UnderActive Bladder or BPH ???

Men's health
1

UnderActive Bladder (UAB) or BPH ?

UAB:

"Detrusor underactivity, urinary retention, high residual urine, and incomplete bladder emptying have been used. Detrusor underactivity is defined by the International Continence Society as a contraction of reduced strength and/or duration resulting in prolonged or incomplete emptying of the bladder, but has received only minimal attention. Patients with UAB have a diminished sense of when the bladder is full and are not able to contract the muscles sufficiently, resulting in incomplete bladder emptying."

UAB also is known as Hypotonic Bladder, Flaccid bladder, Lazy bladder and Detrusor Hypoactivity. The most common symptoms are urinary retention, hesitancy, difficult starting and stopping, stops and pauses during urination, dribbling afterward, urgency, and frequency problems.

Treatments for UAB are generally to protect the kidneys from urinary retention, including:

- Time scheduled voiding, since UAB sufferers can not tell if bladder is full.

- Double voiding, to empty bladder as much as you can.

- Bladder relaxants like Bethanechol, Doxazosin.

- Intermittent self-catheterization (ISC or CIC) and indwelling catheters.

Unfortunately, many of the listed symptoms and treatments are similar to BPHs, while the causes of UAB are many (too many to be listed here), not just prostate obstruction, and affecting men as well as women. This gives ways to many cases where unneeded prostate procedures were suggested or even coerced by ignorant or unscrupulous professionals. The results sometimes can be devastating for the patients.

So the question is how to know if it is UAB or BPH ? I've read some where that the simplest way to tell is by your prostate size. If it is less than 30cc, then it is most likely UAB. If it is higher than 40cc, then it is probably BPH. There might be also one read using PSA readings as indicators.

Another way which was suggested by Jimjames on this forum many times is with urodynamics, where your flow can be measured. Maybe Jim will elaborate more on this test. However, urodynamics was known to be more accurate to show that there is no obstruction (good flow) than whether or not the poor flow is caused by UAB or obtruction.

Now comes my story: 63, blood test shown decline kidney function in 2016. High blood pressure. Symptoms were exactly as UAB now that I know better. Asked for a kidney scan. results : urinary retention + kidneys flooded with urine. Referred to a urologist. Without any test or exam or even a handshake, uro suggested TURP. Said "No", asked for CICs and doxazosin. Have been doing CICs since, 4 times at the beginning. Since kidney functions and retention have improved, I have reduced to 2 times a day. Doxazosin still taking on and off. UAB symptoms are still here, but are more tolerable. Normal blood pressure now. Don't know prostate size. PSA has been around 3.0 for the last 9 years. Some one on this forum (I think it was kenneth1955) gave me an estimate of 35cc for PSA of 3.

How did I get UAB (even though I think I have BPH as well, I think the dominant one is really UAB) ? I have few suspicions:

- I used to donate blood very often for years, until one day I was refused because they said I was anemic. One of the cause of UAB is nerve problem, and B12 deficiency is one of them).

- Years of bladder abuse finally caught up with me. I used drink a lot and then tried to hold it in, especially overnight. I definitely over-stretched my bladder many times over.

- Years of taking antihistamines as a sleep aid.

How about a cure for UAB ? Unfortunately, there is none, at least at the moment. The only thing we can do is to take care of our unique situations, making sure UAB will not cause any further kidney damage.In a way, UAB is worse to have than BPH. Because with BPH we may find a fix via a procedure. However, if you have UAB, it is good to know it since it may save you from unneeded BPH procedures, which is the main purpose of this discussion. I am not anti surgeries or anti drugs. Just make sure what you have and what will help you.

But there is hope !!! My symptoms have improved after a year of CICs, doxazosin, and watching my liquid intake. I am very hopeful that it will get even better. Then here comes Jimjames, who is well known in this forum for his sardines and spinach. Jim had a similar problem 3 years ago. UAB with BPH! Jim self cathed for 2 years + and was able to rehabilitate his bladder and now is free of UAB. No CICs + no drugs.

Actually, I did try to sweet talk (con) Jim into posting this discussion (to save me the hassle) but he is too smart (did I mention sardines and spinach ?) so he did not do it.

Finally, fellow UAB sufferers : You are not alone!

Hank

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I think I may have UAB, but also think I have BPH. As I have had two procedures in the past two years, Itind and FLA, that have given me a lot of relief. But it feels like temporary relief, especially the Itind procedure. 

Since having the FLA procedure, I recently tried using a catheter to see if I have any retention going on. I could not insert the Speedicath 14 that I had no problem with prior to the procedure. I was even using #12 prior and after with no issues. So something changed in the healing process to make insertion more difficult. 

But I guess my point in posting is I believe you can get relief from UAB symptoms by removing some of the obstruction of BPH. 

