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Answered questions

 

Distinguishing LUTS symptoms

How can a GP distinguish lower urinary tract symptoms due to an overactive bladder (OAB) from those of BPH?

Specialist's response: The approach to LUTS should be to interpret the symptoms by dividing them into categories. Storage LUTS include urgency, urge incontinence, frequency and nocturia - symptoms of overactive bladder. Voiding LUTS include slow stream, hesitancy, incomplete emptying and post-micturition dribble, which can occur with prostatic obstruction Often there is overlap and a combination of symptoms. A definitive diagnosis is not necessary to commence lifestyle measures - fluid intake, weight loss, bladder retraining, pelvic floor exercises, etc. Prostatic obstruction can be relieved by the use of alpha-blocking drugs and 5-alpha reductase inhibitors. Antimuscarinic drugs will help the OAB symptoms and desmopressin can be helpful for nocturia. Failure to respond should lead to referral for further investigation. The latest NICE guideline on male LUTS does not support seeking a definitive diagnosis before starting treatment.

 

BPH and nocturia

A 70-year-old man has benign prostatic hyperplasia (BPH) and very troublesome nocturia. His daytime symptoms are well controlled by tamsulosin and finasteride, but he has been unable to tolerate the side-effects of the newer anticholinergics. Is there likely to be any benefit in trying flavoxate at night for the nocturia?

Specialist's response: Nocturia is often the most troublesome symptom of BPH and one of the more difficult ones to resolve. If anticholinergics are not well tolerated by patients because of dryness of the mouth and visual disturbances, desmopressin in the form of Desmotabs or Desmospray taken last thing at night in association with fluid restrictions may be helpful. I have not found flavoxate very useful in my patients, nor is there very good evidence from randomised controlled trials for its safety and effectiveness in this situation.

 

Screening for prostate cancer

Are there any trials/research on screening men with a strong family history of prostate cancer?

Specialist's response: There have been a number of studies on families in which many of the men develop prostate cancer, many undertaken at the Royal Marsden Hospital in the unit of Professor Ros Eeles. As a result of these studies more than 30 prostate cancer susceptibility genes have been identified. In the future it may be possible to identify, on the basis of genetic testing for mutations involving these genes, a subgroup of men who are especially likely to develop prostate cancer. In these individuals, who have a positive family history, screening for prostate cancer should begin as early as 40 years of age.

 

ED after radical robotic prostatectomy

What is the incidence of erectile dysfunction after robotic radical prostatectomy?

Specialist's response: The incidence varies according to the age of the patient, the stage of the cancer and the time after surgery. In most cases erections do recover after a period of up to two years with the help of rehabilitation methods such as PDE5 inhibitors, vacuum devices or treatment with prostaglandin E1. However, patients should always be fully informed about the risks of a negative impact of surgery on their sexual function prior to their operation.

 

 

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