| Lower Urinary Tract Disorders: A Puzzle No Longer
New Technology Achieves More Accurate
Diagnosis
Tri-City Voice, March 11, 2008
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
www.whhs.com and click on "Find a
Physician."
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