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Thanks for your story Hank, I think this is a valid and improtant part of the diagnosis of what is going on for a majority of man with urinary issues. I would guess that in most cases of urinary retention issues it is a combination. I know that in my search for some answers a doctor in North Carolina looked an my MRI and told me, "what ever you do is your choice but my advise to you is to do it sooner rather than later as you have a case or tribeculation starting in your bladder wall. My prostate felt normal and seemed to work fine except for the BPH symptoms but it had grown to 125 cc. which is about 4 times normal size. 

I have a question to ask you, why do you not know what size your prostate is? I would think a simple MRI even without contrast would tell you the size? With contrast the urethra stricture would be visible and messurable. So, I am sure you are correct that these symptoms we call "BPH" symptoms are, alot of times a combination of BPH and UAB. 

jimjames is proof that UAB is cureable and with the correct tissue removal process, I would think both conditions could be dealt with over some time. UAB seems worse than BPH but I bet in reality they go in combination a lot of times. BPH is not cureable as you can only treat the growth and not the condition. jimjames has presented his situation and has evidence that he has cured his UAB at least for the moment. I would think since these two conditions seem to go hand in hand that treating them together may become a option that surfaces. But I don't count on it coming from the medical industry. 

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I agree with you John, hoping I can use Jim's methods.

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" .you can get relief from UAB symptoms by removing some of the obstruction of BPH. ."

I agree Moto, some will definitely can use a procedure, actually some should. The question is which one ? But for some, like me, no procedure is needed, at least not yet. Hank

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I agree with you John. BPH is one of many causes of UAB. Most people have both, just the degree of which is more, or can be handled. Right now I think I have mostly UAB. But that can always change. It is why I am constantly learning for the next procedure.

Actually, I looked up my note. It was Neil3149 that was kind enough to give me an guesstimate of 25mg from my PSA of 3. I had bad experience with my urology people so have not been able to get the actual size yet. Hank

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Hi Hank,

It can get confusing, and part of the problem is that BPH (Benign Prostatic Hyperplasia) is often confused with LUTS (lower urinary tract symptons), and often by your friendly (and all to ready to operate) local urologist! The former is simply an enlarged prostate which could be entirely asymptomatic either because it’s not causing an obstruction, or because the bladder has enough integrity/elasticity to overcome the obstruction. So, a better term is really BPH/LUTS which is more accurate for symptomatic BPH.

The problem is that without proper investigtion, including urodynamics, it’s often hard to determine how much of your LUTS (lower urinary tract symptons) are being caused by the prostate  (oversized or not) and how much by the bladder. The size model you mention would not be helpful in and of itself because there are studies that suggest men can have LUTS with small prostates and no symptons with large prostates, and of course vice versa. Urodynamics can not only help with this, but it can also help determine how successful a prostate reduction surgery or procedure might be.. It does this by measuring such things as flow rates, detrusor pressure and nerve activity. For this reason, more sophisticated urologists often recommend a period of catherization (Foley or CIC) for patients with significant retention,  prior to urodynamic testing (or after a failed urodynamic test) as part of evaluating whether a particular procedure or surgery might work.

As to whether UAB in and of itself can be “cured”, that depends on how much damage was done to the bladder. I think in many cases “managed” would be a better term. UAB can sometimes be managed with drugs, CIC, or a prostate reduction surgery or procedure.

In my case, for example, I ended up rehabilitating my bladder to a significant degree with CIC, but I wouldn’t say anything is cured. Prior to CIC my IPSS score was in the 30’s (severe) and dropped as low as “5” (mild) four months after I stopped CIC.  Now it’s about “9” (mild/moderate) and that’s fine. Should I get more symptomatic, the plan is to go back to CIC for a period of more rehab, per my “on/off” strategy outlined in another thread.

Jim

 

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I have both - and my prostate is only 30, but its growth is all inward, hence my symptoms. I had Rezum done and it helped alot - probably solved about 70% of my problem, but obviously not the bladder issues. Sometimes, my bladder is almost normal, other times I need to pump it to get empty. If you have significant prostate related blockage, you might want to consider one of the less invasive procedures as BPH can cause and/or exacerbate bladder issues.

Best to be scoped and have unrodynamics testing to get a baseline and see where you are. Some (like me) opt for a procedure, others (JimJames) don't think they are worth the risk and opt for CiC. Both can help dramatcially.

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Thanks buzz, I am glad you have some relief with Rezum. Hank

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Hi Moto,

How is your progress with FLA ? I am interested in both iTind and FLA. Did you have retention before iTind and FLA ? I think I know the answer (clue: long motorcycle rides). Did iTind and FLA help your retention ? Thanks.

