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Dr. Arun Phophalia
Dr. Arun Phophalia, Urologist
Category: Urology
Satisfied Customers: 44965
Experience:  MBBS MS (Surgery) Vast experience and routinely perform all urology procedures including endoscopy.
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Is Tamsulosin likely to be of much use when my acute urinary

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Is Tamsulosin likely to be of much use when my acute urinary retention was such that no even a smear of urine was emerging when I had around a litre in the bladder?
JA: Is the condition chronic, or acute?
Customer: It was acute.
JA: Anything else in your medical history you think the doctor should know?
Customer: The night before the acute episode I'd had about 7 glasses of wine and maybe only urinated once; on the same evening urine flow was only in very small amounts.
Customer: replied 9 months ago.
I had added some extra detail of which there is no hint that it ever happened. I was urinating normally apart from small amounts of post urination dribbling which has been the case for years. On the night when the acute retention commenced I'd had about 7 glasses of wine and remember noting at some point that I hadn't urinated in a long time but was presumably anaesthetized. Following this I had regular urges and urinated small amounts. I had a few glasses of water during the day and by the afternoon there was a complete cessation. I'd like to believe and it would seem quite a co-incidence if the wine etc drinking wasn't a factor i.e. distended bladder but even with a catheter it feels painful when I get an urge which suggests that even the catheter is under considerable pressure from the prostate ( or some other blockage). Standard procedure is apparently to take a drug and see how things work out without the catheter. I didn't get a chance to discuss the likely use of Tamsulosin (Flomax in the U.S.A.) so my quandry is that if it were just a distended bladder then the drug shouldn't be necessary and if the urethra is badly blocked then it's also not likely to be of use plus I'll have to endure getting a catheter re-inserted. My conclusion is that if passing urine is painful with a catheter then there is a major constriction. There was a noticeable amount of matter in the urine for the first couple of days which i'd like to believe was some sort of sedimentary obstruction but it was probably coagulated blood or chunks of the urethra. It took two attempts to get the catheter in and it had to be forced which again suggests a very enlarged prostate. It was identified as enlarged around 20 years ago but I've had no further treatment or tests since.

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What is your age?

How big is your prostate gland?

What did your uroflowmetry and video urodynamic study show?

Customer: replied 9 months ago.
64; don't know but info. in question seems to have a clear implication./ Have never heard of the tests mentioned; I'm from Sydney, Australia and as stated the standard protocol at a major hospital is to remove the catheter and see what happens which is the main purport of my question. Getting the catheter in was excruciating so I'm not keen on going through the standard protocol if the evidence is overwhelming that the blockage is total.

Thanks for the additional information. I am writing the answer for you and will get back to you in 5-10 minutes. If you get a phone call request, you may ignore it as that is an automated site trigger. Thank you.

The acute urinary retention and response to the medical or surgical therapy is dependent on the many factors as the following;

1) Size of the prostate and particular lobe pressure on the neck of the bladder.

2) Contractility of the bladder muscle.

3) Pelvic floor dysfunctions.

All of these are assessed by investigations like PSA, uroflowmetry, CT scan/ultrasound, and video urodynamics.

These would also guide whether only surgery would be effective.

Majority of the patients do respond to Tamsulosin and failure of it is again an indication of the surgerical treatment.

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Customer: replied 9 months ago.
are you stating the long period without urinating is likely to be a mere coincidence and that the pain experienced even with the catheter inserted doesn't really give any indication? I would have thought that both the delay in urination and the cessation of urinating combined with painful urges (didn't specify that prev.) were clear indications of cause - except for the fact that I can't see any connection between them or how alcohol and the subsequent full bladder could so rapidly increase prostate induced pressure. Rather than having the catheter removed (with the threat of re-insertion) would not some kind of scan reveal whether the prostate was hard upon the catheter?

Pain experienced during catheter insertion is no indication of the passage narrowing.

CT scan, ultrasound, uroflowmetry collectively give a very good objective assessment of outflow obstruction and selection of the treatment.

Video urodynamics gives an assessment of the bladder nerves and muscles, sphincters and pelvic floor issues.

Customer: replied 9 months ago.
Your recent reply stated: "Pain experienced during catheter insertion is no indication of the passage narrowing" however my question had related to pain in passing urine WITH the catheter inserted. Having stated that on day 6 after insertion that pain following urge has disappeared. You have made no comment about whether the non- urination period while having drunk around 7 glasses (a litre) of wine was somehow a likely contributor or cause.

As we discussed none of these will give an objective assessment of the narrowing of the urinary passage and guideline for the treatment. So pain in passing urine WITH catheter inserted has no significant clinical parameter for the disease severity.

A non-urination period while drinking a liter of wine may be contributory as it may have overstretched the bladder. That causes loss of the tone of the bladder and is commonly seen to cause urinary retention.

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