- March 28, 2024
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DEAR DR. ROACH: I would like your opinion on enlarged prostate. My primary-care doctor sent me for a blood test and said my PSA number was too high, so he then sent me to a urologist. He said my bladder is not emptying and that I am having urine retention in the bladder. After one week of medication (Rapaflo), I had a catheter inserted for another week. He measured the urine in the bladder, and it was 880 ml. Now he is suggesting surgery. Is he going too fast? What are your thoughts on the procedure and side effects? Will this correct the problem? – D.G.
ANSWER: The bladder is drained via a tube called the urethra, and in men, the urethra runs right through the middle of the prostate. As men get older, the prostate commonly enlarges, and this can cause resistance to flow. The symptoms can range from mildly annoying to complete obstruction. Complete obstruction is an emergency, since the kidneys will fail within a few days of being unable to drain urine at all.
But the obstruction does not need to be complete in order to cause kidney damage. It's the high pressure in the urethra, bladder and ureters (the tubes that allow urine to flow from the kidneys to the bladder) that causes kidney damage. Placing a catheter allows the urine to drain at low pressure if the problem is in the urethra.
Normal bladder capacity is between 300-400 ml. At 880 ml, you would experience very abnormal bladder drainage and would be at high risk for ongoing kidney damage. Thus, I completely agree with your urologist that something, probably surgical, needs to be done quickly.
It's not completely clear to me whether your inability to drain the bladder is due to obstruction from enlarged prostate, even though an elevated PSA suggests that this might be the case. It also is possible that there is something wrong with the nerves that go to or from the bladder. I suspect your urologist has done additional bladder tests to help sort this out.
The booklet on the prostate gland discusses enlargement as well as cancer. Readers can obtain a copy by writing: Dr. Roach -- No. 1001W, 628 Virginia Drive, Orlando, FL 32803. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient's printed name and address. Please allow four weeks for delivery.
DEAR DR. ROACH: I have weaned off Zoloft, and I noticed a swelling of my fingers – I can't get my rings on. Do you think it is related? – E.P.
ANSWER: Discontinuing an antidepressant such as sertraline (Zoloft) certainly can cause symptoms. Dizziness, fatigue, muscle aches, anxiety and irritability are common. It happens more frequently if the drug is suddenly stopped versus tapered down over weeks. Paroxitine (Paxil) seems to have the highest incidence of symptoms on stopping.
However, I haven't seen swelling as a result of stopping sertraline. It may be related, but I doubt it. Is it possible that you are consuming more salt? That's the most common reason for increased fluid in the fingers over a short time.
I would see your doctor if it doesn't go away in a week or so.
DEAR DR. ROACH: Could you please discuss the use of ultrasounds during routine pregnancies? How many typically are performed, and are there any possible negative effects on the fetus? Are doctors today performing more ultrasounds (including 3-D ultrasounds) just because they can and because it's exciting for the expectant parents, or is there a medical reason for performing these?
My daughter-in-law is in her sixth month and has had two ultrasounds, plus a 3-D session. She is under the impression that she will have at least one more. To my knowledge, this is not a high-risk pregnancy (she's 26 and everything is going fine). I'm just wondering if so many sessions are really needed and what is known about the effects on the fetus. – G.M.
ANSWER: There is some controversy over whether an ultrasound poses risks to the developing fetus. The Food and Drug Administration has noted that there may be some heating of tissues and that any long-term risks are unknown. I did find studies showing that there is no long-term risk of leukemia, hearing loss or abnormal eye development.
A 2013 guideline from multiple groups, including the American College of Obstetricians and Gynecologists, recommended a standard first-trimester ultrasound, and a standard second- or third-trimester ultrasound. Any other ultrasounds would be based on a clinician's concern for a potential problem.
The guideline specifically states: "Fetal ultrasound should be performed only when there is a valid medical reason, and the lowest possible ultrasonic exposure settings should be used to gain the necessary diagnostic information." I don't have enough information to know why your daughter-in-law has had more ultrasounds than is usually recommended for a normal pregnancy. Perhaps her obstetrician has a low-level concern she hasn't shared with her, or your daughter-in-law with you.
While not the case for her, I am concerned about the growing trend of so-called keepsake ultrasounds that are not performed for valid medical reasons, such as those done in shopping malls. These might not be administered with the same degree of expertise and safety as a medical ultrasound.
DEAR DR. ROACH: I am 78 and have had urinary tract infections continually for the past eight or nine months. My urologist prescribed methenamine for six months, then a month of cephalexin, then back to the first prescription. Why is it so hard to get rid of UTIs? What would you recommend? – A.C.S.
ANSWER: Frequent urine infections are common. However, it is important to find out if this is the same infection that hasn't ever gone away, or a series of new infections. An infection that doesn't go away needs an evaluation for something abnormal in the urinary tract, such as a kidney stone. Your urologist is treating you with medication to prevent new infections. Methanamine is a urinary antiseptic, and cephalexin is a broad-spectrum antibiotic.
You didn't tell me if you are a man or a woman. Men with recurrent infections should be evaluated for prostate issues. Women with recurrent UTIs frequently are affected by atrophic vaginitis. There are many other causes. It's worth discussing further with your urologist.
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 [email protected]. To view and order health pamphlets, visit www.rbmamall.com, or write to Good Health, 628 Virginia Drive, Orlando, FL 32803. (c) 2016 North America Synd., Inc. All Rights Reserved