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Posted by on Jan 23, 2019 in Overactive bladder | 0 comments

In a nutshell

This study looked at overactive bladder (OAB) symptoms after prostate removal. It found that there are many treatment options for the symptoms. 

Some background

Overactive Bladder (OAB) is a sudden, frequent urge to urinate. It may result in urge incontinence. This is an inability to hold on to urine. OAB urination is usually eight or more times a day and two or more times at night. OAB can also cause stress urinary incontinence (SUI). OAB can have a negative impact on quality of life. Some OAB symptoms may occur after prostate removal. 

OAB can be treated with medication or surgery. It may also be treated with pelvic floor muscle training (PFMT) or repeated urination. Repeated urination ensures the bladder is empty. Surgery might be chosen if medications do not work. An artificial urinary sphincter (AUS) is a surgical option. It involves implanting a band. This band restricts urine leaving the bladder. Medications may include solifenacin (Vesicare), tolterodine (Detrol), mirabegron (Myrbetriq) and tadalafil (Adcirca). Most medications work by affecting bladder muscles. 

There are many treatment options available for OAB. These treatment options do not work for every patient. Treatment for OAB caused by prostate removal needs to be looked at. 

Methods & findings

PFMT has been shown to improve SUI and mixed urinary incontinence. PFMT may be effective for men with mild or moderate incontinence after prostate removal. Duloxetine (Cymbalta) improved SUI in two studies. It can treat increased urination and urgency. Repeated urination or timed urination can work. Catheterization is used where the bladder is not emptied fully. Bladder training, a controlled diet and easing constipation may also help. 

If SUI remains at 1 year after removal, surgery may be considered. AUS has been shown to improve OAB symptoms 6-12 months after implantation. Some of these surgeries also fail. Failed surgeries may cause SUI or OAB. Some patients prefer medication when the urethra is affected or the bladder is blocked. The urethra is the tube which carries urine out of the body.

Medication may also be offered. Solifenacin has shown conflicting results in treating OAB. Solifenacin has shown quicker symptom improvement after surgery. Tolterodine (Detrol) has been shown to decrease urge incontinence after catheterization. Mirabegron shows less side effects than other medications. There's no evidence showing if mirabegron is effective in OAB caused by prostate removal. Tadalafil has been shown to be an effective OAB treatment. 

Onobotulinum toxin A (Botox) injections have been shown to improve urge incontinence. Botox has shown success in men who had prostate removal. Nerve modulation can improve newly developed OAB. It has not been tested in men who develop OAB after prostate removal. 

Some men may find these options ineffective or do not want surgery. These men may choose other treatment options. These include penile clamps, condom catheters or pads. 

The bottom line

This study concluded that there are many treatment options available to treat OAB caused by prostate removal. 

The fine print

Duloxetine is not FDA approved to treat SUI in the USA. It may not be available in the USA for all men who have OAB after prostate removal. Mirabegron is the only drug of its type that is approved by the FDA to treat OAB.

What’s next?

If you would like to learn more about OAB treatments after prostate surgery, talk to your doctor. 

Published By :

Current urology reports

Date :

Oct 10, 2018

Original Title :
Management of Overactive Bladder Symptoms After Radical Prostatectomy.
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