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About Arthur Goldstein, M.D.
Expertise
Any problems or questions related to the field of urology; ie urinary stone disease, urinary cancers (kidney, bladder, prostate, testis, etc.), urinary infections, impotency, etc.
Experience
I am retired from the active practice of urology. My 34 years was totally in the clinical field and involved the entire gamut of genitourinary problems, with special interest in male impotence and endourology.
Organizations
American Medical Association, American Urological Association, American College of Surgeons
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You are here: Experts > Health/Fitness > Urology > Urology > Trouble urinating
Expert: Arthur Goldstein, M.D.
Date: 9/17/2008
Subject: Trouble urinating
Question
I'm a 40 y/o male who recently has had severe difficulty urinating even when my bladder is ready to bust. The only way I can is to sit on the toilet and relax and even then it takes me upward of five minutes to produce a stream, but even then it is difficult to maintain.
Answer
William, the ability to urinate depends on 2 basic factors: the force generated by the bladder muscle and the resistance in the urinary canal.
Anything that decreases the ability of your bladder to contract normally, can make it difficult to generate a good stream. some of the factors that might cause this include side effects from a number of medications, excessive alcohol or drug use, ignoring the desire to void for long periods of time and a variety of primary muscle disorders of the urinary bladder.
Likewise, increased resistance at the bladder neck, prostate, or anywhere in the urethra causes a poor stream. The most common etiology is relative obstruction due to swelling or enlargement of the prostate gland. In a man your age, inflammation of the prostate gland, so called prostatitis is probably the cause. However, bladder neck contracture and benign prostatic hypertrophy (BPH) might also occur. In the urethra, a stricture (narrow area) may be present at any location.
As there are so many possibilities for your difficulty voiding, I strongly suggest that you arrange to see a urologist in consultation. A complete urologic history, physical examination and basic lab tests (at the very least a urinalysis) need to be done. A specific treatment cannot be advised until the cause of your condition is established. Good luck.
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