What can be done for frequent urination in a prostatitis patient?

Question

Hello doctor,

I am a 50-year-old male. I am suffering from prostatitis and have the following complaints like weak urine flow (4.8 ml/sec average flow and 8.8 maximum flow), dribbling at the end of passing urine, mild pain in testes, and frequent urination (four to five times a day and none at night). I got the USG abdomen and pelvis, USG scrotum, DRE, and uroflowmetry tests done. The important findings are prostate size 1.1 x 1.2 x 1.1 inch (14 cc), pre-void bladder volume 202 cc, post-void residue 14 cc, and prostate is normal in size and echotexture. There were normal ultrasound findings in both scrotal viscera. The prostate was found to be normal, smooth, firm, and tender in the DRE test. Currently taking Alfoo 10 mg (once daily) and Tadalafil 5 mg (twice weekly). The current complaint is that I have got all complaints resolved except urine flow after one month but have a flare-back. Please suggest advice on any more medicine needed.

Answer 1

Hi,

Welcome to icliniq.com.

I have reviewed your query and the reports (attachment removed to protect patient identity). You definitely have an obstructive pattern of urination on uroflowmetry. You also mentioned that your flow had not improved after one month of medical therapy. I would like to know whether any urine analysis was done to diagnose prostatitis. As your prostate glands are not enlarged, and your flow is relatively poor, I would also not rule out any urethral stricture. Instead, I would first get a urinalysis before and after the prostatic massage to rule out any prostatic infection or inflammation. Then, give a trial of some newer alpha-blockers for a month to assess any improvement in symptom scoring and repeat uroflowmetry. If there is no improvement, then I would suggest a urethrogram with or without an office flexible cystoscopy to ascertain the site of obstruction.

Answer 2

Hi,

Welcome back to icliniq.com.

Your repeat uroflowmetry (attachment removed to protect patient identity) shows you have a very poor response to medical therapy. Urethrogram is done to see whether there is any urethral stricture, the same can be confirmed by cystoscopy, and in addition, it can see whether the prostate is causing any significant obstruction. Even small prostate can occasionally cause obstruction. Regarding newer alpha-blockers, there are newer drugs like Silodosin, but I cannot prescribe any medication online without actually examining you. You can consult with your local urologist. But seeing your poor response to medical therapy, I would change my previous suggestion and go ahead with a urethrogram and cystoscopy.