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March 12, 2008 > Lower Urinary Tract Disorders: A Puzzle No Longer

Lower Urinary Tract Disorders: A Puzzle No Longer

New Technology Achieves More Accurate Diagnosis

Lower urinary tract disorders can puzzle even the most knowledgeable specialists, given that their symptoms can overlap and conflict with other diagnoses. Compounding this is often patients' reluctance to discuss symptoms they find embarrassing, such as urgent or frequent urination or retention.
Far from being unusual, lower urinary tract disorders will affect a significant proportion of the population - men and women alike. The good news is that there is help available, according to Dr. Mark Saleh, M.D., a urology specialist with Washington Township Medical Group.
"If you live long enough, probably 100 percent of the population would face some type of urinary tract disorder," Dr. Saleh explains. "Just about every man over 40 will have a prostate problem, and just about any woman who has had one or two children will face some kind of leakage or incontinence. Urology problems are a big part of primary care practice. It's these types of diagnoses that keep primary care physicians busy."
Despite how common lower urinary tract disorders are, diagnosing them based purely on patients' symptoms can be frustrating and inaccurate, according to Dr. Saleh. That's why he says he is relieved that his practice has acquired a diagnostic tool called Urodynamics.
Urodynamics refers to a series of diagnostic tests that evaluate the function of the bladder and urethra for patients experiencing symptoms including urinary incontinence (leakage of urine), recurrent bladder infections, slow or weak urinary stream, incomplete bladder emptying or frequent urination.
The results help Dr. Saleh in making a proper diagnosis and in developing an appropriate treatment plan. The tests themselves, which are performed by a trained urology nurse, are an outpatient procedure performed in the doctor's office. Patients don't require anesthesia and can drive home after the test.
"The beauty of urodynamics is that it can show you where the problem is, and it can provide you with a more focused treatment approach," according to Dr. Saleh.
Many times, he notes, patients may not know that there is technology available that is able to diagnose their symptoms - or they may not know that it is available right here in the local community.
The tests involve putting a very small tube, called a catheter, into the patient's bladder, Dr. Saleh explains. The tube is then hooked up to both a saline solution source and a urodynamics-equipped computer. The system's monitoring device takes measurements about bladder capacity and bladder pressure that help Dr. Saleh in diagnosing a patient's particular issue.
"If we're planning surgery, having this information is very helpful," he says. "It helps us predict success, tells us what type of procedure will be helpful, as well as whether a surgery should be done in the first place."
Lower urinary tract problems exhibit different symptoms in men and women. In female patients, Dr. Saleh says, the most common complaint is urinary incontinence, and urodynamics can help determine whether an individual will benefit from surgery. The tests can also pinpoint whether frequency and urgency of urination stems from an overactive bladder, which may be treated with medications.
For men, the most common issue is incomplete emptying of the bladder caused by an enlarged prostate and for some men, the standard medications will not be enough to provide them with relief. Fortunately, the urodynamics testing can help Dr. Saleh rule out a problem with the bladder which might also be contributing to the symptoms.
"Urodynamics testing does not have a role in the diagnosis of prostate cancer," Dr. Saleh cautions. "However, urodynamics can be very helpful in determining the cause of the lower urinary tract symptoms that might develop in a patient after the treatment of prostate cancer which helps the physician determine the best treatment option."
Those patients whose sensation has been altered by illness or injury - for instance, those with major neurological issues, spine injury or Multiple Sclerosis (MS) - can also benefit from Urodynamics testing to pinpoint the cause of symptoms such as retention or leakage of urine.
Without the information provided by Urodynamics testing, it is almost impossible to tell if a certain treatment will alleviate the symptoms. The tool is vital, Dr. Saleh says, because it spares both the patient and physician from most guesswork before choosing a method of treatment. In fact, if his practice didn't have access to the technology, he says he would most likely have to refer patients out of the area to receive the testing.
Dr. Saleh urges patients suffering from lower urinary tract symptoms to talk to their primary care physician to see if they require further testing.
"If the symptoms impact your life, then you have a problem," he says. "If you're reducing activities, then you should talk to your doctor. Lower urinary tract disorders are very under-treated. Many times, the patient is too embarrassed or doesn't know there's a treatment. I want people to know that it's common and there are ways to deal with it."
To find a local physician, visit Washington Hospital's Web site at and click on "Find a Physician."

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