Difficulty urinating in men: Symptoms and treatment

We thank Dimitrios Kotsiris, Military Physician and Surgeon Urologist-Andrologist, curator of the Urology Clinic of the Athens Naval Hospital, candidate for Doctor of Medicine at the University of Patras, specialized in Andrology and Infertility at the 1st University Department of Urology of AUTH, author of articles in international urological journals and books (www.demo.kotsiris-urology.com).

Difficulty urinating affects a large percentage of men of all ages, with the largest percentage affecting men over 50 years of age. Symptoms include stinging when urinating, frequent urination, waking up at night to urinate, the urge to urinate at short intervals without a large amount of urine, decreased and intermittent urine flow, difficulty starting to urinate, and feeling like urine remains after urination. The correct diagnostic approach and the subsequent targeted treatment are required for the correct treatment and remission of symptoms.

First visit to the doctor's office

• Taking a detailed personal and sexual history (lifestyle, medication, surgeries and possible neurological conditions).
• Urination Assessment Questionnaires (IPSSQuestionnaire).
• Clinical examination of the external genitalia to rule out gagging, stricture of the urethral opening, penile cancer.
• Digital examination to exclude prostate malignancy in men over 50 years of age.
• Ultrasound measurement of residual urine after voiding. On competent residual urine, laboratory evaluation of renal function and renal ultrasound.
• Ultrasound assessment of prostate size.
• Urine test to rule out infection or malignancy.
• PSA in men >50 years requiring treatment for benign prostatic hyperplasia to rule out malignancy.

Further check on indications

• For symptoms of frequent urination, nocturia and urge to urinate, a 3-day urination diary is recommended, where both fluid intake and urine output are recorded with time detail for an objective evaluation of the symptoms.
• At the same time, a urinalysis can be performed, a special test in which the man urinates in a special machine and his urine is presented as a curve that suggests a blockage or narrowing of the urethra. In men <50 years of age, urinalysis can diagnose urethral stricture and high bladder neck, conditions that produce symptoms without prostate involvement and are primarily treated surgically.
• Additionally, urethrocystoscopy is also used as a diagnostic tool, which confirms the existence of urethral stricture and a high bladder neck, while at the same time the size of the prostate is evaluated as well as any pathology of the bladder (tumour, bladder trabeculae in the context of difficulty emptying the bladder ).
  Finally, the urodynamic study evaluates urination and the detrusor muscle of the bladder, without being able to predict the outcome of a prostate surgery.

 

The above diagnostic test sets the relative and absolute indications for prostate surgery and helps in the effective choice of conservative treatment.