I have copied the below conversation from another thread (UTI by Roy,den) as it is more appropriate here and was hijacking his thread.
I will reply later
Cheers
Bill
Bill63
Posted 12 Apr 2020 at 18:03
Originally Posted by: Andy62
"If your pee rate is slow and you are incomplete voiding, you might ask your doctor about trying Tamsulosin."
Anyone know if Tamsulosin would a be of any help with post RARP bladder neck constriction and would it aggrivate urge and frequency issues or incontinence. My flow is down to 3ml/sec max but detiriates quickly to a dribble. No chance of getting it sorted any time soon.
Cheers
Bill
Andy62
Posted 12 Apr 2020 at 19:30
Someone asked me exactly the same question just recently (maybe on another forum).
If the constriction is significantly smooth muscle based (which is certainly a possibility with it being at the bladder neck), then it might work. If it's predominantly scar tissue, it's less likely to work. The flow rate quickly deteriorating to a dribble could be smooth muscle of the sphincter contracting, and it might help with that, even if it doesn't change peak flow rate because it's limited by scar tissue. Reducing flow rate could alternatively be lack of contraction of the bladder muscle, and it won't help with that (and might even make it worse).
Tamsulosin is quick acting, so you could ask to try it. It could aggravate incontinence, in which case you could stop it and it should be out of your system in a day or two (it doesn't normally last quite 24h).
I'll also say that Tamsulosin works mainly on the smooth muscle of the internal urinary sphincter (and prostate), and I'm not sure exactly what difference it will make post RP where this sphincter (and prostate) is lost, and you rely on the external urinary sphincter. I have asked a couple of urologists how the external sphincter (which is classically regarded as skeletal muscle which can't remain contracted and give continence) does end up providing continence in most cases after RP, and they've thought for a moment, before saying they don't know. There may be some smooth muscle in the external sphincter too (as is the case for women who only have one urinary sphincter), in which case Tamsulosin would work on that.
It would be interesting to know if there's anyone here, who following a RP, still finds that Tamsulosin increases flow rate. That would suggest the male external urinary sphincter does contain smooth muscle, in addition to skeletal muscle, and would also explain how it takes over primary continence control from the lost internal urinary sphincter.
Thanked 1 time
colwickchris
Posted 12 Apr 2020 at 21:39
Bill
I probably have taken tamsulosin in the early days of my stricture but cannot recall it being effective, hence the reason for trying all sorts of other medications. Good points from Andy on how tamsulosin works.
You say your max flow of 3mls/sec quickly slows to a dribble, do you mean at each visit to the toilet or over a period of time.
Post dilation I could sometimes do an average of between 20 and 10mls/sec and it usually took three or four months to get back down to 0.5mls/sec. Scar tissue continues to grow which is why I needed numerous dilations.
Thanks Chris
Thanked 1 timecolwickchris
Bill63
Posted 13 Apr 2020 at 07:32
Originally Posted by: colwickchris
"You say your max flow of 3mls/sec quickly slows to a dribble, do you mean at each visit to the toilet or over a period of time"
Andy/Chris, thanks very much for the replies.
Chris, I meant each pee,
first minute or so is about 3ml/sec then it slows to a dribble then it stops at which point I have to push down and then push out, kind of push and squirt until no more comes out. Also the first 20 secs or so is painful, not the stinging urethra pain like with a UTI but a horrible pain from inside.
Cheers
Bill
Andy62
Posted 13 Apr 2020 at 08:17
Originally Posted by: Bill63
"first minute or so is about 3ml/sec then it slows to a dribble then it stops at which point I have to push down and then push out, kind of push and squirt until no more comes out."
I'll suggest an alternative strategy to try. Don't try fighting it when the stream stops. Just wait 30 seconds, and then go for a pee again (by relaxing like normal, not by forcing). This is called double voiding. Keep doing this until you reach the point there is nothing more left in the bladder other than the few cc's your kidneys will have generated in the last 30 seconds wait. I can't promise it will work, but it's probably worth a try.
The smooth muscle of the sphincter doesn't relax until your bladder is empty - it relaxes for a length of time which is normally ample to empty your bladder at a reasonable flow rate. For a slow flow rate, it will contract and close the sphincter before your bladder is empty (which is why slow flow causes incomplete voiding). So the suggestion above is to accept that will happen, but then go for a pee again to repeat the process as necessary until you do empty your bladder. Trying to force pee out by tensing can be counter productive by also tensing muscles that restrict flow, and might do some other damage in your abdomen/bowel.
Going for a pee should be a relaxing task. If you find yourself all tensed up worrying if it will work or not, try taking in something to distract you like a book or a smartphone, sit on the loo, and use those between pees to take your mind off it. (Don't sit on the loo for hours - it's not great for circulation in the legs.)
Originally Posted by: Bill63
"Also the first 20 secs or so is painful, not the stinging urethra pain like with a UTI but a horrible pain from inside."
Maybe urine running past an open scar. You probably restrict your fluid intake in the light of the difficulty voiding, and that may make your urine more concentrated and acidic. If you get more confident that you can empty your bladder, increase your fluid intake to make your urine more dilute. It should look no more concentrated than pale straw coloured. If it looks more like orange juice, that might be part of the explanation for the pain.
I've given some quite detailed suggestions here, but note that I am not a clinician, and you may have some condition I have failed to recognise. You might want to run them past your own clinicians first. At a flow rate of 3ml/s, you are at risk of going in to retention.
Edited by member 13 Apr 2020 at 08:33 | Reason: Not specified
Thanked 1 time
colwickchris
Posted 13 Apr 2020 at 08:45
Bill
Question time, have you had a flow test at the hospital, what was the result , how much do you urinate at each visit to the toilet , how often do you go, how much fluid do you drink per day and what do you drink. How much do you output per day. How long have you had the flow of 3 or 4mls.
Have I already mentioned may favourite subject of hem o lok clips migrating into the Urethra or bladder neck being the cause of the problem ?
Until you get camera in there you are not going to find a solution, you could ask about self dilation, but that is before done after surgical dilation. I appreciate and understand why you are trying to find a solution in the current covid situation.
Brissac has had a flow of 5mls for years and seems to cope quite well if he does not see this conversation you could perhaps PM him.
Finally apologies to Royden for hijacking your conversation.
Thanks Chris