How do I manage my mildly enlarged prostate?

Hi,

Welcome to icliniq.com.

I understand your concern.

Based on what you have shared (the attachments were removed to protect the patient's identity), your ultrasound findings are reassuring in one important way.

Pre-void volume: 357 cc.

Post-void residual: 4 cc.

This indicates that you are emptying your bladder very well (near-complete emptying). It usually suggests that there is no significant obstruction or urinary retention at present.

Your main symptom appears to be evening urinary frequency, with multiple voids before bedtime and occasional once-nightly urination (nocturia), especially when you wake up with even mild bladder sensation.

This pattern often reflects bladder sensitivity or fluid timing, rather than a significantly “blocked” prostate.

Since your post-void residual is only 4 mL, medications aimed purely at relaxing the prostate may help symptoms, but you are not in a high-risk category for urinary retention based on these numbers.

One additional test that would help clarify the situation is uroflowmetry (uroflow).

Even though the ultrasound shows excellent bladder emptying, uroflowmetry can objectively determine whether:

• You truly have a weak or obstructed urinary flow (suggesting prostate or bladder outlet obstruction), or

• Your urinary stream is adequate, and the main issue is urgency, frequency, or bladder sensitivity.

Based on the uroflow report, we can then decide between the following:

• One alpha-blocker if obstruction is suggested, or

• A bladder-focused treatment approach if urinary flow is normal.

Based on your current report, we can choose either Silodosin or Urimax (Tamsulosin), but I do not feel that Urimax is appropriate at this stage, as it carries a risk of erectile dysfunction and is generally used only when clearly indicated.

Please also let me know if you have any of the following:

• Diabetes.

• Recurrent urinary tract infections.

• Snoring at night.

• Overweight or obesity.

Non-medical measures that may help:

• Stop drinking fluids two to three hours before bedtime.

• Avoid tea, coffee, and alcohol after 5 pm.

• Practice double voiding: urinate, wait two minutes, then urinate again.

• If constipation is present, treat it, as constipation can worsen urinary symptoms.

I also need the following information:

1. PSA (prostate-specific antigen) value (with date).

2. Urine test results (routine examination or culture, if done).

Please share these details, and I will do my best to assist you further.

I hope this has helped you.

Thank you.