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is this a symptom?

User
Posted 28 Jun 2020 at 21:13

A question, if I may?

Last year analysis suggested I needed to my prostate to be checked. I'm 73 now, was rushed in for an urgent MRI, then a digital exam, plus required to fill in a questionaire about symptoms. I had none of the symptoms exactly[1], so answered no to all. The final diagnosis was that just had a naturally enlarged prostate.

Aside from that, I have one failed kidney, one kidney to which and artery stent was added earlier this year - I had no noticeable issues before or after the stent.

[1] I never usually need to get up during the night, though I do sometimes have to get up in the morning with a full bladder and struggle to empty it, with a very slow flow. An hour later I will likely have a full-ish bladder again and need to pee again, at which time (and the rest of the day) I will get a full flow. 

It seems to suggest to me that my bladder fills overnight, my kidneys then produce no more, until my bladder is emptied, then refill my empty bladder. 

I would welcome opinion on this.

 

 

 

   

User
Posted 29 Jun 2020 at 10:35
Ask if your GP will prescribe Tamulosin tablets which might help with the constriction of your urethra caused by your enlarged prostate.

If you have persistent problems you need to go back to urology.

Cheers, John.

User
Posted 29 Jun 2020 at 14:04

Harry

I produce more urine in the first hour or so of the day than at other times. I have a catheter so I see what is happening. Also have CKD3, although it has never given me any issues.

Thanks Chris

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User
Posted 29 Jun 2020 at 07:40

Harry

What tests have you had,  PSA, a biopsy perhaps ?

Apart from the initial slow flow your urine production sound familiar. 

Thanks Chris

Edited by member 29 Jun 2020 at 07:41  | Reason: Not specified

User
Posted 29 Jun 2020 at 08:36
Chris,

As much as I understood - The PSA values triggered the concerns, so I was sent for MRI scans, then the digital exam - there was no prostate biopsy done.

The slow flow occurs throughout the entire first pee of the day, but not a problem every day. It seems to relate to how full my bladder is/ how desperate I am to go. I have absolutely no problems throughout the rest of the day, when I am awake and more aware of the building pressure and then flow is good. I have absolutely never had any sort of pain or discomfort. Situation is now, that they will keep an eye on the PSA values.

Might it be the build up of urine pressure in my bladder, which is somehow restricting the urine flow?

User
Posted 29 Jun 2020 at 10:35
Ask if your GP will prescribe Tamulosin tablets which might help with the constriction of your urethra caused by your enlarged prostate.

If you have persistent problems you need to go back to urology.

Cheers, John.

User
Posted 29 Jun 2020 at 11:45

Everyone pees slower at night and immediately after waking up. This is because your internal urinary sphincter is controlled by a part of your autonomous nervous system (not under conscious control) which also goes to sleep, but it takes longer to wake up than your conscious nervous system, so it's still half asleep while you are wanting it to pee for you. Prostate growth can make this more noticeable, whether due to BPH or (less often) cancer, but it's often noticeable with neither of these conditions. It is a symptom you should get checked out though, just in case it's cancer. If it's not causing you to get up multiple times during the night, and not a problem during the day, I wouldn't bother with Tamsulosin. It becomes a problem if you are peeing sufficiently slowly that you don't fully empty your bladder, because then you'll have to pee more often, and it raises the chance of getting a urinary tract infection.

You should get your PSA measured again, and you should make sure you keep a record of dates and readings. Excellent that you already have one (ask your GP to tell you what it is), because you can quickly flag up if it's rising, and get checked out again. After that, make a point of having it measured annually, so you are tracking it.

User
Posted 29 Jun 2020 at 12:00

Thanks Andy, that does seem to fit the slight issue I am noticing which was causing me slight concern and something I had not heard of before.

Yes, my bladder does feel as if it empties completely, its just a very slow process sometimes first thing on a morning. So slow in fact, that when I am still half asleep, I find it so much easier to just sit down for the performance.

I'm already scheduled to have the regular PSA level checks annually. Dates and values I can access in my online patient record. My last check gave the following results:

Serum prostate specific antigen level (XabAM) 6.6 ug/L [< 5]
Above high reference limit
PSA: age-related reference ranges in use, values as recommended
by the Prostate Cancer Risk Management Programme
Total PSA : Siemens Centaur methodology

I have a phone call due this afternoon, from the kidney consultant who arranged for the stent. If I remember to ask, I will ask about the emptying my full bladder first thing, then having the need to go a second time an hour later - as if urine is backing up in my kidneys.

