BPH + bladder issues + sleep issues

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I've been suffering from bph symptoms for more than 10 years (noctura, frequency, weak stream, etc.), but since surgery was not an attractive option for me, I learned to live with them. Then late last summer I went through a period where I had a great deal of difficulty to initiate urination. I was worried enough I went to my GP and got a prescription for flomax and a referral to an urologist. My symptoms improved after visiting the GP. I concluded that riding my bicycle had caused my worsening symptoms, and initially, the flomax did seem to help, but only for a short time. I just visited my urologist and because my PSA was normal (2.7), my prostate was not huge (55 cc described as mildly enlarged), and because the flomax was not very effective, he concluded that bph was not the whole problem. He suggested a combination of bladder issues, sleep disorders, and some bph were causing my symptoms. He said surgery would not be very helpful. I'm writing this to advise readers to take a broader view of bph symptoms before they agree to surgery which may not help and may cause a lot of other problems. I was lucky to find a good urologist who looked at the big picture rather than just the symptoms (which are classic bph). He suggested bladder retraining and a sleep medication would be the best treatment option. There are some bad outcomes from prostate surgery so I caution anyone considering it to look at the big picture before agreeing to surgery. 

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  • Posted

    Thanks interesting topic.

    How did the Urologist suggest you can retrain your bladder?

    You don't mention whether they did a test to see how much urine is retained in bladder after you pee.

    How would a sleep disorder affect frequency during the day? Or is frequency just at night?

    Is i possible prostate enlarged enough just around the urethra to cause the problem?

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    • Posted

      As I indicated, it wasn't just one issue, but a combination of the three. I know it's partly BPH, how much is difficult to know. I also know I have sleep and  bladder issues. I can cope with the symptons, at least for the present. Bladder retraining info can be found online.

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  • Posted

    Hello Reg,

    Thanks for sharing your experiences and thoughts. 

    Your doctor is right that bph (an enlarged prostate) does not always account for LUTS (lower urinary tract symptons). Yet, too often, urolologists often equate the two and therefore rush off into unecessary surgeries.

    That is not to say that BPH isn't often a primary cause of LUTS. Its a very individual thing and each case requires investigation.

    What tests did your doctor's run? Did they do a bladder scan for PVR (retention volume) for example?

    I assume that bladder retraining and sleep medication helped you? I'm also assuming that your PVR is normal because if it's not, then sleep medication could cause more harm than good. As to bladder retraining, that is most useful when the bladder is emptying out normally but too frequently. If the cause of frequent urination is retention, then bladder retraining is not indicated. Again, each case is different. 

    Whatever your situation is I would have your PVR checked again now that you are on sleep medications to make sure you are not retaining too much urine at night.

    Jim

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  • Posted

    Without doing tests on your bladder, there is no way he could have rightfully concluded anything. Prostate size can be very misleading - mine is 30cc (essentially normal) but because of the way it grew inward, a scope confirmed that it was casuing significant symptoms indicative of a much bigger prostate. Conversely, there are men with prostates over 100 cc who have no issues.

    Only after scoping you and confirming that your urethra wasn't restricted, could your doctor have reasonably concluded that most or all of your issues are bladder related and unless he did that and you didn't mention it, you may well be suffering with a treatable condition. Further, your your problems could well be a combination - mine turned out to be, but although I have some residual issues port Rezum (underactive bladder) I got a lot of relief from it and am glad I did it.

    I'm also glad that my urologist didn't take my prostate size at face value and conclude that I would have to continue to suffer. I recommend finding another urologist who will diagnose you properly.

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    • Posted

      He  didn't say they were all bladder related; he did say they were a combination of factors (as I stated in my discussion). I did have an ultrasound done before I saw him. He used various criteria to drawthe conclusions he did. Unnecessary surgery cal lead to a lot of unnecessary sufering. Sometimes surgery works: sometimes it deosn't. It's a judgement call at times; I trust his judgement at least for now.  Generally  doctors like to write prescriptions  and surgeons like to do surgery so it's refreshing when they buck the norm..   

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    • Posted

      I can't react to this unless I know what criteria he used. As far as I know, the only test that can verify how open your urethra is is a scope. He basically said that you would have to suffer indefinitely if not forever. FWIW, My issues are a combination of problems and a procdure helped a lot.

      I don't know if any procdures are advisable for you or not - neither does your urologist. Only after determining how blocked your urethra is can he/you make that determination. Then, you can look at various options and weigh the risks and benefits. Any procdure would be elective and you could decide to pass even if there was a really good chance one could offer significant relief.

