Help for Overactive Bladder

Dear Dr. SerVaas,
I am an 82-year-old male and have the urge to urinate every 30 to 60 minutes. I‘ve had this for about three months and no medicines seem to help. I had prostate surgery about 25 years ago. Do other urologists have patients as old as me with similar symptoms?

R. D.

Texas
Dr. Jerry Blaivas replies:

“The symptoms you describe match those of refractory overactive bladder (OAB), a very common condition with many causes. In general, there are two options for treating OAB. The first is to try different treatments, like the medications you have taken. The second method is to do additional diagnostic testing to determine if an underlying cause might require different treatment. In men your age, common causes of OAB include: 1) a blockage by the prostate or by scar tissue from your previous prostate surgery; 2) neurologic conditions such as stroke; 3) bladder cancer; and 4) bladder stones. In my opinion, it would be prudent to undergo testing for these conditions before considering electrostimulation. If none are present, then that therapy may be indicated.

“The theory of electrical stimulation is that stimulating certain nerves blocks other impulses that are giving false signals and making you feel as though you need to urinate when you really don’t. The basic type of electrostimulation is a weekly outpatient treatment consisting of stimulating an electrode placed at the ankle or anus for a short period of time.

“The second type, known as neuromodulation, is often more effective. It consists of two minor operations that are usually performed one week apart and under local anesthesia. Both procedures are very safe. In the first stage, the electrode is implanted alongside nerves in your lower back and connected to a battery box worn on your belt. If effective, the second stage is to permanently implant the battery beneath your skin. This treatment can be very effective in men your age.”

Dr. Jerry Blaivas is a clinical professor of urology at Cornell University’s Weill Medical College and serves on the Project Advisory Council of the National Association for Continence (nafc.org).

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April 17, 2009