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Urinary Retention, appears to be BPH
Male 68, 165 pounds. Started with very slight slow flow 10 years ago. In the last year or two, urgency, leaking, and frequency started. Ultrasound showed bladder retaining 800ml. Sept 23, Urologist inserted a catheter and drained 800ml. Sept. 24 started self catheter twice a day and 0.4 Tamsulosin. Each catheter drains about 600ml after voiding as much as I can. This amount has not changed in 9 days. Doc did a Cystoscope and said prostate was about 70, pushing into the bladder a bit, and no other issues. Said I was a good candidate for surgery. Doc could do TURP but I'm leaning towards HoLEP which has to be done several hours away.
But I want to make sure my problem is BPH and not something else. Does this sound like enlarged Prostate or could this be a bladder contraction problem? Doc said there was no need to do imaging or urodynamics.
Interestingly, if my bladder is not at least 400 or 500ml, I can't get anything out. Using a catheter, the flow is decent and I can push and make it flow more, but this might be squeezing muscles in my abdomen. But when the flow is finished, it stops immediately.
Thanks for looking.
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Obviously I’m NOT a doctor, nor do I have any medical background whatsoever. In other words, based strictly on “Dr. Google” and AI, I was under the impression that a “normal” prostate is about 25, and an enlarged prostate is anything over 80.
[btw, pardon my curiosity, but if your slow leak started 10 years ago, any idea why someone didn't start you on Tamsulosin until now? Also, do you know whether your urologist rejected the possibility of prescribing Finasteride because your prostate wasn’t very enlarged, or because it wouldn’t be effective for at least 3 months?]
It was not that bad 10 years ago, no leaks, just slow. The very few leaks started about a year ago and only a total of maybe 20 times in a year. I did mention it to my GP, but they said it didn't sound bad enough for meds. Finasteride was prescribed and I am delaying it to see what the Tamsulosin does. One thing at a time.
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1 ReactionThat makes a lot of sense, IMO.
For me, I started Tamsulosin maybe 10 years ago for simple nighttime “hesitation.” After an unexplained episode of “acute” urinary retention, I required a catheter for about a week before everything was baseline, and the dosage was then doubled.
More recently, I started seeing a new URO, who suggested Finasteride, but I declined. However, I became more “interested” a few months later, when I had “POUR” (post-operative urinary retention), which required a catheter. This lasted for about 10 weeks before my bladder suddenly became fully functional. I then saw a surgeon to discuss HoLEP, but when I asked, he agreed that, since my bladder was again completely emptying, with no leaks, etc., starting Finasteride was worth a try.
So, at 75, I decided that if it meant being on Finasteride for the rest of my life, I wasn't that concerned with RE, if it meant avoiding surgery. It’s been less than 3 months, but so far all is well. Hopefully, whatever our choices, we both have successful outcomes!
I am 70. I had these same symptoms. The doc put me on tamsulosin twice a day and finasteride once a day. After a few months I was able to stop self-catherizing. After six months I was able to cut my medication in half. Added note: amitriptyline can make bladder retention much worse.
Did you have any side effects from the tamsulosin and finasteride? After 11 days of tamsulosin, I don't see a chance. How long did it take before the tamsulosin started working?
It often takes several months for finasteride to make a noticeable impact. You can take tamsulosin (.4 mg) twice a day and this may help temporarily. With the degree of obstruction you have, it certainly seems you will need surgery. When I had to make the decision about getting a TURP locally or traveling for a HOLEP I opted to travel for HOLEP and am glad I did.
Absolutely get an MRI. I was retaining 500ML and had a median lobe issue with a 64 gram prostate which was causing the blockage. I did a HoLEP to clear the blockage, even though I knew RE would be an issue/ I only retain 21ML now. The MRI gave a clear picture of where the obstruction is and what to do about it. I could have also chosen Aquablation, it was a tough decision, and not a choice I enjoyed having to make.