What diagnostic tests recommended for LUTS?

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Hi all,

    In many of the discussions, diagnostic tests to determine best course of action for dealing with LUTS have been discussed. These all occurred after I had already decided on PAE, so I only paid a little attention to those posts. I've now been contacted by a friend of a friend who has pretty bad LUTS, and I offered to track down this info for him. He's had a couple of complete retention episodes requiring a Foley catheter, is up 2 to 6 times a night, and has great frequency and urgency during the day (even taking tamsulosin). What tests are advisable? Are any invasive?  Thanks!

Rich

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  • Posted

    Has he been examined by a urologist? Size of prostate etc.? An ultrasound (non-invasive) can give an estimate of prostate size and also retention and bladder info. My  urologist told me: if flomax doesn't help then there is more to the problem then prostate. In my case, it is prostate, bladder, and sleep issues. 

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    • Posted

      He has been examined by a couple of urologists, and from the sound of it rec'd unusual advice. They didn't tell him the size of his prostate, only that it is very large (85 on a scale of 1 to 100). I've encouraged him to get an actual number. Are there other test besides an u/s that would give more info on bladder and retention?

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    • Posted

      There are many tests but some of them are quite invasive. He could also try medication (avodart and flomax) to try to ease the symptoms. Avodart is supposed to shrink the prostate and flomax relaxes urinary muscles but there are side effects. There is lots of info online  about tests and treatment options. 
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  • Posted

    I had nearly a year of recurring E-Coli Urine Infections. Nitrofurantoin was eventually found to be the most effective antibiotic after lab urine test results showed which bacterium was present. I had 3 months on a low dose after yet another recurrence, and it finally cured me. Haven't had another infection now for over a year.

    Your friend could ask for flow tests with ultrasound to see how much retention after urinating is contributing to LUTS.

     - He could also get trained in self-catherisation.

    I had similar symptoms but don't have BPH. Have now succeeded in getting a vast improvement by taking my urologist's advice and giving up tea and coffee. It took several months to gain a real improvement. 

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  • Posted

    Hi Rich,

    In the office, a urologist would routinely do a DRE, Uro Flow test, bladder scan and blood work. The bladder scan should be done both pre and post void, but often just done post void. In your friend's case, a flexible cystoscopy might be indicated.

    Outside the office, a bladder/kidney scan will give more bladder detail plus check for any kidney damage such as hydronephrosis. A TRUS or other imaging is helpful in determing prostate size.

    Lastly, Urodynamic testing will help diagnose how much of the LUTS issues are bladder versus prostate related. Video urodynamics are better than without video as they visualize bladder operation in real time. 

    Cystoscopy and Urodynamics are slightly invasive, but no more so than having a Foley catheter inserted. 

    Given his history and the AUR episodes, your friend would benefit from learning self catherization (CIC) until things get more sorted out. 

    Jim

     

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  • Posted

    Depending on patient specifics, I think it's OK if a urologist does a cystoscopy prior to imaging, or vice versa. For example, I assume your friend had a Foley inserted without conditional prior imaging. And unlike a Foley, with a cystoscope the urologist is not going in blind. There is a camera guiding the way. 

    Jim

     

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