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Urology/Overactive ballder symptoms

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Question
Hi Doc
I am 38 years old and have for the last few years been having nocturia symptoms and havent had a decent nights sleep in years. These urgent need to urinate without the bladder actually being full occurs during the day as well. far in access to what others experience. Sometimes a burning sensation and I havent emptied the bladder fully with some leakage from time to time. Been to a urologist and he diagnosed me with Overactive bladder. The medication he gave me didnt have any effect. Went to him again and prescribed Tofrinal. Not helped a bit. (I only used it for a few days and it seemed to make things worse) After a while I started feel like the head of my penis would explode under the extreme blood pressure when I had an erection. And it made sex uncomfortable (not sure whether this is related but had to mention it) The uroligist suggested a circumcision. havent gone through this. I have read many stating the lack of sensation after a circumcision.
I went for a second opinion. the Urologist did a flow test and the graph outcome showed I might have a blockage and the peak flow was very low and did not happen fast enough. He suggested doing a procedure but informed me I might not ejaculate normally afterwards... I declined at the time and he gave me an alpha blocker which I tried for a few days and it did not have any effect. Please advise if there is anything else I could try. This not being able to sleep at night is just ruining my overall health and life.
Thanks
Vincent

Answer
Vincent:

Your problem is not a simple one.  If there is blockage, an alpha blocker medication is reasonable.  It may take more than a few days to work or the particular medication or dosage may need adjustment.  A specific overactive bladder medication may also be necessary but is not likely to work unless any abnormal blockage is managed.

You may need to get an opinion from the urology department at a major tertiary care university center.  A bladder pressure test called a CMG may need to be done to clarify the situation and help with treatment.

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Stephen W. Leslie, MD

Expertise

Questions concerning erectile dysfunction, kidney stones and prostate disorders including prostate cancer. I have a special interest in kidney stone disease prevention.

Experience

Full time practicing urologist with 30 years experience. Associate Professor of Surgery and Chief of Urology at Creighton University Medical Center. Editor in Chief of eMedicine Urology internet textbook. Author of only NIH approved book written for patients by a urologist on the subject of kidney stones "The Kidney Stones Handbook". Inventor of the "Parachute" and "Escape" kidney stone baskets and the "Calculus" stone prevention analysis computer program.

Organizations
American Urological Association, Ohio State Medical Association, Sexual Medicine Society

Publications
Men's Health, Journal of Urology, Urology, Healthwatch Magazine, Emergency Medicine Monthly, eMedicine, "The Kidney Stones Handbook", and numerous articles in various newspapers. He is also the editor of the Urology Board Review by McGraw-Hill used by urologists to study for their Board Certification Examinations.

Education/Credentials
Graduate of New York Medical College with residencies completed at Metropolitan Hospital New York, Albany Medical Center and University of Wisconsin-Madison.

Awards and Honors
Thirlby Award of the American Urological Association. Rated as one the country's Best Urologists by the Independent Consumer's Research Institute

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