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Dear Dr. Roach: I am 71 and began having urinary issues due to benign prostatic hyperplasia (BPH) many years ago. I took alpha blockers (Flomax, double Flomax and tadalifil), which didn't provide any improvement. I was never offered finasteride or dutasteride. I managed my urinary issues well by double-voiding before leaving the house and not drinking fluids after 8 p.m. (Too well, I guess.)
I recently changed urologists, and he performed a post-void residual (PVR) ultrasound and cystoscope, and he determined that my bladder was very enlarged. He also stated that my PVR urine retention was way too much, at 450 mL. He was very concerned about my condition worsening into acute urinary retention (AUR) or even damaging my kidneys.
I had green-light laser ablation surgery performed on my prostate and unfortunately suffered an infection and sepsis, for which I had to be hospitalized for a week. Post-ablation, my bladder still isn't functioning properly, and I am now on a foley catheter and taking bethanechol for 28 days. If only I could have avoided all this! I now know that dutasteride can both shrink the prostate and prevent it from continuing to enlarge.
I was wondering if you recommend that all men with urinary issues associated with BPH take dutasteride in addition to alpha blockers, in order to shrink and stop further enlargement of the prostate before its too late? Should all men request that their urologist perform a PVR ultrasound to assess their bladder condition and their risk for AUR or kidney damage? Lastly, what do you think my chances are for having normal bladder function again? -- G.M.
Answer: I am sorry that you had so much trouble and want to echo your point that men who develop prostate trouble should take it seriously. Noncancerous growth of the prostate (BPH) is common.
The urethra, which drains the bladder, runs right through the center of the prostate, so enlargement of this gland can cause difficulty urinating.
Any treatment that is effective at improving urinary flow should prevent urinary obstruction and kidney damage. The use of a PVR (aka the amount of urine left in the bladder after voiding, which should be very small) is not always necessary, but it can be a very good idea for men with symptoms that don't respond to medical therapy.