ABSTRACT
A significant workforce shortage of urologists available to serve the US population has been projected to occur over the next decade. Accordingly, much of the management of urologic patients will need to be assumed by other specialties and practitioners. Since primary care physicians are often first evaluate common urologic complaints, it makes sense that these physicians are in an excellent position to intervene in the management of these patients when appropriate. One of the most common complaints in urology is voiding dysfunction. The incidence of voiding dysfunction increases with age, with conservative estimates showing that over 50% of elderly patients suffer. Despite this high prevalence and its negative impact on quality of life, however, few seek or receive treatment, as many do not readily disclose these impactful yet personal symptoms. We sought to summarize the typical presentation, evaluation, assessment and therapeutic options for both male and female patients presenting with voiding dysfunction.
Subject(s)
Prostatism/therapy , Urinary Bladder, Overactive/therapy , Urination Disorders/diagnosis , Urination Disorders/therapy , Cystitis, Interstitial/diagnosis , Cystitis, Interstitial/etiology , Cystitis, Interstitial/therapy , Female , Humans , Male , Prostatism/diagnosis , Prostatism/etiology , Urinary Bladder, Overactive/diagnosis , Urinary Bladder, Overactive/etiology , Urinary Bladder, Underactive/diagnosis , Urinary Bladder, Underactive/etiology , Urinary Bladder, Underactive/therapy , Urinary Incontinence, Stress/diagnosis , Urinary Incontinence, Stress/etiology , Urinary Incontinence, Stress/therapy , Urination Disorders/etiologyABSTRACT
INTRODUCTION: The prevalence of bladder outlet obstruction in men has been overestimated leading to improper clinical results after transurethral resection of the prostate. PATIENTS AND METHODS: 3,830 consecutive male cases submitted for urodynamic evaluation were prospectively analyzed using a Schaefer nomogram. The prevalence of detrusor overactivity and the occurrence of obstruction were prospectively studied using standardized urodynamic practice. RESULTS: Infravesical obstruction was diagnosed in 44.8% of the studied population: 0.7% of the obstructed cases were obstructed at the sphincter zone and 7.9% showed obstruction as a high-pressure, high-flow-rate pattern. Detrusor overactivity was demonstrated in 73.9% of the obstructed cases and in 22% of the unobstructed. Older patients (>60 years) seemed more likely (odds ratio: 2.8) to present detrusor overactivity, but at the same time showed less frequent obstruction. The oldest subjects (>80 years) showed a lower prevalence of obstruction, although overactive bladder was a common finding. CONCLUSION: Infravesical obstruction is less frequent than previously stated. The common assumption that obstruction is the cause of lower urinary tract symptoms in older men is wrong. Older men are more likely to suffer from detrusor overactivity resulting from lower urinary tract symptoms rather than infravesical obstruction. Urodynamic studies seem to be crucial for a proper diagnosis in men considered candidates for surgical treatment.