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Dr. Andrew Rynne

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What causes weak flow and incomplete urination?

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Dr. P. T. Patil

Urologist

Practicing since :1971

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Posted on Sat, 24 Oct 2015 in Urinary and Bladder Problems
Question: I do suffer from BPH for at least 10 years. My PSA has been staying around 2-3 for the past 10 years, However recently has gone up to 5.1. My flow is extremely week,
I do have to go to bathroom 2 to 3 times a night. Flow stops and starts a few times and I never feel completely emptied. Local urologist has suggested a biopsy and partial or full prostate removal.
My question is (1) shouldn't I have an MRI taken before the biopsy to pin point the location of the biopsy or even eliminate the need for biopsy.
(2) what kind od procedure is least invasive, and do you recommend. Lately I have XXXXXXX having incontinence at night as well.
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Answered by Dr. P. T. Patil 1 hour later
Brief Answer:
You need to revaluate again .

Detailed Answer:
Hello
Thanks for your query ,based on the facts that you have posted it appears that you have been diagnosed to have Enlarged Prostate and have been taking Terazocin since last 10 years ,and have noticed aggravation of obstructive urinary symptoms like nocturia,urgency and poor flow of urine .

I shall be happy if you can post me few more details to help me in making comments on your problem.
1) Have you done Ultrasound Scanning of Abdomen very recently? if so what is the size of the prostate and post void urine volume ?

Though your PSA has raised to 5.1 ng it is marginally higher than normal value of 4 ng Which could happen even with super added infection of prostate (Prostatitis).

I would suggest you to consult qualified Urologist for clinical and digital rectal examination and get following basic tests done to confirm the diagnosis.
1) Urine routine and culture.
2) Ultrasound scanning of abdomen and pelvis

If you were my patient I would have not directly jump for biopsy of the prostate but to treat you on following lines
1) To start with, take antibiotics like Cefixime along with Nitrofurantoin twice daily.Later on switch on to appropriate antibiotic as per culture report .
2) Add Tomsulosin once daily in addition to Terazosin
3) Repeat PSA after 2 weeks and 4 weeks and if it turns out to be same or raised than present level then take a call about doing biopsy .

If it is less than 4.1 I would suggest you to get enlarged prostate resected by endoscopic surgery of TURP ,

This is simple surgery with less morbidity practiced all over the world and offers permanent relief from night mares .

Hope I have answered your query ,please feel free to ask if you have more questions ,I shall be happy to help you
Thanks and Regards.
Dr.Patil

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