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Urology/enlarged prostate.


Dear Sir,

I am regularly taking Himaplasia one tablet in the morning & Veltam at night,since March 2013,with frequency reduction from 5/6  to 3/4 times at night at 76.

Is it preferred to change over to Veltam Plus,if it has any further advantage with shrinkage of external enlargement?
I don't have any pain,burning sensation or infection so far.

No surgery is anticipated yet.

GOD always bless you for such help.
with warm regards.


THere is no formal medical information on himaplasia, but veltam (tamsulosin) is a known medication that helps with urinary flow.  Veltam plus addes dutasteride, a prostate shrinking medication to the tamsulosin.  There is an advantage to this in that veltam by itself may start to lose effectiveness as the prostate grows.  This growth can be stopped by the dutasteride in the veltam plus.  WHile there may be some benefit from the prostate to the switch to veltam plus, it is uncertain if this will further help your nocturia.  Here is my outline on nocturia which may help.


Nocturia (Getting Up at Night to Void)
Stephen W. Leslie, MD

Nocturia is defined by the International Continence Society as ďthe need for an individual to wake up at night one or more times to void.Ē  Nocturia is typically found in over 50% of all men and women over 60 years of age.  The prevalence increases with age such that the vast majority of individuals age 80 years and over will get up at least once every night to void.  

Nocturia has significant effects on general health, vitality and quality of life.  Sleep disruption can result in daytime sleepiness, fatigue, mood changes, memory problems, cognitive dysfunction with poor concentration and performance.  Nocturia is often described as the single most bothersome of all lower urinary tract symptoms and more than 25% of all falls at home occur at night in relation to toilet visits.

There are four basic conditions leading to nocturia.  These are:

1) High 24 Hour Urine Volume as in Diabetes.
2) Nocturnal Urine Overproduction as in Heart Failure and Vasopressin Hormone Disorders.
3) Bladder Storage Dysfunction as in Overactive Bladder and Prostate Problems.
4) Sleep Disorders such as Sleep Apnea.

Patients with nocturia do not necessarily require treatment.  Most of the time, we only evaluate and treat nocturia when it is truly bothersome to the patient (usually 3 or more voids each night) or significantly interferes with the patientís sleep.  An important consideration is whether or not the patient is awakened by the need to void rather than waking up for some other reason.  

The patientís usual total sleep time is also important because the number of voiding sessions per night will vary according to how much time the patient is actually asleep.

We like to know the total daily urine volume which is determined by measuring the voided urine amount every time you void for 24 hours.  This is called a Voiding Diary (a one day list of the time and amount in ml that you void) and is very helpful in determining the nature of the problem causing the nocturia.  It turns out that some people just naturally make more urine per hour when they are asleep than when they are awake due to a hormonal imbalance while others will produce far more urine a day than average.  The 24 hour Voiding Diary helps us diagnose these problems without any costly or uncomfortable testing.  In general, less than 2,000 ccís per day of urine output is usually recommended.

Managing Nocturia

For most typical patients with nocturia, we recommend limiting the fluid intake somewhat, starting right after dinner unless otherwise instructed by your physician.  

Avoid alcohol and caffeine especially after lunchtime.

Refrain from extra hours in bed.  (Excess hours in bed will make sleep shallower, leading to worsening of the nocturia.

Engage in moderate daily exercise.  This usually consists of trying to walk at least 20 minutes a day.  The additional exercise will be more effective in helping with nocturia if done in the evening.

Try to stay a little extra warm in bed, such as by using a hot water bottle.

After dinnertime, try to keep the legs and feet elevated.  This helps any fluid collected in the legs to return to the heart and kidneys long before bedtime.  A small, extra pillow placed under the knees can make this position even more comfortable.  (The legs and feet act like sponges and tend to hold onto fluid.  Raising the legs up helps this extra fluid return to the general circulation and become urine.  Otherwise, this happens after bedtime when the patient usually wants to avoid getting up from bed to void.)  The use of compression stockings can also help reduce excess fluid accumulations in the legs that otherwise would increase urine production after bedtime causing extra trips to the bathroom.

Change the timing of your water pill (diuretic) medication if OK with your physicians.  For example, if you normally take Lasix every morning, you will probably reduce your nighttime voiding just by changing the time you take the medication to mid afternoon.  Diuretics like Lasix typically work for around 6-8 hours.  Then, fluid tends to return to the body over the next 6-8 hours.  After that, there is no extra room for more fluid so itís converted to urine at a faster rate.  If you take Lasix early in the morning, the overnight period becomes the most likely time for this extra urine production to occur.  Moving the Lasix dosing to later in the day reduces overnight urine production and helps limit nocturia.  We usually recommend that patients take their Lasix about 8 hours prior to their usual bedtime, which for most patients is sometime in the mid-afternoon.

If you have an enlarged prostate, have it treated. In many cases, standard medical treatment of an enlarged prostate can cause a significant reduction in nocturia episodes.

When simpler methods fail, consider medications.  If a hormone problem is to blame for the nocturia, then a medication to correct that specific condition can be very useful.  A clinical trial of an overactive bladder drug, prostate medication, sleeping pill or the use of anti-diuretic hormone supplements can often be quite helpful when simpler measures are not adequate to control the nocturia.  There is evidence that the use of 2 mg of melatonin, a natural sleep aid available without a prescription, taken at bedtime can also help.

Nocturia is not a disease in itself.  Itís a common but abnormal condition that is caused by a variety of disorders.  But it can be completely eliminated or at least significantly improved using the simple measures mentioned above.  


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Stephen W. Leslie, MD


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


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.

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

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.

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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