I have problem with urine retention. Kindly help.

Hi,

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Weak flow, prolonged urination, incomplete emptying of the bladder, and waking up at night to pass urine are symptoms of an enlarged prostate or prostatic obstruction. After the age of 50 years prostate start to enlarge in size and causing the above-mentioned symptoms. I reviewed your ultrasound (attachment removed to protect patient identity), which showed the prostate volume of 23 ml. It is not enlarged, but sometimes the shape of the prostate causes blockage and symptoms. Investigations should include a blood test to check on serum PSA. Medical treatment at the moment and follow up with blood result is indicated. Take tablet Tamsulosin 0.4mg once at night. Please follow up after two weeks and update me about your improvement and the blood test.

Hello,

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Multiple sclerosis can cause neurogenic bladder (problem with the nerve supply to the bladder) rather than prostate enlargement issue. Since you are already taking Flomax and your PSA is normal, that is great information. The management now will be an assessment of your bladder function by urodynamic study, and according to the result, I can prescribe medications to help you resolve your problem. The issue now is multiple sclerosis, which causes an overactive bladder. So your symptoms will be increased frequency, urgency, and incontinence, and no weak flow. Therefore you need urodynamic study as it will help me know your bladder capacity and pressures so I can know what medications suit you the best.

Hello,

Welcome back to icliniq.com.

Thanks for the follow-up. I wish you were here, so I can treat you better, but anyway, online consultation can give you a clear idea about your problems. And you can approach me any time you want as well. Well, Furosemide will not help with your problem. In fact it might worsen it. Reaching a clear diagnosis is the key to treat your bladder as you have mixed picture the diagnosis of MS and the opposite behavior of your bladder, which is more towards the diagnosis of BPH (benign prostatic enlargement). Therefore further workup is required like I said, urodynamics, and then decide on the treatment later stage if things are not clear. Then further requirements of a flexible cystoscopy will be required but better to go one by one step to reach a proper diagnosis.

Hello,

Welcome back to icliniq.com.

Yes, Hydrochlorothiazide (diuretic) will not help. If you have used Flomax without improvements, then you can stop both Flomax and Thiazide diuretics. Then carry on with the urodynamic study and send me the report, please. So I can carry on with the treatment. If Flomax has made the difference, then stop the Thiazide and continue Flomax.