Current Medical Issues

CLINICAL QUERIES
Year
: 2016  |  Volume : 14  |  Issue : 4  |  Page : 85--86

Clinical questions: Responses to queries from readers: Benign prostatic hypertrophy and overactive bladder


TJ Nirmal 
 Professor, Department of Urology, CMC, Vellore, India

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How to cite this article:
Nirmal T J. Clinical questions: Responses to queries from readers: Benign prostatic hypertrophy and overactive bladder.Curr Med Issues 2016;14:85-86


How to cite this URL:
Nirmal T J. Clinical questions: Responses to queries from readers: Benign prostatic hypertrophy and overactive bladder. Curr Med Issues [serial online] 2016 [cited 2021 Sep 16 ];14:85-86
Available from: https://www.cmijournal.org/text.asp?2016/14/4/85/194456


Full Text

Question 5

How does one differentiate between benign prostatic hypertrophy and overactive bladder?

Lower urinary tract symptoms (LUTSs) can be divided into storage (frequency, urgency, urge incontinence, and nocturia), voiding (poor flow, intermittency, and straining), and postmicturition (dribbling) symptoms.

Of all men over the age of 40, a certain proportion will develop histologic hyperplasia of the prostate (BPH) and result in benign enlargement of the prostate (BPE). Of these, some but not all will develop bladder prostatic obstruction (BPO) resulting in LUTS [Figure 2].{Figure 2}

LUTSs have traditionally been associated with BPH in the male. However, LUTS can occur as a result of reasons other than BPH (e.g., detrusor dysfunction resulting in an overactive bladder (OAB), urethral stricture, stones, inflammation, etc.). Hence, LUTS is not disease specific. Moreover, we must remember that these factors can coexist, i.e., patients with BPH can have an OAB and vice versa [Figure 3].{Figure 3}

OAB is characterized by urinary urgency, with or without urge incontinence, usually with increased daytime frequency and nocturia (Storage LUTS only), if there is no proven infection or other obvious pathology. Benign prostatic obstruction, on the other hand, is diagnosed when the cause of bladder outlet obstruction is determined to be secondary to benign prostatic enlargement and presents with voiding/without storage LUTS. BPH is generally seen in elderly males whereas OAB is more prevalent in the younger population. Both conditions are generally progressive and aging is associated with worsening LUTS. Evaluation in both entails taking a detailed history to rule out other differentials, assessment of LUTS severity and bother using validated questionnaires, digital rectal examination (DRE), focused neurological examination, urinalysis, and frequency volume charting. Uroflowmetry is the single best noninvasive urodynamic test to detect BOO. Clinically, an enlarged prostate on DRE along with poor flow rates supports the diagnosis of BPO. An algorithm for the management of LUTS is given in [Figure 4]. [1] {Figure 4}

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Conflicts of interest

There are no conflicts of interest.

References

1Abrams P, Chapple C, Khoury S, Roehrborn C, de la Rosette J; International Scientific Committee. Evaluation and treatment of lower urinary tract symptoms in older men. J Urol 2009;181:1779-87.