Distinguishing between obstruction, an unstable bladder, and OAB is not so easy, physicians find.

Overactive bladder (OAB) is usually associated with women, but it afflicts nearly one out of every eight American men. Its symptoms can also be confused with those of BPH, resulting in unneeded surgery.

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“Sometimes when a surgeon does a prostatectomy for BPH, in retrospect it turns out that the symptoms were due to an unstable bladder,” says Ryan Paterson, MD, assistant professor of urology at the University of British Columbia in Vancouver. “Post-surgery these patients may have a stronger urinary stream, but they may still be miserable—and angry at their doctors.”


Distinguishing between obstruction and OAB can be tricky because symptoms can overlap, notes David Staskin, MD, associate professor of urology at New York-Presbyterian Hospital/ Weill Cornell Medical Center. “As a result, there is sometimes a lack of understanding about whether a patient’s symptoms are the result of a primary bladder problem—with or without an identifiable cause—or are secondary to obstruction. If men are not obstructed,” he adds, “you can probably treat them the same way you’d treat women with OAB because the pathophysiology is the same.”


Dr. Paterson points out that OAB produces specific irritative symptoms, including urinary frequency, urgency, and nocturia, in the absence of significant pathology such as bladder tumors or bladder stones. “If a patient has a stroke and develops an unstable bladder, it’s not OAB,” he says. Less frequent causes of lower urinary tract symptoms (LUTS) include infection, urethral stricture, advanced prostate cancer, and bladder stones.


Genders not so different?


Simon Hall, MD, chairman of the department of urology and director of the Deane Prostate Health and ResearchCenter at the Mount Sinai School of Medicine in New York, says it’s not clear how OAB differs in men and women. “A lot of the symptoms that we ascribe to prostate problems in men may if fact be due to things that happen to women as well,” he explains. “For example, as we age, the bladder becomes stiffer and less elastic. In women there are post-menopausal changes, too, but there is commonality between the genders that we have not fully appreciated.”