Bladder vs. Prostate: What’s Causing Your Urinary Frequency and Urgency Symptoms?
Speaker 1:
Welcome back to the Armour men’s health hour with dr. Mystery and Donna Lee. Hello and welcome to the women’s health hour. I’m dr. Mr. Your host here as always with my cohost. Donna Lee. Hello everybody. Donna, how are you doing with this coronavirus suck warranty?
Speaker 2:
Oh, I’m good. Except for the technical difficulties that we’re having with the mix.
Speaker 1:
I’m an, I’ll tell you if it were known that you’d have to deal with computers so much. I don’t know if I’d make you our sound engineer.
Speaker 2:
Well, you know what? I’m all you got. So I’m a producer now.
Speaker 1:
Uh, I’m dr. Mystery. This is my real name. I’m with Donna Lee, my office manager and cohost, and apparently the best I can do.
Speaker 2:
Wow. Zingers off the beginning.
Speaker 1:
This show is brought to you by NAU urology specialist. I’m a men’s health expert and a urologic health, a health expert I’m board certified in urology. Uh, we have a practice that has treated the Austin area since 2007 and deal with the entire smorgasbord big word of your logic conditions. Donna, how do people get ahold of us and tell about our practice?
Speaker 2:
You can reach us during the week at (512) 238-0762. You can call and ask for me, cause sometimes they do dr. Mystery, is that, does that make you jealous looking for a shirt? You can also get a free tee shirt for me, email addresses, armor men’s health@gmail.com. You can also send us questions and inquiries through our website, which is armor men’s health.com. We have a special guest today. Yeah,
Speaker 1:
Well, I mean, you don’t really cause a call. One of your family members have guest one when my daughter comes over now and that was even got out. I was just kind of a guest. We got to treat her like, I guess. Uh, so our practice has a four physicians for physician assistant nurse practitioner practitioners as well. I have dr. Lucas. Jack is here joining us again. Hey, welcome Lucas. It’s fantastic to be here and to be treated with so special. And I, I with coronavirus have dropped octaves in my voice, but I think Donna has actually a higher pitch. I don’t know. We don’t say that you have coronavirus with the COVID. I think it’s so hard defensively, you know, don’t worry. I’m good. I’m tested the audience. Can’t see the commas in your statement. I like Collins my family and big thanks to our KLBJ news radio folks, Kelly, and our team here and allowing us to do this show with Lucas.
Speaker 1:
What I really love is number one, hanging out with urologists. People wouldn’t know that about us, but we really do. You know, you know what I’m saying, feathers like to flock together as this is, somebody should tell me with that, that real estate is anyway. We, uh, there’s a, there’s a humor. There’s a, a certain type of conversation that we have just a certain disposition that I think urologists really enjoy each other’s company. So, and you could rent one of us if you just want to have a friend and just, you know, just hang out with a urologist for a day. I don’t know, thousand dollars a day rent a Lucas. What’s really great about us talking together on the show is to kind of showcase differences in how we deal with certain conditions. Really talk about those areas of urology that we’ve had a lot of experience with less experience with and how powerful it is to be part of a group like ours, that takes such a holistic approach to urology.
Speaker 1:
And so I thought I’d talk a little bit about urgency and frequency in men. When I was in training, we really only learned that men had one condition that was an enlarged prostate, and that was like the mother of all the urinary symptoms. And that was it, but certainly in practice and, and just kind of biologically, as we’ve learned as a profession, we know that there’s lots of nuances there in what can cause a man to have urinary symptoms. So when a man comes to you predominantly with nighttime peeing and daytime urgency and frequency, well, what’s some of that little speech that you give him.
Speaker 3:
Yeah, that’s a great question. I mean, I think it’s very important to get to the bottom of that pretty quickly. And you know, the counterintuitive explanation, I try to give them as I’m going to do something to possibly make your frequency and urgency a little worse to start with. And that is that I’m going to help you urinate better in some way form or fashion because it isn’t, it’s very counterintuitive. You think about it like, well, I’m getting in the bathroom every hour. Like great, let’s do a surgery or medication is going to make you go even better, but even quicker, the reason I think we we’ve stressed the prostate and the bladder outlet first is because historically I’m concerned, am I going to make this guy worse? If I give him a pill to slow him down, to make him go less often? Well, he’ll be in the ER later that night with a urinary retention and a Foley catheter placed.
Speaker 3:
So I think that right away, we do things in the office that we can try to ascertain if they truly empty their bladder. That’s a very important question. So personally, I like them to come in with a full tank or a comfortably full bladder, get back in there and get a flow rate on them and see how fast I can go into a little cylinder and then measure how much they leave behind. And then subjectively try to get to the bottom of what is their bigger problem. As far as the urgency, the frequency, the stream is getting started, getting empty is the harder part, or is it more the overactivity you really hit on it
Speaker 1:
Is is that when men come in for urinary problems, trying to distinguish those symptoms that are obstructive, such as difficulty getting started, slow flow. And I put post-void dribbling in there as well versus irritative, which is nighttime ping, urgency and frequency can really give me an idea of whether or not I think the prostate’s the primary problem or their bladder’s the problem. How does age play a role?
