I am diagnosed with BPH and cannot empty my bladder even after taking medications. Why?

Question

Hello doctor,

I am a 60-year-old male diagnosed with BPH for three years now. I have been taking Tamsulosin .4 mg and Dutasteride .5 mg once a day for the entire three years under the supervision of my GP. For the past three months, my symptoms have gotten progressively worse. My bladder does not empty completely and I have to urinate every hour. The longest I have gone without urinating in the last three months is three hours and it is very rare that I can wait that long. I have done some research and see that there are several surgical options. I am looking for a recommendation for the least invasive but effective procedure. On a side note, the only time I can go for hours without having to urinate is if I am drinking alcohol (beer). After three or four beers, I urinate with a very strong stream and for a long time. I then do not have the urge to go again for almost three hours. I realize that drinking beer is not an effective treatment but thought I would mention it in case it is helpful.

Answer 1

Hi,

Welcome to icliniq.com.

You will need to see your urologist and get a uroflow test done. If the flow is fair with current medications, and you do not hold much residual urine on sonography, you may consider continuing the same medications and add an anticholinergic to reduce the frequency of urination. If the flow is poor and/or if there is large residual urine or if you are tired of taking medications, you can consider surgery. Prostate surgery is minimally invasive, done through urine tube and usually requires one to two day stay in hospital. The gold standard is TURP (transurethral resection of the prostate) or HoLEP (Holmium laser enucleation of the prostate). HoLEP is basically prostate surgery done endoscopically with Holmium laser. This reduces bleeding and gives faster recovery compared to the older TURP method. Thulium laser is equally good. Other less invasive options are green light laser, TUMT (transurethral microwave thermotherapy), prostate lift, etc., which are day care but success rates are lower and generally indicated for smaller prostates or unfit patients. Alcohol increases urine formation and so temporarily you feel better flow but it only puts more strain on your bladder. So avoid binge drinking or holding urine for a long. Consult your doctor for the best decision.

I hope this helps.