What are the basic tests that should be done to determine the cause of LUTS? Based on my understanding at the time, I assumed that my enlarged prostate (98 cc) was causing my LUTS symptoms. I had a PAE in March of this year and I’ve experienced only marginal improvement. Now from following the posts on the forum, I understand that the symptoms could also be caused or exacerbated by an underactive bladder, an overactive bladder, and/or strictures. I have an appointment with my urologist at the end of August, and I would like to discuss further testing with him before deciding on possible future procedures. The tests that I have seen mentioned on the forum include a bladder scan (to see if there is PVR?), a urodynamics study, and cystoscopy.
Re: the bladder scan. I’ve been tracking and documenting my urine output carefully for over two weeks, and there seems to be significant variation throughout the day. Would a one-time bladder scan in an office really provide useful information based on a single reading?
Thanks for posting this. I'm just recovering from the second infection in three weeks and am seeing my urologist tomorrow to ask similar questions. Will be interested in others' responses.
If you don´t mind please, which were your symptoms after your PAE? Whay do you mean by "marginal improvement'? Best urine flow? Improvement in night urine frequency? Can you elaborate, please?
Basic tests are DRE, office bladder scan, urodynamics, bladder/kidney ultrasound, cystoscopy. As you suggest, PVRs can vary from time to day or even day to day depending on numerous factors such as fluid intake. Assuming you get a bladder scan each visit (which you should), I suggest you schedule your urologist's appointment at different times of the day for this reason. You also might want to take the scan with your normal fluid intake and resist fluid loading at the office to rush things along. Of course, if you self cath, you can check your PVR at home anytime. Same if you have a home bladder scanner.
My symptoms after my PAE were similar to the ones before, just somewhat less pronounced. When I've taken a tamsulosin, my stream is much better than before (when I had taken a tamsulosin), and when I've been off Tamsulosin for several days I have less urgency and better stream than before, but still not good. I also have periods where I don't need to urinate for 3 or even 4 hours, which pretty much never happened pre-PAE. With that said, I still have occassional episodes of extreme urgency, and nightime frequency is pretty much the same. The main concern is that both pre and post PAE, if I haven't taken a tamsulosin in a few days, the first time I awaken after going to sleep, I have difficulty starting urination, and have to lie down and stand up a second time to finish. That's a little to close to AUR for my peace of mind.
While some office scanners give more information than other, in general a portable office bladder scanner just give you bladder volumes and therefore are useful at checking PVRs but not much else. A bladder/kidney ultrasound study is usually done at a radiology facility with bigger equiptment and in addition to measuring bladder volumes can also give you bladder size and architecture such as bladder wall thickness and whether it's trabeculated or not. It will also scan the kidneys and can pick up abnormalities such as hydronephrosis.
A void log without self catherization cannot directly tell you PVR although if you know your PVR from a bladder scanner, however if you happen to know your PVR from a multiple bladder scans (or CIC) and previous void volumes (without fluid loading) you might be able to make a rough approximation by correlating void volumes and PVR.
What a void log will tell you is the frequency of your voids, void volumes, and the percentage of daytime versus night time void volumes. Void volumes can be useful both diagnostically and historically in terms of PVR and to help differentiate OAB from BPH LUTS. The day/night time percentage will help diagnose nocturia and what kind it is.
For example, if it turns out that you get up five times per night, but only 50ml comes out each time, then you might conclude that the cause of your nocturia is incomplete bladder emptying. On the other hand, if you get up five times and your voids are 300ml each time, then you might conclude that you're body is simply producing more urine at night. If the latter, a prostate reduction surgery or procedure might not help.
i had the PAE procedure 21 months ago and have been off Flomax for 20 months. I was on two flomax aday and still had problems. A month after the PAE procedure and off flomax I was peeing as good or somewhat better than when I was on flomax twice aday. After 21 months I am still off flomax, but the finishing process takes a little longer now than it did. I have to wait and be sure I am really finished. About 10 percent of the time when I think I am finished it starts again just as if i had not unirated at all. I still do not have retention issues, or a problem having to get up at night. But this new developement indicates something is happening that not good. Will have a psa test in early Oct. I am still satisfied with the results, but concerned about what happens next.
My nightime voiding is usually in the mid 40% of total daily voiding, on occasion in the low 30s. My average void amount at night varies from 125 to 180 ml, which is somewhat higher than my daytime average voiding amount. Does this shed any light on the possible causation of LUTS?
Also, curious as to what the urodynamics test consists of.
Sounds to me like you're really doing well. How is the PSA test related to the urination issues?
I'm going to try switching from tamsulosin (Flomax) to daily Cialis to see if it helps and doesn't produce the same difficult side effects that the tamsulosin does.
Sounds like prostate reduction might help in general as your low void volumes suggest retention. As to nocturia, you sound borderline so a prostate reduction procedure might help some but not necessarily completely. How many times do you get up at night?
Urodynamics is a collection of tests including uroflow (measures flow rate) but usually consists of a thin catheter that goes into the bladder and a thin probe in the anus. The test measures several things including detrussor pressure and nerve activity. Video urodynamics is a more advanced type of testing that shows the actual voiding process. "Urocuff" is sort of an abbreviated test that is non invasive.
Just want to modify regarding "prostate reduction" in first sentence, above. A procedure would only be helpful if you had adequate detrusor pressure and bladder and nerve tone per urodynamics.
The up and down in the PSA seems to track somewhat my peeing efficiency. Tracking status just before PAE 12plus, six weeks after 3.4, 12 months after 5.8 round of antibotics and back to 4.2. Last checked in May 5.5 Will have it tested in Oct. to see if it has stablized.
Was taking 2 flomax a day before PAE and none since 4 weeks after the procedure. I am taking now 5mg of Cialis every other day or so.
Will see, hopefully I can get another couple of years before I have to do something else. Maybe longer .. If it stays where it is now I will be a happy camper.
seem to have mild pain behind the eyes several hours after use. Have not noticed any others. I use to cut the pills in half which gave me 2.5 mg a day. Now just take one 5mg every other day or so.Seems to work better that way. The damn pills are so high in the US vs Canada. four times as much
Well, let's see how my math is ballpark. 150 average per overnight void x 3 (number of voids) equals 450 overnight output.
So let's say you do something so you can empty your bladder completely -- either a prostate reduction procedure, bladder rehab, a combination of the two, CIC, whatever -- and let's say your new voids then become 350ml. So given that, you could probably decrease your number of bathroom trips from 3 to 1 or zero.
Have you had a cystoscopy? The diameter of the catheter used for urodynamics is much smaller than that. Personally, I couldn't feel it at all but then again I'm used to self cathing. Like with cystoscopy, if they give you a single dose of antibiotics at the time of the procedure you should be OK. If they don't give out antibiotics, I'd ask for them.
Eye problems are know issues with Cialis. I found that my vision was slightly blurred at times. They did a study with 2.5 mg cialis (4mg constant blood serum level) and found improvements but not quite as good as with 5 a day. YMMV.