Episode # 3 • 17 Jan 2025
Understanding Overactive Bladder in Male Patients
How many prostate medications and procedures should a man try before anyone checks his bladder? Dr. Bilal Chughtai has met men who worked through an alpha blocker, add-on medications, a minimally invasive prostate procedure, and even resective surgery before anyone named overactive bladder as part of the problem. On this episode of BackTable Urology, Dr. Anjali Kapur, urogynecologist at Hackensack Meridian Health, welcomes Dr. Chughtai, chief of urology at Northwell Health's Plainview and Syosset hospitals, to rethink how urologists separate overactive bladder (OAB) from benign prostatic hyperplasia (BPH) in men. Dr. Chughtai explains how he reads the storage and voiding items of the International Prostate Symptom Score (IPSS), why he usually starts with a beta-3 agonist rather than an anticholinergic, how he trims polypharmacy one medication holiday at a time, and when urodynamics helps decide whether to treat the prostate, the bladder, or both.
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Timestamps
00:00 - Introduction
02:37 - Initial Evaluation and First-Line Therapy
06:11 - Combination Therapy and Medication Holidays
09:37 - Reassessing Symptoms After an Outlet Procedure
11:59 - Botox and Neuromodulation in Men
15:14 - Persistent Symptoms After Prior BPH Treatment
18:44 - The COURAGE Trial and Urge Incontinence
23:22 - Combining Therapies and Setting Goals
25:48 - Questionnaires, Bladder Diaries, and Underreporting
29:05 - OAB Awareness in Primary Care
31:14 - Nocturia and Sleep Apnea
33:23 - Timing of Intervention and Bladder Health
38:04 - Final Takeaways and Closing Remarks
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More about this episode
The two then turn to third-line therapy in men, including intradetrusor botulinum toxin, sacral neuromodulation, and tibial nerve stimulation, and to men whose storage symptoms persist or appear after an outlet procedure. Dr. Chughtai shares what the COURAGE trial of a beta-3 agonist added to BPH therapy taught him about asking men directly about urge incontinence, along with his goal of a 50% improvement in symptoms, the limits of questionnaires and bladder diaries, his research on OAB awareness in primary care, and the link between nocturia and sleep apnea. They close on the open question of when to treat the bladder before it changes, and why counseling should inform men without threatening them.
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