The Chinese speak of “Yin-Yang” as opposing but complementary forces present throughout nature. Urologically, this concept can also be applied to urination as being a balance of opposing forces.
First are the forces that help you to urinate and the second, those that hold back urine giving you control to avoid wetting yourself. Increases in the forces that help urination such as stronger contraction of the bladder or abdominal muscles would result in a more forceful urinary flow. This is because the bladder lies within the abdomen so any increase in abdominal pressure is reflected as an increase in bladder pressure. An increase of forces holding back urination results in a weaker flow. When the urologist wants to be sure that the patient’s symptoms are coming from an enlarged or obstructive prostate, the “Urodynamic Study” is done. This permits demonstration of an abnormally high bladder pressure during urination caused by an increased force of contraction of the bladder muscle itself. That is the hallmark of the obstructive prostate.
The set of forces that tend to hold back the urine are of two types. First is the result of a mechanical obstruction or narrowing to the outflow of urine, such as might be caused by an enlarged prostate or by a stricture or narrowing in the urethra. Strictures can occur anywhere in the urethra from the tip of the penis right up to the bladder neck where the prostate connects to the bladder. They are usually the result of scarification from trauma or past infections.
The second type of force that retains urine and results in a slow and weak urinary stream is the type that weakens the force of the bladder contractions. These may be caused by some abnormality of the central and/or peripheral nervous system resulting in a weak-walled bladder.
Another common cause of a weak bladder can be an obstructive prostate. In the beginning, the bladder muscle gets stronger and stronger as it struggles to overcome the prostate obstruction. Eventually, if the obstruction is not relieved, the bladder muscle will fail just as the heart muscle can fail when it is over worked and the result is a weak bladder no longer able to contract efficiently. The consequence of course is a thin weak urinary stream.
Treatment for the obstructive prostate has changed over the years. Catheterization was replaced by surgery and surgery is now largely being replaced by medications, which can shrink the size of the prostate and relax the muscles within the gland. This diminishes resistance to the flow of urine through the prostatic pathway and improves the “Yin and Yang” of flow. Not everyone however can tolerate the possible side effects or drug interactions of these medications and for these men, a “Microwave” treatment of the prostate may be ideally suited to relieve their symptoms without surgery or never-ending medication.
Question? Call Dr. Okun at 718-241-6767
