Have Prostatic Enlargement But No Bladder Deterioration. What Is The Treatment?

Posted on Tue, 19 Nov 2013

Medically reviewed by Ask A Doctor - 24x7 Medical Review Team

Tue, 19 Nov 2013 Answered on

Tue, 10 Dec 2013 Last reviewed on

Question : Hi, I am a 77 -year-old male with some prostatic enlargement (mild prostatic impression at the bladder base), and no bladder deterioration. I have history of Diabetes. I am on Rapoflo for years, that gives no positive effect. I have nocturia x 1-3 and progressively decreased stream for 15 years (which is now my main and frightening concern because I feel I am closely standing toward to stop regular voiding). I will be grateful for of any modern treatment that urologists could recommend me. I have friendly feelings to them and wish to thank them. XXXXXXX Sheftel, MD, environmental toxicologist -11.18.2013

Answered by Dr. Dr. P. T. Patil (30 minutes later)

Brief Answer: Better to get operated.(TURP) Detailed Answer: Hello Thanks for your query,based on the facts that you have posted it appears that you have Benign Enlargement of prostate since last 15 years. You have been taking (Rapoflo) Silodosin to improve urine flow but the results are not to your satisfaction. I shall be happy if you can post me few more details to help me in making comments on your problem and suggest the mode of treatment. 1) What is average frequency during day time ? 2) Do you have urgency for urination? 3)Do you have dribbling of urine after passing urine? 4)How is your urine stream? 5)Do you take long time to pass urine? Please consult qualified Urologist for clinical and digital rectal examination to assess the size of the prostate and get following investigations done to decide regarding further modality of treatment. 1) Urine Routine and urine culture. 2) Ultrasound scanning of the abdomen to assess the size of the prostate and any back pressure changes in bladder,kidney and ureter. There are two treatment options for enlarged prostate either medical line of treatment or Surgery (TURP).Medicine do help in improving the symptoms but the effects are not longer lasting and do not prevent the progress of the disease. Since you have this problem since almost 15 years it will be better if you get enlarged prostate resected (TURP)to make your urine passage cleared off obstruction due to enlarged prostate. This is time tasted gold standard treatment for enlarged prostate accepted and carried out world wide .It gives permanent solution to resolve the problem and helps to improve quality of life at this age Hope I have answered your query. If you have any more questions please feel free to ask me I shall be happy to help you . Thanks and Regards. Dr.Patil.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. P. T. Patil (2 days later)

Dr XXXXXXX Thank you very much for your expert advice. I am sending you some details of my problem you required. 1} average frequency during day time ? – around 4 times 2) urgency for urination? – no. I have not 3) dribbling of urine after passing urine? – a few drops 4)your urine stream?- very weak 5)how long time to pass urine? Around 3 minutes My postvoid is 40 cc. PSA around 2.5 for last years. I have currently no recent US of kidney and bladder. In May 2011 it was: Questioned increased renal cortical echogenicity which could represent mild renal disease. Bilateral renal cysts. Enlarged prostate 4.0 x 3.0 x 6.8 cm. My urologist who was checking my prostate for the last years considered a large prostate and atonic detrusor. Meanwhile, he thinks I would not likely benefit from TURP or laser ablation. In a few days, I am going to get US of kidney and bladder. I am sure you are 100%- right stating that “there are two treatment options for enlarged prostate, either medical line of treatment or Surgery (TURP).Medicine do help in improving the symptoms but the effects are not longer lasting and do not prevent the progress of the disease”. Do you still think that I would benefit from surgery? I’d like to hear your suggestion concerning the mode of treatment. Thank you in advance and best regards, XXXXXXX

Answered by Dr. Dr. P. T. Patil (4 hours later)

Brief Answer: Still you can be perated for TURP Detailed Answer: Hello Thanks for feedback. You have large size enlarged prostate with atonic bladder that is the reason for weal urinary stream Please get two more tests done 1) Urodynamic study to ascertain the tone of detrusor muscles of bladder 2)Uroflowmetry to know the urine flow pattern.(Average urine flow /Sec). If it is proved to be a atonic bladder on urodynaemic study, then I would prefer a supra-pubic catheter (SPC)to drain a bladder continuously.This will give complete rest to the bladder and will help to regain bladder tone.This is rather cumbersome for patient to be with SPC for such a long period. You may need to do Urodynaemic study every month to see the improvement in bladder tone.This may take more than six months.Once the tone has improved to normal then TURP can be done which will give gratifying results. I have been practising this modality in my long carrier of last 40 years in a patient with large prostate with atonic bladder and have given me best results. Please discuss this modality with your Urologist . Thanks and Regards. Dr.Patil.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar