14 replies to this topic

[albedo]

I am male, 56 yo, with mild symptoms of BPH which I am treating with alpha blockers (tamsulosin), the LEF prostate formula and others.

My PVR or residual after urination (450+mL) is cause of concern as it can lead to surgery one day. However, I found huge difference with last year measurement by a different urologist (was 100mL). I would like advice if you have a similar experience with PVR and got relieve using a nutritional approach or others.

[InVeritate]

Albedo: My knowledge of urology comes from having a flaccid bladder since a young age and taking care of my own urological health, so it is not authoritative. Even 100mL PVR is still cause for concern. 450ml? Definitely so. Have you also had your prostate checked since then? I am curious if volume was measured in the same way by both urologist: ultrasound or catheter.

Anyway, one way to improve voiding is kegel exercises, to stregthen the pelvic floor muscles.

Also, Saw Palmetto my have some effectiveness in reducing BPH.

Edited by InVeritate, 20 March 2011 - 03:03 AM.

[InVeritate]

I meant to add that 450ml would be considered a normal elimination, so if you have that much still after voiding you may be holding it too long as well. Do you measure how much you void? Because of my flaccid bladder I constantly monitor my fluid intake and voiding. I try to go when I estimate my bladder to be about 450ml.

[albedo]

InVeritate, thank you for your reply.

I am monitoring prostate, PSA and hormonal status since several years. I posted some recent results (also using supplementation & tamsulosin for BPH) HERE. Also DRE, prostate volume etc .. all look fine. I am due to a second check in few weeks time where I will visit after voiding at home (not to suffer the stress of the clinical setting). I was never tested using a catheter and both urologists used ultrasound. There is ample literature of ultrasound test variability but I suspect my variation is too large to be explained that way.

While the simplest explication is BPH, hence a prostate conditions, I always wondered about the bladder itself, neurotransmitter levels, tone etc.. and your comment on bladder flaccidity points in that direction.

I normally take ~1.5L/d liquid (also due to a past ~25+ years kidney stone event) and might have (naive point maybe) "deconditioned" the bladder by drinking too much.

Kegel was discouraged, as well as a cytoscopy, when I asked some time ago as not really effective but will ask again!

[albedo]

I did some small research which may point to bladder dysfuntion rather than obstruction due to BPH:

"...The key underlying mechanisms of voiding dysfunction in the elderly appear to include deterioration of detrusor muscle function, bladder wall fibrosis, and increased sensitivity to neurotransmitters (especially norepinephrine)"

http://www.ncbi.nlm....les/PMC1472849/

"...Postvoid residual urine is a sign of abnormal bladder function rather than the result of BOO (bladder outlet obstruction) ... …A large part of BPH symptomatology may be explained by bladder dysfunction, which tends to be discounted in discussions about BPH"

http://www.ncbi.nlm..../pubmed/9586591

"...Pharmacotherapiesthat target the prostate (alpha1-receptor antagonists and 5alpha-reductaseinhibitors) often fail to alleviate OAB symptoms, and may not be the most appropriate therapy for men with storage LUTS. Multiple studies have suggested that antimuscarinic therapy alone or in combination with alpha1-receptor antagonists improve OAB symptoms in men with and without bladder outlet obstruction"

http://www.ncbi.nlm....pubmed/16530611

I am giving a try increasing consumption of caffeine:

"... caffeine and coffee may have beneficial effects on bladder dysfunction in the early stage ofdiabetes by increasing cAMP content in the lower urinary tract, recovering the micturition reflex and improving the detrusor contractility."

http://www.chinaphar...083/27/1037.htm

"...Treatment options for patients with urinary retention include biofeedback to teach muscle relaxation, drug therapy with bethanechol chloride, and sacral nerve neuromodulation. In addition, injection of botulinum toxin to suppress pelvic floor spasticity has shown success in patients refractory to first-line therapy. Stem cell transplantation and gene therapy for impaired bladder emptying are also being investigated"

http://www.ncbi.nlm....cles/PMC1472851

[albedo]

Last ultrasound measurement turned much better at ~200 mL (following last urination ~10' before measurement, 4:30 pm,~2 L liquid ingested since morning, ~10x urinations pushing to empty). As the average is basically stable over last 5 years my urologist suggested for the time being no further controls (cytoscopy, measurement by catheterization, bladder compliance, etc ..) and will recheck in one year. He tends for the simplest explication (obstruction vs bladder dysfunction) and is not in favor of finasteride (in a bi-therapy approach with the alpha blocker I am taking) shrinking my prostate (quite normal) as affecting sexual life and masking PSA.

Beside not forgetting my tamsulosin dose (0.4mg) the only nutritional approach I tried during the last weeks is to reintroduce coffee/caffeine as per one the studies I mentioned earlier ("increasing cAMP content in the lower urinary tract, recovering the micturition reflex and improving the detrusor contractility"). This together with all my prostate supplementation program. Also tried some Kegel exercise.

Considering no major troubles as bothering night wakes up etc .. I am overall reasonably happy with my watchful waiting but PLEASE feel free to challenge this if you think so.

[albedo]

I had a TURP surgery and results are quite positive. I continued posting on this subject in this thread:
http://www.longecity...ts/page__st__30

[johnross47]

My residual volume (ultrasound) was 800 at the last assessment. They are talking about teaching me self-catheterisation. Does anyone have any experience of this procedure? I have had suspicions about the diagnosis......it may well be correct but the investigation seemed lazy and presumptive. How would distinguish BPH from other causes?

[albedo]

This study might be of interest to you:

A prospective randomized trial comparing transurethral prostatic resection and clean intermittent self-catheterization in men with chronic urinary retention.
http://www.ncbi.nlm....pubmed/15963128

You can check the link I gave above for some personal experience. Maybe you can consider a full pressure-flow study before taking any decision and have a better chance to have your question replied. Note: I am not a doctor.

[johnross47]

Looks quite reassuring. I'll probably give the CISC a go.

[Sillewater]

AOR Prostaphil. Some good studies behind it, well it's version of extraction.

[albedo]

I am using the LEF formula since several years which contains it too to some extent:
http://www.lef.org/V...ch&key=prostate

[albedo]

Also discussed here

[johnross47]

Now using cisc. When I finally saw another specialist he agreed that my suspicions as to what the problem is, were correct. They have diagnosed bladder spasm and started me on cisc. The results are good. Unbroken sleep for example, for the first time in years. I can drive for three hours on a long trip and not have to pull over to rush into the bushes. Recently went to London by train, which from my door to the hotel was about five and a half hours, without a problem. I would now recommend this to anyone.

[albedo]

Happy to hear that John. I am trying to avoid CISC for obvious reasons but treasure your experience in case I will need it one day. I will go soon for a check up of my PVR (following the TURP in January). I followed a physiotherapy which helped me to be aware of the necessity to relax when urinating to better void. Using care and time and by a process described in details here, I feel I am able to almost completely void. I use to set a watch every 2-3 hour max, not waiting for the urge. I will post results in the links I just gave.