Speaker 3:
We were more about as patients age, especially they’ve had a lot of years of obstruction that perhaps they’re going to develop a dead bladder and contractility issues. So then they become a really high risk for retention as you place it. I think about medications, about constipation. There’s a lot that goes to that. You know, you start to say, um, you know, this person has trouble elimination. They’re going to end up higher with retention, I think, and also medication side effects. I also think about polyuria, which we really don’t talk about. Or I personally, I admit I need to get more into that conversation to find out that for some reason, I noticed that the older we get, we almost flip our circadian rhythms to where we actually make more urine at, than we used to. So I tell them if you’re ever in the hospital, see what your nighttime shift, your 12 hour shifts seven, the penis seven eight is versus for seven 80 7:00 PM. If you’re making a lot more urine at night, you have nocturnal polyuria.
Speaker 1:
So our great point. So, so what I do is I give them a urinal at night and I have them pee it, their last pee of the night in the toilet, then all the ones through the night in the urinal. And if you’re making more than 800 milliliters of urine throughout the course of the night, I consider you to be at someone who’s making too much peak because if you’re making 800, then you did need to get up twice to be. But if you’re only making 300, then that sensation to get up and pee at night was a false sensation that may be treated better with medications. And I also feel like the younger you are, if you’re under the age of 30 or under the age of 40, you probably don’t have an enlarged. Prostate is the cause of your urinary urgency and frequency. And I’m looking for other things like overactive bladder and pelvic floor spasticity as the cost.
Speaker 3:
And also some of the other non-biologic things like sleep apnea or something that got you up or pain, chronic pain. I mean, the big question we always ask folks is when you feel the urge to wake up and go to the bathroom, the first thing you do is you wake up and go to the bathroom. You think that’s what woke you up, but sometimes it’s your dog. It’s your wife kicking you, or it’s the fact that you snore and woke yourself up and you suddenly you realize, Oh, I need to go to the bathroom. I’m going to wet this bed. Um, yeah, especially in the older patients too. We gotta think about that as well. So
Speaker 1:
In somebody let’s say you got the quintessential 62 year old man coming into you, um, with, uh, urgency frequency and a slow flow. Um, walk me through kind of the steps of, um, what they would go through diagnostically and through medication.
Speaker 3:
Well, I think you, you know, I see, I try to read what the patient is mostly interested in. Especially if they, if they come to you with medications, it’s probably time to start thinking, okay, they’ve maximized their meds. And a lot of them have, I mean, doubling a two Flomax pills instead of one, isn’t going to help him in my opinion. So, so then I started to think diagnostically or do I need to look in their prostate, especially if on exam, they don’t have a big prostate, but it may be all caving in on the inside. And that may be their problem. Or maybe they have scar tissue or some reason to look inside their prostate. And then I also offered to also measure their prostate, uh, to see if they’re a candidate for a lesser invasive procedure, for some patients say the last thing they want to think about as a surgery. And they come to you Denovo, having never been on a single pill and sometimes I’ll give them the option, say, okay, we’ll try this for a month, see how you do. And let’s see if it got better and then come back and see me and then decide, you know, that really helped. But I really don’t like to take the medications where I got these side effects.
Speaker 1:
I think what I find is that patients really like to know that you have a next step, if the first step doesn’t work and that you’re not just coming up with a brand new plan every time you see them. And so for a patient like that, I will often put them on a tamsulosin or Flomax to start with. If they’re not on it already, I’ll have them come back and I’ll look in their bladder with a camera to make sure nothing’s blocking and I’ll measure their prostate with an ultrasound. And if that medicine doesn’t work, then I’ll flip it to medicines that work predominantly on the bladder. And then if I feel that person’s going to benefit from a surgical procedure, then I either try to go the line of overactive bladder or enlarged prostate, which to many of our listeners may sound like the same thing, but we know biologically and how we treat it are completely separate things.
Speaker 1:
I think you lose an important point to that early on is that, um, you know, that men and women have overactive bladder at the same degree. It’s not like somehow the extra Y chromosome denies us the need and have an overactive bladder. We still have overactive bladder as much as women do. It’s important to probably treat that and at least set that expectation that you still may be getting up at night. It’s just that you’re going to get to the bathroom and get more out of you. So I think, you know, certainly I saw a guy yesterday that I thought this guy just needs a procedure. I just needed to go in there and I find it look in and you can drive a truck through his prostate. He can knock the bark off a tree afterwards. Like you don’t have a prostate problem. It’s a bladder problem.
Speaker 1:
Let’s go after it. I think that’s really great. And if you feel like you’ve been stuck into a one size fits all mentality of your urinary issues, we would love to see you as a second opinion. It’s been one of the most powerful, um, things that we’ve, uh, implored, uh, our listeners and our patients to do. We’ve done hundreds and hundreds and hundreds of second opinions for a variety of your logic conditions, predominantly surrounded around prostate cancer, predominantly around BPH, but we’ll take care of questions about your low testosterone measurement or whatnot. And in this environment, doing telemedicine visits is, uh, is, is very accessible, very easy and very informative for you. So Donna, how do people get ahold of us?
Speaker 2:
You can call us at (512) 238-0762. Our email addresses Armour men’s health@gmail.com and our website is our men’s health.com to go back to your bird analogy, we’re going to get the fuck outta here. The armor men’s health hour. We’ll be right back. If you have questions for dr. Mystery, email him at Armour men’s health, ed gmail.com.