Spread...I like your description of BPH vs overactive bladder (OB), and I
find this question the OP asked very interesting and somewhat difficult to
answer, even though a cystoscopy should rule out BPH or a stricture.  I
basically agree with you but would like to expand on it if I may.

I have some comments and questions on the subject for everyone.  First let
me refresh everyone's memory that I just had a TURP in April (and it wasn't
really for gross BPH, but to remove scar tissue from a previous TUIP -  i.e.
my prostate was not grossly enlarged).  Therefore I shouldn't have BPH.  And
I do not believe I am retaining based on ultrasounds after voiding.

I have kind of a strange deal with the uro's (there all in one room where I
live - 5 surgeon MD's and one PA).  I see the PA most of the time (for
office visits and massages), and he will prescribe stuff that may or may not
help me, including stuff I ask for - if you recall I just asked him for some
elmiron (which is for IC) as a last resort recently -  which is going to be
a long haul (takes 3 months to a year to work, if it works at all), esp.
since I am not diagnosed with IC (based on the surgeon's cysto).

The PA said he thought I might have an overactive bladder before I had the
cysto and TURP (and my ultrasound was showing very little post void urine).
I told him I felt urgency all the time but could not go and had difficulty
going.  I believe that the people who have OB feel like they have to go (ie
the urge) *but* they *can go without difficulty* even though it may be a
small volume.  In other words the detrussor muscle in the bladder seems to
be over reacting or malfunctioning (for god only knows what reasons) and it
is creating an urge feeling to go even though the bladder is far from full.
If you watch the Detrol LA commercial, you see the woman getting off the
rowboat and running to the head.  But I think she can go, when she gets
there.

Sorry for the long lead in, but its relevant and leads to questions I can
never get an answer to from my uro's.  Anyway the uro gave me some detrol LA
capsules and said they may take a while to work (which I knew was BS since
they are anti-cholinergics which work on the sympathetic nervous system and
should start working right away - which they do).  I took the first pill and
within four to six hours I could hardly pee at all and I was already having
trouble peeing (especially at night).  So they were doing there job -
slowing down the contractions of the bladder detrussor muscle, and
consequently making it harder to pee (and in fact the package insert says
they can cause retention and you should not take them if you already have
retention).  I was going to stop taking them immediately, but took one more
the next day and it just blocked me up worse, so that was the end of that.
There are many anti-cholinergic drugs on the market (anti spasmodics etc)
that do similar things, (as well as the opiates like oxycodone and
hydrocodone and the anti depressants like amitriptyline) that can cause
constipation and urine retention.  Apparently detrol LA has an affinity for
the detrussor muscle, as well as its other systemic effects.

I told the uro I couldn't take it and he said I didn't give it long enough.
Bullshit, if it makes me worse I am not going to take it.  I think if you
already have trouble urinating (even though you don't have a blockage), then
the stuff is contraindicated.  The package insert does say it is
contraindicated if you have a blockage such as BPH or a stricture.  So
therefore it is for people who do not have retention from blockage and that
can pee, except that it feels like they have to pee too soon.  Do you see
what I am getting at.

If I was having difficulty voiding (even though I did not have a significant
blockage except for the previous scar tissue), I do not think it was
textbook OB like you see on the TV commercials.  Apparently there are many
people with "true" OB that are relieved by detrol LA and its sister drugs,
but its not for me, and I still don't know why I can't pee good later on in
the day and at night, but feel like I have to.  Incidentally IC (which is
90% female related) definitely causes the urgency syndrome, and people take
detrol for that also, along with elmiron, neurontin, etc.

I would like to ask the following questions if you all haven't fallen asleep
reading this.  Never could get a good answer from a uro.  Oh, BTW there is
another very popular uro term (which I'm sure you are all familiar with)
called "nocturia" which means getting up at night to urinate.  I certainly
have that big time, but like the OB, I think most people that have nocturia,
get up, but they can go, and some even go more at night than during the day
(which gets complicated).

Here is my main question/quandary.  I have a lot of pain/discomfort/urge
which I have told you about in the past, and I mainly contribute it to
prostatitis/urethritis/cystitis (non bacterial).  The TURP really messed me
up for three months afterward (then I really had the urge).  I can void
pretty good if I drink a lot during the day (it would seem the roto router
opened me up some and I certainly would hope got rid of my previous scar
tissue).  But my urge is still there even shortly after voiding, and I have
difficulty voiding later in the day and all night.  It's like some kind of
inflammation is closing my urethra up later in the day.  I go to bed late
and get up late but I believe that is not relevant.  It makes sense that if
I drink more (say from 12 noon to 6 pm), I would pee more (I'm not stupid).
But there is something taking place later on, and it seems to definitely get
worse at night.  I don't eat dinner till 9 pm or after, but again I consider
that irrelevant.

Does anyone have any idea what may be causing the difficulty at late day and
night.  One theory I have is salt in my food helps retain urine, and I told
the uro that once and he said eating should make you void more (I believe he
meant from the liquid in the food as well as what you drank).  And even if I
don't have as much volume in my bladder at night because I have stopped
drinking so to speak, why the hell does it feel like I have to go all the
time.  I believe it is definitely some king of inflammatory response, but
not retention caused by a blockage from BPH.

Sorry this was so long.  Probably should have started a new thread, but the
subject here was certainly relevant, as well as Spreads response.  Thanks
for taking the time to read it...Pete

Dr. Sancha...Thank you for your detailed and informative post.  What is the
name of the urodynamic study (and how is it done) you refer to that
demonstrates the presence of involuntary bladder contractions during bladder
filling...Pete