Diagnosis and Treatment of Overactive Bladder and Benign Prostatic Hyperplasia

Diagnosis of BPH

• The American Urological Association recommends a comprehensive medical history focusing on urinary symptoms, physical examination including digital rectal examination to assess prostate size, and urinalysis to exclude other conditions in the diagnosis of BPH 1, 2
• A detailed medical history focusing on lower urinary tract symptoms (LUTS), including both voiding symptoms and storage symptoms, is essential for diagnosing BPH 1, 2
• Physical examination with digital rectal examination to assess prostate size, shape, and consistency is a crucial step in diagnosing BPH 1, 3
• Urinalysis to exclude microhematuria and infection is necessary for diagnosing BPH 1, 2

Treatment for Overactive Bladder (OAB)

First-Line Treatment: Behavioral Therapies

• The American Urological Association recommends bladder training with timed voiding and gradual extension of voiding intervals for all OAB patients due to its excellent safety profile 5, 6
• Pelvic floor muscle training to improve urge suppression techniques is recommended for OAB patients 5, 6
• Fluid management, including optimizing timing and volume of fluid intake, is essential for OAB patients 4, 6
• Dietary modifications to reduce bladder irritants are recommended for OAB patients 4, 6
• Weight loss for obese patients, targeting 8% weight loss, can reduce urgency incontinence episodes in OAB patients 5, 6

Treatment for BPH with OAB

• The American Urological Association recommends combination therapy with an alpha blocker and either an antimuscarinic medication or a beta-3 agonist for optimal symptom control in patients with BPH and bothersome OAB symptoms 7
• Alpha blockers can relieve bladder outlet obstruction in patients with BPH 7
• Combination therapy with alpha blockers and antimuscarinics or beta-3 agonists can improve storage symptoms in patients with BPH and OAB 7

Special Considerations and Precautions

• Post-void residual volume should be monitored when using antimuscarinics in BPH patients 7
• Antimuscarinics should be used with caution in patients with narrow-angle glaucoma, impaired gastric emptying, or history of urinary retention 5
• A post-void residual volume greater than 250-300mL is a relative contraindication for antimuscarinic use 5
• Most patients experience significant symptom reduction rather than complete resolution with treatment 5, 4
• Patients with BPH may experience de novo or worsening OAB symptoms after surgical interventions for BPH 7