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Did you have retention and did Rezum help it ? Right now my symptoms are very mild. But thanks for the advice. Hank

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My IPSS is probably fairly low right now, mostly involving hesitancy and weak flow, which is more of an annoyance than problematic. I am aware that the model is not perfect. But it should be used as a general guide. Hank

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Motoman,

That is strange, you would think the opposite, now that at least some of thee obstruction has been removed by FLA.

Did you meet resistance at the prostate, bladder sphincter, or somewhere else? If you didn't try a coude, that might help make navigation easier. Either the standard Speedicath coude or the new Speedicath FLEX coude. 

In any even, further investigation might be useful, not just in regard to CIC, but to find out why you are having more difficulty inserting a catheter.

Jim

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Something else to ponder:

If you have retention, you most likely have UAB.

If your prostate is small (and assume that obstruction is also minimal), you may be able to rid of the retention by CICs. Surgeries probably will not make a big difference.

If your prostate is large (and with serious obtruction), what should you do ? Try surgeries first, but be warned that you may still have problems, because you still have UAB. Is it why so many people complained of unsuccessful procedures ? Or try to rehab the bladder first ? Hank

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Interesting, Jim. Two questions:  1) My undertstanding is that when it comes to BPH, it's not so much the size of the prostate as configuration that matters: A prostate, regardless of size, that isn't pressing on the urethra will be asymptomatic, whereas a prostate that is pressing on the urethra will cause LUTS. If that's right, then why the difficulty diagnosing BPH? Wouldn't a cystoscopy or MRI show if the prostate is pressing on the urethra? 2) if BPH medication--in my case, Finasteride and Cialis--eliminate or reduce symptoms, wouldn't that point to BPH as the main culprit? Or can BPH drugs also alleviate UAB symptoms? 

Don

 

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@hank: If your prostate is large (and with serious obtruction), what should you do ? Try surgeries first, but be warned that you may still have problems, because you still have UAB. Is it why so many people complained of unsuccessful procedures ? Or try to rehab the bladder first ? 

-------------

Either decision can make sense as long as testing suggests a reasonable chance of improvement from the surgery or procedure. 

The advantage of having the procedure first is that: (1) It might work; and (2) If it doesn't work, bladder rehab might be easier with less obstruction, plus you were going to do it anyway.

The advantage of trying CIC (or CIC rehab) first is that: (1) you will spare yourself any risks and side effects of a procedure that might not work; (2) you can buy time waiting for newer and possibly better procedures; (3) you may find out that CIC solves all your issues without a surgery, and if you're lucky you may even be able to stop CIC at some point.

Jim

 

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I would have thought it would be easier, but it was more difficult for the prostate, and impossible to go past the sphincter. I twisted it a little, backed it out, etc, and finally gave up. Maybe a new false passage? I was able to use a coude a couple weeks prior, but that was really painful, so I thought I would try my old standby. 

I did just order a few of the new flex coude, in both 14 and 16. Just a handful of each. Maybe they will work better. I don't really want to do it, but it is good to check my PVR now and again. Only done it once since my FLA.

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Good answers Jim. However, re testing, would you not be concerned who will do the testing ? My uro did not need any test, already suggested TURP. Do you think he will not do the same if I let him run some tests on me, especially the tests that he can freely interprete the results ? Hank

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Hank,

I did have retention before the Itind. I guess I did before the FLA as well, but knew how to self cath by then so not a big issue.

I am wondering if the motorcycle riding is causing some issues with my prostate. You are basically sitting on it the whole time. Plus it takes a beating when I am riding my dirt bike, which is at least weekly. I would never give it up. The prostate will be gone before the bikes at this point of my life.

As for the FLA, I would say it has worked great short term, but I am watching and waiting to see if it holds up for the long term. I have some hesitation, especially in the middle of the night, that was not there for the first three months after the procedure.

20

Don,

Yes, in terms of LUTS, configuration matters more than size, but the other factor is the bladder. As an example. Two patients with the same bladder configuration with say moderate obstruction. The first patient has a healthy, elastic bladder. The second patient has a stretched, flaccid bladder. The first patient could be almost entirely asymptomatic while the second patient could be moderatly or even severely affected by LUTS. So, it's not really even the configuration (how much it presses on the urethra) but the big picture of prostate and bladder together. 

For this reason, functional testing like urodynamics will be more helpful then a cystoscopy or MRI which would show bladder size and obstruction, but not directly measure bladder function. That doesn't mean the cystoscopy or MRI can't be useful, but you really want functional testing as well. 

Finesteride and Cialis do different things so if used together, hard to tell what is helping what, but a case could be made that BPH/LUTS is secondary to UAB. Still, there's no reason not to have a urodynamic study, preferably video urodynamics. These surgeries and procedures can be a big life decision, and the more information both you and your doctor have the better.

Jim