People are unhappy if they can not hold and empty urine in and out of the bladder comfortably at will for convenience. To fulfill such functions requires the muscle and nerves of bladder and urethra in their healthy and stable state to work in adequate coordination. Any
disorders affecting such stability and coordination in the muscles and nerves of both will make the affected unhappy, frustrated, stress, and depressed.
traumatic and surgical damage to muscles and nerves
Drug adverse effects
Realistic Goals of Care
Medical professionals have never cured anything for anyone, but just help someone to modify something to some degree with or without medications and / or procedures at reasonable time in reasonable way for reasonable patients.
Thereby, people can look nicer, feel better, and live longer; this is reality of life and medicine. Likewise, urologists just help reasonable patients with disorders to modify their urinary tract to function better and longer for reasonable comfort and convenience; hereinbelow we
talk about how to make the affected patients' bladder and urethra to work better and longer.
Approach of Care
Always start out the care for any disorders with understanding and accepting the facts of life and disease and proceed with, first, applying least invasive conservative measure with lifestyle modification and behavioral modification, and then, upgrading to minor procedures and
finally to major procedures as the last resort of care; this approach is true and applicable for every disease.
Steps and Options of Care
1. Realize, Understand, and accept the facts of life reality and disease through counseling;
2. Keep up healthy lifestyle without overindulgence and obsession;
3. Take on behavioral modification with necessary and realistic adjustment according to personal mental and physical capacity; examples - timed voiding, adjusting water drinking and timing of taking medication as needed if possible, using protective pad or wearing depends or pull-ups, urethral milking after each voiding for postvoid dribbling in men, avoiding bladder irritants like coffee, caffeine-containing beverages, alcohol, red pepper, etc.
4. Use medications as needed and as tolerated. There are three groups of drugs to help improve urination and incontinence, but always coming along with their unique side effects for some people to some degree - even intolerable:
a. Drugs to improved urine flow by relaxing urinary sphincter: Chiefly, alpha-blockers are used, such as alfuzosin (Uroxatrol), doxazosin (Cardura), tamsulosin (Flomax), terazosin (Hytrin), etc. Key side effects: dizziness from postural hypotension.
b. Drugs to improve urine flow by shrinking the size of prostate: Examples are finasteride (Proscar) and dutasteride (Avodart). Key side effect: Impair erection.
c. Drugs to ease bladder instability, bladder spam: Examples: oxybutynin (Diropan, Ditropan
XLor Urotrol), tolterodine (Detrol, Detrol LA), fesoterodine (Toviaz), Trospium, Darifenacin (Enablex), solifenacin (Vesicare), mirabegron (Myrbetriq), etc. Key side effect: dry mouth, constipation,
5. Surgical procedures as the last resort of care for LUTS after failing to conservative measures as described above. Review the detail in Surgical Options for Prostate Obstruction