DEAR DR. ROACH: I am 71 and began having urinary issues due to benign prostatic hyperplasia (BPH) many years ago. I took alpha blockers (Flomax, double Flomax and tadalifil), which didn’t provide any improvement. I was never offered finasteride or dutasteride. I managed my urinary issues well by double-voiding before leaving the house and not drinking fluids after 8 p.m. (Too well, I guess.)

I recently changed urologists, and he performed a post-void residual (PVR) ultrasound and cystoscope, and he determined that my bladder was very enlarged. He also stated that my PVR urine retention was way too much, at 450 mL. He was very concerned about my condition worsening into acute urinary retention (AUR) or even damaging my kidneys.

I had green-light laser ablation surgery performed on my prostate and unfortunately suffered an infection and sepsis, for which I had to be hospitalized for a week. Post-ablation, my bladder still isn’t functioning properly, and I am now on a foley catheter and taking bethanechol for 28 days. If only I could have avoided all this! I now know that dutasteride can both shrink the prostate and prevent it from continuing to enlarge.

I was wondering if you recommend that all men with urinary issues associated with BPH take dutasteride in addition to alpha blockers, in order to shrink and stop further enlargement of the prostate before its too late? Should all men request that their urologist perform a PVR ultrasound to assess their bladder condition and their risk for AUR or kidney damage? Lastly, what do you think my chances are for having normal bladder function again? — G.M.

ANSWER: I am sorry that you had so much trouble and want to echo your point that men who develop prostate trouble should take it seriously. Noncancerous growth of the prostate (BPH) is common, and although it commonly begins in the 50s and 60s, it can occur earlier or later.

The urethra, which drains the bladder, runs right through the center of the prostate, so enlargement of this gland can cause difficulty urinating. Men find it hard to initiate a urinary flow, have a slow or weak stream, feel like they haven’t emptied their bladder all the way, or have to go again right away.

Not all urinary symptoms in men are due to the prostate. Bladder conditions, especially overactive bladder and an infection of the prostate or bladder, may also cause symptoms that can be difficult to distinguish from bladder obstruction. Strictures in the urethra, urinary stones, some medications, and tumors can all mimic prostate symptoms as well.

If the pressure in the bladder remains high in cases of moderate to severe BPH, the bladder stays full (called “retention”), and the high pressure needed to urinate is also transmitted to the kidneys, causing kidney damage that can be permanent. It’s important to recognize that you can get kidney injury from bladder obstruction and still make urine. It’s just the high pressure that damages the kidneys.

Any treatment that is effective at improving urinary flow should prevent urinary obstruction and kidney damage. Alpha blockers like tamsolusin (Flomax) work well for many men, but it does not slow the progression of BPH. Dutasteride does slow/reverse the progression of BPH and is a good long-term choice for men with more severe symptoms, although it has potential sexual side effects. A combination of the two drug classes is effective and available as a single pill.

The use of a PVR (aka the amount of urine left in the bladder after voiding, which should be very small) is not always necessary, but it can be a very good idea for men with symptoms that don’t respond to medical therapy.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu. (c) 2025 North America Syndicate Inc. All Rights Reserved