dr Goldstein I used to urinate every hour,went to urologist he did cysscope and found normal bladder but bph/enlarged prostate.i have episodes where I will go frequently the next day urinary retention and no pee for 17 hours.i worry that going that long stretch might damage my kidneys,the next day after not going I will pee normally,kidney ultrasaound no problems.i have diabetes and my cardiologist wont give me clearance for operation unless I take strss test.seems catherer is only option.but somedays I pee normally im afraid catherer will give me infection.i am frusted.maybe minimum invasive surgert that wont endanger my heart loke local or regional.any help is appreciated.i don't understand why I urinate normally one day and cant urinate the next
Howard, it is not unusual with an enlarged prostate gland (BPH - benign prostatic hyperplasia) to have symptoms that vary from day to day. Assuming that BPH is the cause of your symptoms, there are many treatment options available. To follow is some information I have written on this condition that should clarify the disease and choices of therapy.
Benign enlargement of the prostate gland (benign prostatic hyperplasia or BPH) occurs to varying degrees in all men as they age. The prostate surrounds the urinary canal (urethra) just after its connection to the urinary bladder. Inward growth of the prostate either into the bladder neck (opening) or into the urethra itself can cause difficulty with urinating. The prostate is checked by digital examination through the rectum. This gives the doctor an idea as to the size and benignity of the gland. However, it does not always correlate to symptoms as a small gland may have significant inward growth and a large glands enlargement may be entirely peripheral.
The ability to urinate involves the urinary bladder muscle actually becoming stronger as it works against increasing resistance from the prostate. This delicate balance can be upset by any factor that decreases the bladder muscles ability to contract with sufficient force to open the prostate (such as medications, anesthesia, too much alcohol, ignoring the desire to urinate, etc.) or those factors that might cause the prostate to suddenly swell (ie acute prostatitis, sitting for extended periods of time, biking,
horseback riding, etc.). The typical symptoms that occur include diurnal frequency (daytime), nocturia (night-time frequency), urgency, hesitancy, slow stream and dribbling after voiding. This complex of symptoms is termed “prostatism”. If the obstruction to flow progressively worsens, the bladder eventually may not be able to empty completely. This leads to the accumulation of “residual urine” which may predispose to urinary infections and kidney damage from back pressure.
However, relatively asymptomatic men with BPH do NOT necessarily require therapy. Treatment is indicated to relieve symptoms and prevent complications. In many cases medications can be used. Alpha - blockers (ie Hytrin, Cardura, Flomax, Uroxatral etc.) work by relaxing the bladder neck and urethra so the pressure generated by a bladder contraction has less resistance to work against. Natural herbal products such a saw palmetto and pygeum often provide symptomatic relief but the exact mechanism of action has not yet been defined. The prescription drugs Proscar and Avodart actually shrink the prostate. They work best in the larger glands and improvement may not be noted for up to 6 months. In cases refractory to medication, interventional measures are indicated. The “gold standard” for treatment is the time honored transurethral resection (TUR) of the prostate. For huge glands, open surgery may be necessary. In the past 20 years a number of other less invasive interventional therapies have been developed to reduce the obstructing prostate tissue utilizing various forms of energy. These include laser prostatectomy (green light), microwave (TUMP or transurethral microwave of the prostate), and radiofrequency (TUNA or transurethral needle ablation of the prostate). TUMP & TUNA are minimally invasive & out-patient treatment that can be tried initially if the patient's gland size is appropriate.
Here is an explanation of a TUR of the prostate gland. The prostate gland can be thought of as being composed basically of three parts which from inside to out are: the prostatic portion of the urethra (urinary canal), the prostatic glandular tissue causing the obstruction (adenoma) and the compressed capsule of the prostate. In a TUR, the prostatic urethra and adenoma are removed leaving only the capsule. This surgery can be likened to coring out an apple from the inside leaving only the skin. The prostate is resected into many tissue slivers which wash into the bladder and then are removed at the end of the operation by suction. This leaves a raw bed, which, over a period of 6-8 weeks, regenerates a new urethra! At the termination of the procedure, one can look from the far end of the prostate into the bladder without residual obstruction. A catheter is left in for a few days to drain the bladder and to initiate the healing process.
Green light laser gives very similar results to TURP. The advantages are that it can usually be done as an out-patient, there is less bleeding, one returns to work in a few days and full activity in 4-6 weeks. The main disadvantage that urinary frequency and urgency are greater in the first month.
The choice of technique is best left to the experience and preference of the surgeon. Good luck!