therapy (lupron shots and cassadex)for 12 years. My psa is now 30 and I am 73 years old. Recently, my urine flow has become very weak and I need a TURP procedure. I am concerned because of all of the scar tissue. Is there data that supports successful treatment under these conditions?
Posted by: bray | March 11, 2010 8:39 AM
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Is Detrol LA comparable to oxybutrin in strength? My insurance company stopped paying for Detrol LA and I am not finding oxybutrin working as well...
Posted by: alice Arlen | March 6, 2010 9:09 AM