Difficulty urninating after holding it, would urolift help (47 years old)

Men's health
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I’m considering the urolift procedure. I’m 47, and have a prostate measured by MRI that is 55cc. PSA has been consistently 3.0 for the last year, and MRI was negative for PC. Declined a biopsy due to risk of complications. PSA normalized to volume is OK according to Dr. For the last year and a half I am have been dealing with many of the common symptoms of BPH, nocturia, weak stream, start and stopping, difficulty starting the stream. I did take a course of antibiotics, but that didnt help. I tried flomax, but stopped due to RE.

My most bothersome symptom I have, which I have seen others mention on this forum, is that if I hold my urine too long, my stream is very weak. This makes doing the uroflow test very hard. My last QMAX was 7. Sometimes if I wake up at night and I have been holding my urine in my sleep, the stream is very weak even though I really have to go. There have been a couple instances where I thought I was having full retention. During the day if this happens, generally I can get a strong stream if I try and void again a few minutes later. I am wondering if there is a term for this condition and if Urolift will help with this issue(weak stream after holding it). This has been especially problematic when I used to travel and may not always be able to go when needed. It makes flying stressful. My Dr doesn’t really seem to understand this condition, but is suggesting urolift due to other symptoms. He also did a cystoscope, and didn’t see any obstructions, but did see that the prostate is pushing into the bladder and show me how I am peeing through more of a slit than a hole.

I have also tried diet changes, which haven’t helped with the exception of reducing alcohol consumption. I am a fit, thin 47 year old, so weight and other health conditions are not the issue.

From doing research, aquablation may be the best treatment option for me, but isn’t done in my area yet, and I have Kaiser in the Northwest which limits my options further. I am somewhat concerned about have Urolift implants in my for my remaing 40+ years(hopefully) as it seems like leaving anything in the body can eventually cause problems or prevent other procedures in the future. Although I did find out that I could still do aquablation after urolift which is good.

Anyone had urolift at my age? Anyone have the symptom of difficulty voiding after holding it, and seen improvement with Urolift or some other BPH procedure. Should I just deal with my symptoms for another year or two and see what other options come down the line for treatment? I am also concerned about my bladder health. During my cystoscope, the doctor did see some trabeculation.

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Hello! You mention stopping Flomax due to RE. Was Flomax working well but you didn’t like the idea of not ejaculating “normally”? I’m 59 and last year considered Urolift with my urologist’s urging but found out that my prostate was too long/large so I went with a TURP instead. Many others on this discussion board have had good results with Urolift. (I’m in Oregon but don’t have Kaiser insurance btw) I went with TURP since it seems to be considered as the “gold standard” and it’s been around for a long time. You do want to avoid losing elasticity of the bladder since that is something they cannot fix, as I’ve been told anyway.

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Flomax may be one of your best options now. I did not like the stuffy nose symptom of Flomax at first but I got used to it. For me the RE cause by Flomax lasts about 14 hours, that leaves 10 hours with out RE so if I time it right it does not affect my sex life.
The symptom of difficulty urinating after holding it may have something to do with your enlarged median lobe pushing into your bladder. The liquid in the bladder may put pressure on the median lobe and cause it to kink the hose. Some people call it a ball valve effect. You may also have the problem when holding a bowel movement, the contents of the bowel put pressure on the median lobe causing it to kink. I am not a doctor so take what I am saying with a grain of salt.
You may have to take the enlarged median lobe into account when selecting a procedure for the prostate. There is an ejaculation preserving TURP that mostly removes material from the median lobe while staying away from the ejaculatory ducts in the middle of the prostate. South Bay Urology in Torrance California advertises epTURP.

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I may give flomax another try. Thanks for the replies. The RE, stuffiness and just general blah feeling made me stop before, but it may be the lesser of the evils now.

I had an issue Sunday where I had a few drinks and fell asleep. I woke up with a full bladder. It took a few minutes before I could go at all. Very scary. Now I feel like my urine production is less than usual. I’m a little concerned I may have done some damage to my bladder or kidneys. Going in today to get a scan of my bladder to see if I am actually emptying it.