      There are several prcocedures with low side effect profiles, that do not require anesthesia and work (realistically) something like 80% of the time. Doing one doesn't preclude doing another or just deciding to live with things if it doesn't work. My suggestion is that you get a better, more fact based diagnosis, find out if any of these (Rezum/PAE/Urolift/FLA) are indicated, look at the risks vs benefits and make a decision. Right now it doesn't seem that you have enough info about your condition or the less invasive treatments to make an informed decision.

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    • Posted

      I'm fully aware of the options out there because I've researched all the procedures available (Holep, Pae, ITind, urolift, etc.). I've already considered the risks and benefits and that's why I'm doing what I'm doing. My symptoms are manageable , at least for now.

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    • Posted

      Thats fine and everyone has their own line as to when/if surgery is worth the risk. All I'm saying is that your decision is based on the symptom severity - not a diagnosis, which IMO you don't have. If you were told that your problem is 100% prostate related and you would make the same decision, its the right one for you. If not, I would consider another urologist who can diagnose you properly so you can make a decision based on facts. 

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  • Posted

    Good advise i wish you the best reg52510. That said how was your prostate measured? I ask this because I was told (by 3 different uros )my prostate was <50 cc based on DRE. A lot of looking around I found a uro that looked at my CT scans. Turns out my prostate is 120 cc. YMMV just a word of caution when using only DRE to determine prostate size.

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    • Posted

      what is good advice? I'm sorry but a Urologist who suggests I take retrain bladder and take sleeping pills because I have a weak flow, frequency etc. for TEN YEARS - doesn't sound like he actually knows what the problem is. No offense reg52510 and I also wish you well.

      Not rush in to surgery? Of course that makes sense, most are looking at these messages because they don't want surgery that has risks and side effects.

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    • Posted

      It was  done by DRE, low PSA readings,  and an ultrasound. Perhaps not sper accurate but I'm willing to accept it because I am not ready for surgery as long as I can manage my symptoms as well as I am now. It would be nice to pee like a racehorse and sleep all night but there is no gaurantee that surgery would do that for me. Sometimes the so called cure is worse than the disease.

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    • Posted

      Reg,

      What was your PVR (post void residual) per ultrasound? I'm assuming it's zero or very close?

      I mention this again, because if you (or anyone else) has retention, then sleep meds are not only counter productive but possibly dangerous. For similar reasons, bladder retraining would not be indicated either.

      No one here disputes that LUTS often has a combination of different causes, or that there are many unecessary surgeries performed.

      However, the non surgical treatments can also have consequences if they don't match the symptons. I would also add that personally I would explore some non pharmaceutical approaches to nocturia before sleep meds. If that didnt' work, possibly try a mild diuretic early afternoon to force stimulate more daytime urination. 

      Jim

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    • Posted

      PVR was 93 ml. I won't be going on prescription sleep meds; I take melatonin now with chamomile and valerian which seems to help. Surgery is always a last resort for me. I can live with my symptoms because they aren't seriouls life altering. Accepting inconvenience is worth it if function is preserved.

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    • Posted

      I'm 74. I live a healthy, active lifestyle; my BMI is in the normal range and  I  still function at a younger age. That's why I'm not  interested in jeopardizing my current level of function. That could change if my situation changes drastically.  

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    • Posted

      Reg, you're preaching to the choir with me. I'm just a little bit younger than you but decided against surgery as well. 

      Given your age, your PVR is not bad, but I would your PVR measured more frequently now that you are using sleep aids. Remember, the sleep aids most probably will not effect urine production at night, but rather just let you sleep through it. That means that any urine you might ordinary void during the night will still be in your bladder come morning. Depending on how much that is, your bladder could start stretching which would make the whole sleep aid thing counter productive and accelerate your hypothetical "situation change".  

      That's why I suggested looking into alternative strategies for nocturia, but if not at least have bladder scans every four months or so to make sure your PVR isn't increasing. Same with bladder retraining. Bladder retraining is only good as long as you keep volumes under the average bladder capacity which is around 400ml. If you train yourself to hold more urine then that on a regular basis, you may again stretch the bladder and end up more symptomatic.

      Jim

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    • Posted

      Thank you Jim. The sleep aids are quite benign so they don't really keep me from waking up, but I think they help me go back to sleep. I still get up about 3 times a night, but I usually manage 7-8 hours of sleep a night even at that. I don't have a lot of faith in doctors, but I do like my urologist, however. Before going to him, I beleived that my symptoms were more than just prostate related. He confirmed my own thoughts even though my GP thought otherwise. 

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