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Dr. Lin's Quest beyond Medication and Surgery                     

    Formula and Steps of Treating Voiding Disorders

    Introduction
    People are unhappy if they can not hold and empty urine in and out of the bladder comfortably at will for convenience. To fulfill such
    functions requires the muscle and nerves of bladder and urethra in their healthy and stable state to work in adequate coordination. Any
    disorders affecting such stability and coordination in the muscles and nerves of both will make the affected unhappy, frustrated, stress, and
    depressed.  

    Causes
  1. Aging
  2. Infection-inflammation
  3. Nerve diseases
  4. traumatic and surgical damage to muscles and nerves
  5. Drug adverse effects

    Realistic Goals of Care
    Medical professionals have never cured anything for anyone, but just help someone to modify something to some degree with or without
    medications and / or procedures at reasonable time in reasonable way for reasonable patients.

    Thereby, people can look nicer, feel better, and live longer; this is reality of life and medicine. Likewise, urologists just help reasonable
    patients with disorders to modify their urinary tract to function better and longer for reasonable comfort and convenience; hereinbelow we
    talk about how to make the affected patients' bladder and urethra to work better and longer.

    Approach of Care
    Always start out the care for any disorders with understanding and accepting the facts of life and disease and proceed with, first, applying
    least invasive conservative measure with lifestyle modification and behavioral modification, and then, upgrading to minor procedures and
    finally to major procedures as the last resort of care; this approach is true and applicable for every disease.

    Steps and Options of Care
    1. Realize, Understand, and accept the facts of life reality and disease through counseling;

    2. Keep up healthy lifestyle without overindulgence and obsession;

    3. Take on behavioral modification with necessary and realistic adjustment according to personal mental and physical capacity;
       examples - timed voiding, adjusting water drinking and timing of taking medication as needed if possible, using protective pad or
       wearing depends or pull-ups, urethral milking after each voiding for postvoid dribbling in men, avoiding bladder irritants like coffee,
       caffeine-containing beverages, alcohol, red pepper, etc.  

    4. Use medications as needed and as tolerated. There are three groups of drugs to help improve urination and incontinence, but always
       coming along with their unique side effects for some people to some degree - even intolerable:
       a. Drugs to improved urine flow by relaxing urinary sphincter: Chiefly, alpha-blockers are used, such as alfuzosin (Uroxatrol),
           doxazosin (Cardura), tamsulosin (Flomax), terazosin (Hytrin), etc.
           Key side effects: dizziness from postural hypotension.
       b. Drugs to improve urine flow by shrinking the size of prostate: Examples are finasteride (Proscar) and dutasteride (Avodart).
           Key side effect: Impair erection.
       c. Drugs to ease bladder instability, bladder spam: Examples: oxybutynin (Diropan, Ditropan XLor Urotrol),
           tolterodine (Detrol, Detrol LA),  fesoterodine (Toviaz), Trospium, Darifenacin (Enablex), solifenacin (Vesicare),
           mirabegron (Myrbetriq), etc.
           Key side effect: dry mouth, constipation,

    5. Surgical procedures as the last resort of care for LUTS after failing to conservative measures as described above. Review the details
        in Surgical Options for Prostate Obstruction




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