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Wednesday, May 31, 2023

Men’s Health Month: Men’s Plumbing 101

Poor urination can impact one’s quality of life

Few will argue that a strong shower is a great way to start the day. It invigorates you and gets you ready to hit the ground running. On the flip side, low shower pressure first thing in the morning may be quite disappointing. Much like low shower pressure, poor urination in men can be quite frustrating and significantly impact their quality of life.

Much of this can be attributed to men getting older and having some element of prostate enlargement, commonly called benign prostatic hypertrophy, or BPH. The prostate is a walnut-sized gland that sits between the bladder and the urine channel (urethra) in men and, when enlarged, may cause some blockage of urinary flow. Men can then experience symptoms such as slow stream, hesitancy, intermittent stream and a delay in initiating their stream.

In the worst-case scenario, a man may not be able to pass their urine entirely or at all. While prostate enlargement may be an inevitable part of aging, it does not always cause symptoms. Fortunately, when symptoms appear, there are options to help those men urinate better.

To troubleshoot urinary problems, it is important to understand the potential problem areas in the process. The urinary emptying mechanism functions much like a pump shower. The shower pump (bladder) pumps and propels water (urine) forward through the pipes. The piping leads to a valve that can be loosened or tightened to regulate the flow (bladder neck or the junction between bladder and prostate). Finally, the pipes must be without buildup or plaque to produce strong shower pressure.

Any blockage of the piping is similar to the effect an enlarged prostate may have on the flow. To summarize, if the bladder pumps appropriately, the valve relaxes sufficiently, and there is no blockage of the pipes, then the pressure will be high.

Alternatively, urinary symptoms can develop from a poor pump, non-relaxing valve, clogged piping or a combination of the three. The toughest of these to fix is a poor pump (bladder) since, currently, there is no good way to either jumpstart the bladder or replace it with a new one. While there are almost no ways to improve the bladder if it is irreversibly damaged from chronic blockage or neurologic problems, there are good treatments for a faulty valve or clogged piping. Fortunately, these days, there are many options for these men that can help improve their pressure and quality of life.

If a man has a poorly relaxing valve during urination, some medications can help relax and open the valve. The medicines for a nonrelaxing valve (hypertonic bladder neck) include tamsulosin, silodosin and doxazosin. These medicines are typically taken once daily and will relax the muscles between the bladder and prostate to open the urine channel. A common side effect may be lightheadedness, so the medicine may be better taken closer to bedtime.

Additionally, if the piping is blocked by an obstructing prostate, then the prostate can be shrunk with medication, or a surgical procedure can be performed to remove the blockage. Drugs to shrink the prostate include finasteride and dutasteride. They may take a few months to kick in but can significantly decrease the size of the prostate over time. This would involve shrinking the portion of the prostate that protrudes into the urine channel and blocks flow. These medicines can be taken together for a non-relaxing valve and can often produce a better result than each medicine individually.

If the medicines are ineffective in improving a man’s urinary symptoms sufficiently, or if the side effects or costs are prohibitive, surgery can be discussed. Each surgical intervention, whether traditional or minimally invasive, aims to reduce the obstruction of urine outflow. In other words, these procedures would remove any plaque or buildup inside the pipe to give the water a larger channel to flow through. Interestingly enough, if a man was treated for urine blockage from an enlarged prostate a couple of decades ago, he may have undergone a “roto-rooter” procedure. Rather than a drill or a snake, this procedure involves a heated instrument that would gradually scoop out the obstructing portion of the prostate. While this procedure, known as a TURP (transurethral resection of the prostate), is still performed today, other options exist. Procedures may include lasers that evaporate the obstructive tissue, having the tissue heated or cooled to cause sloughing, or shaving the tissue out with various delicate instruments. Some surgical procedures may be performed as day surgery, and some may require an overnight hospital stay.

As with any “plumbing issue,” the treatment options will depend on the location of the problem, the degree of blockage and the impact on quality of life. Through a good history, physical examination and testing, a urologist can determine where the problem lies and offer that gentleman various treatment options that suit their lifestyle. That way, any man could enjoy the benefits of a “strong shower” anytime.

Alexander Gomelsky, MD, is the chair and professor of urology at LSU Health Shreveport. Dr. Gomelsky is a fellowship-trained urologist in Shreveport with a focus on men’s and women’s health, incontinence, pelvic prolapse and neurologic voiding dysfunction. To learn more or schedule an appointment, call 318-683-0411.

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