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Urology/Frequent Urination

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QUESTION: My question is what can be the reason for frequent urination during the day and night and pressure in the penis that is relieved by urinating? I took a CT scan and the radiologist stated," Reveals that the prostatic shadow looks prominent causing some indentation of the base of the urinary bladder". The urologist used ultra sound to show my bladder is emptying. He also did a cytoscopy and said my prostate is perfectly normal.My PSA level is at a .5, no chlamydia,and urinalysis showed no infection.

I took plenty of anitibiodics, vesicare, enablex, flmoax, and now im taking Rapaflo 8mg.

I have to urinate every hour and get up 3 to 4 times in the middle of the night.I am desperate for answer, I am 23 years old and this has been happening for 3 months. I would deeply appreciate any answer, suggestion or solution.

ANSWER: Arturo:

Your urologist should be giving you this information.  Flomax and rapaflo can help with emptying, but don't help much with urgency in some cases.

A 24 hour voiding diary would help.

Given the failure of both alpha blocker meds and antichlinergics, you need further testing of the bladder function.  This can be done with a urodynamics or CMG test where bladder muscle activity can be directly measured.

One possible cause of your problem is interstitial cystitis which can be hard to diagnoise.

If your current urologist is unable to help you, I suggest you get a second urology opinion or go to a urology department at a university tertiary care center.

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QUESTION: I took a urodynamic test and the doctor said it was "relatively normal" but pointed it out that my sphincter muscle is not completely opening when i void. He also mentioned that my bladder capacity is a little low. He persribed me Elavil.

My question is if any medication or treatment exist that will open up the sphincter muscle to allow more urine to pass? I would deeply appreciate any suggestions. My symptoms include voiding every hour and 3 times at night.

Answer
Arturo:

If the bladder is not emptying completely, then it will obviously fill up faster and you will have to void that much more often.  If the bladder muscle is overactive or hyperactive, likewise you will have to void more often.  

I don't see where elavil is going to help either of these problems.  Medications called alpha blockers like Flomax can help with bladder emptying and opening the sphincter.  Increasing the bladder capacity is usually done with OAB drugs like Vesicare or Oxybutynin.

You may want to get another opinion if you are not getting any help from your current physician.

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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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