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What Causes Less Powerful Urine Flow?

Posted on Mon, 21 Apr 2014

Question: Dear doctor Question regarding urology. I am 71 year old .I have diabetes since 3 years and Hypothyroid since 2 years.Both are under control. For quite some time , I am passing urine normally but the flow is a little bit slow.If i give pressure, well , it passes off well. I do not know whether this is a weak or slow urninary stream.I never felt any of the following symptoms. 1Never felt incomeplet bladder emptying. 2.Never had difficulty in starting urination 3.there is no frequent urination or urgency to urinate. 4.Not getting up frequently at night . 5.The urine stream does not start and stops. 6.No dribbling . 7.Never returned to urinate after finishing. Only thing is the stream is not strong. and forceful. so i underwent abdomen scan to day. The finding is as follows.:Urinary bladder is normal in capacity and contour.Walls and contents do not show any abnormality.Post void residual urine is 28 ml (slightly increased).Prostate is enlarged in size measuring 50x38x43 mm(Vol=42.4.cc) .Parenchymal echogensity is normal.No focal lesion is seen.Seminal vesicles are normal. All other organs viz:liver, gall bladder, pancreas, right and left kidneys all are normal.No splenomegaly,lymphadenopathy or free fluid is seen and all are normal. I have had same scan 3 years ago. It shows post void residual urine is 10 ml (insignificant) Prostate is measuring 47x36x29 mm(vol=27cc) . Now what i wish to know whether i should start taking tablet like flomax or urimax right away or can i wait and watch for some time ? Or can i take a combination of two meidicnes to have free flow and reducing the enlargement of the prostate? Is there any safest medicine in this regard? Kindly go through my case patiently and advise me.

Answered by Dr. V. Sasanka (32 minutes later)

Brief Answer: medicines certainly should be of help Detailed Answer: Hi It looks like you have certainly done your research. You are most likely going to experience improvement in stream once you start using drugs like urimax or flomax. At doses of 0.4mh pet day, mild giddiness can be expected in the initial few days of starting therapy especially if you get up from a supine position abruptly but this should go away within a week. Dutasteride is drug to reduce the chances of you going in for retention of urine and also risk of surgery. This reduces the size if the prostate over prolonged use. By itself it does not improve symptoms greatly but it could add value when combined with alpha-blockers like urimax. I suggest that you have a baseline uroflowmetry to assess the pattern of avoiding now so that it can be compared to a study done after you start treatment . Serum PSA testing for screening for prostate cancer is controversial and before you get it done I suggest you discuss with your family physician if you should get this done or not. Hope I have been of help. Regards.

Above answer was peer-reviewed by : Dr. Shanthi.E

Follow up: Dr. V. Sasanka (33 minutes later)

Dear Doctr, Thank you for your prompt reply. Since i am taking beta blockers ,statins and nitrates since many years, does this drug urimax or flomax has any tendency of interacting with these drugs.On the other hand i understand that taking Dutasteride does not improve the present position immediately unlike the above two drugs,but will certainly give results in the long run. So i feel i should start taking urimax 0.4 mg right away or flomax as you suggested. by the way i am told that ayurveda has excellent medicine to reduce the size of prostate. Do you recommend this besides urimax?

Answered by Dr. V. Sasanka (16 minutes later)

Brief Answer: tamsulosin should be useful Detailed Answer: Hi again, In your case I feel you can try a combination of dutasteride and tamsulosin (urimax). It should give you the most optimum results especially considering your prostate is over 40cc by ultrasound. Tdulosin had a tendency to cause low bp in patients already on anti hypertension meds such as the ones you are on but if you ate prepared for this, you will find that any mild dizziness passes away soon. I personally have never advocated use of ayurveda drugs for ptostate. They have never undergone the clinical trials that the regular drugs have and any benefit obtained might need to be explained anecdotal or as a placebo effect. Same with saw palmetto which has been marketed as prostate tonic in USA. It has not been shown to benefit in clinical studies. At best you can say they might not harm you. If you are fine with it, you can try. I actually will be quite happy to know your response:-) For the moment, firm recommendation for a combo of tamsulosin and dutasteride. Hope I have answered your doubts. Regards.

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Above answer was peer-reviewed by : Dr. Vinay Bhardwaj