Edited by member 29 Jun 2020 at 14:51  | Reason: Not specified

User
Posted 29 Jun 2020 at 14:04

Harry

I produce more urine in the first hour or so of the day than at other times. I have a catheter so I see what is happening. Also have CKD3, although it has never given me any issues.

Thanks Chris

User
Posted 29 Jun 2020 at 15:30
The consultant has just rung and suggested everything is stable kidney wise, so I asked about the slow flow morning urinary issue, explaining no other issues during the day. They agreed with Andy62's opinion on the issue, the internal sphincter still asleep and limiting the flow.
User
Posted 29 Jun 2020 at 21:38

I had a similar problem. When talking to the urologist he said that the muscles squeezing a full bladder can generate less pressure than the same muscles squeezing a half full bladder. This does tie in with a physics experiment called the two balloon experiment. It is not intuitive but it is correct. A not quite correct explanation, but good enough for the layman, is that the force delivered by the muscles squeezing the bladder is the same irrespective of how full the bladder is, but that force is dissipated over a larger volume of urine in a full bladder, so the average pressure per unit of urine is less. 

Dave

User
Posted 30 Jun 2020 at 06:44

Originally Posted by: Online Community Member
I have a phone call due this afternoon, from the kidney consultant who arranged for the stent. If I remember to ask, I will ask about the emptying my full bladder first thing, then having the need to go a second time an hour later - as if urine is backing up in my kidneys.

Your hypothalamas monitor's your body's hydration levels. When the interstitial water level between cells starts getting low, it releases antidiuretic hormone. This is picked up by the kidneys, and tells them to recover the water from the urine, so your body doesn't lose so much water, preserving water in the body and making more concentrated urine instead.

During the day, your pituitary also steals some of the antidiuretic hormone, and then releases it overnight. This is intended to slow the rate of water loss into urine overnight, so you don't need to wake up and pee. Excess water is stored elsewhere in the body (blood, which is why blood pressure can raise over night, and as interstitial water between cells). After you wake, your pituitary stops releasing antidiuretic hormone, so this excess water is now excreted by the kidneys.

So your first pee when you wake up is usually quite concentrated, because the overnight antidiuretic hormone told the kidneys to recover the water from the urine, and then after you're awake, you can end up peeing again soon, much more diluted, as your kidneys get rid of that excess water they avoided losing overnight.

So what you describe in the form of peeing twice in quite quick succession when you wake up is quite normal, and shows your antidiuretic hormone mechanism is working well. It is something that deteriorates as we get older, and is one reason you can end up needing to get up to pee at night.

However, that isn't an excuse for any complacency with monitoring for prostate cancer. Your PSA is high, and the slowing of flow first thing could also be caused by growth of the prostate, BPH and/or cancer. It doesn't look to me like you've had an mpMRI scan for prostate cancer, which I would have expected given your symptoms.

 

Edited by member 30 Jun 2020 at 12:15  | Reason: Not specified

User
Posted 30 Jun 2020 at 11:10

I have no idea whether I have or haven't had an mpMRI. I have had three scans over recent years for various reasons, During one I do recall they said they were injecting some sort of dye to make the images clearer, during in which scan I am not sure. My prostate MRI was obviously done as a matter of some urgency, because they squeezed me in for it on a Sunday evening and at short notice.

 

Edited by member 30 Jun 2020 at 11:11  | Reason: Not specified

User
Posted 30 Jun 2020 at 12:13

Ah, I assumed because you hadn't said. If the injection was inside an MRI scanner part way through the scan, then yes, you've had an mpMRI (multi-parametric). The injection is a Gadolinium contrast dye to show up blood vessels, which are more numerous and more haphazard in a tumor. (You can also have an mpMRI scan without an injection, but that's rarer.) If they didn't follow that with a biopsy, it's presumably because they didn't find anything which looked like cancer on the scan.

User
Posted 30 Jun 2020 at 12:31

I had an head scan for a very minor stroke, a kidney scan and the much more urgent prostate scan. As said, which ones involved the dye I cannot remember, but the dye went in on the MRI scanner. I was told to expect it too be a bit cool, as the dye went in, but I felt nothing. No, they didn't do a prostate biopsy. 

They did do a kidney biopsy, after the kidney MRI scan. 

Anyway - thanks all for the advice, it seems I don't really have a problem and it has set my mind at rest, as well as learning a few things.

 

 
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