Q. I have low urine flow with hesitancy. Please suggest treatment options.

Answered by
Dr. Samer S J Altawil
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on Dec 25, 2020

Hello doctor,

I am suffering from poor urine flow and hesitancy. My USG and KFT are normal. I have attached the reports. What is the issue, and what are the treatment options?



Welcome to icliniq.com.

I believe you have enlarged prostate causing obstruction to your flow. The size of prostate does not matter rather the shape of prostate is more important and the anatomy of prostate is well seen on the flexible cystoscopy if facility is available. You have mild symptoms of enlarged prostate.

Best is to do a serum PSA and start the tablet Tamsulosine 0.4 mg once at night. Follow up with blood test and we see how it goes. Medication will start acting after three days

I could see your reports of uroflowmetery, UDS and uss scan. All investigations showed that your bladder pressure is normal but flow is weak this indicates obstruction. After the age of 50 years normal prostate becomes occlusive but either its shape or its fibromuscular components this leads to reduced urine flow. With normal prostate size it is difficult to diagnose the cause of obstruction whether it is a median lobe of prostate causing it or a stricture in the urethra some where. Therefore I do a flexible cystoscopy for all my patients who got normal sized prostate with poor flow. Since the Q max in the uroflow is 10 ml per second then the obstruction is not really bad and you can use medications of it. As I mentioned you can take tablet Tamsulosine 0.4 mg once daily before bed time.

All patients above years of age complaining of urinary symptoms should go for blood test called PSA to role out prostate cancer. Therefore follow up with PSA and result of tablet treatment is indicated. If tablet is working well and PSA is normal then we will continue with the treatment. If you still have urinary symptoms and you are not satisfied with the medical treatment then flexible cystoscopy should be done before deciding on surgical treatment. Surgical treatment have many options like microwave therapy, fine needle ablation of prostate, TUNA, urolift, TURP or laser prostatectomy. Those surgical options will discussed later for all patients who failed medications and have occlusive prostate.

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