Are you are suffering from poor flow ? Do you notice that the stream doesn’t go far any more ? Do you notice that you have to strain to pass urine ? In case any of the answers are positive then you are suffering from poor urinary flow. Don’t worry, it is completely remediable and we are there to help you. First of all we will understand what can be the various diseases/causes which can lead to poor flow.
Blockage at the tip of the penis in males which may be due to tight foreskin (phimosis) which may cause blockage due to decreased lumen at the tip.
Meatal Stenosis is another cause which can lead to poor flow in both males and females. It is due to the decreased caliber of the meatus which lead to poor urinary stream.
Urethral stricture: it is a common condition where there is a decrease in the caliber of urethral lumen due to inflammatory/idiopathic causes which leads to poor flow. Following an infection or injury the inside lining of the urethra may be destroyed and lead to narrowing of that area which ultimately causes the urethral lumen to become narrow.
Prostate enlargement: this is a very common old age condition only found in males which leads to increase in the size of prostate gland leading to the blockage of the urethra leading to poor flow.
Bladder neck obstruction: this can also cause obstruction in the path of urine because of the conditions at the bladder neck, which can lead to the obstruction of the bladder neck not allowing/reducing the flow of urine.
Stone disease: sometimes the bladder and the urethral stones can also lead the blockage of the urinary tract which may lead to poor flow.
Weak bladder: In some patients, the bladder is unable to propel the urine out because of the poor muscles (detrusor muscle) in the urinary bladder leading to the poor flow due to less force generated. This condition is called neurogenic bladder
Investigations needed to diagnose
There are some tests that our experts will prescribe to differentiate the various conditions. These test may include:
Uroflowmetry : This investigation gives us a very good insight into the cause of the poor flow. Uroflowmetry, also called a uroflow test, measures the flow and force of urine stream during urination. Uroflowmetry is performed by urinating into a special funnel. The device calculates the amount of urine, rate of flow in seconds, and the length of time until all urine has been passed and then decodes the urine behaviour in curves which can then gives idea regarding the underlying disease.
Urine Routine and Culture: These tests are done from the voided urine sample of the patient which give us the very good idea regarding most of the pathologies of the urinary tract. Urine routine test is a combination of tests that are performed on urine and is one of the most frequently conducted tests. It comprises of the physical, chemical and microscopic examination of urine.
Urine culture is a test in which the urine is kept over a culture media which is favourable for the bacterial growth and after 2 days. The growth of various bacterias and their sensitivity to various drugs are identified.
Ultrasonogram: in this test the sound waves travel through the body and various body organs are seen according to the amount of the sound waves reflected
by them. This test is very good to assess the urinary tract organs like kidneys, upper and lower ureters, urinary bladder and various pathologies.
Urodynamic study: it is a procedure that looks at how well the bladder, sphincters, and urethra are storing and releasing urine. This test focus on the bladder’s ability to hold urine and empty steadily and completely.
Treatment of Poor Urinary Flow
Creams: the manual application of medicated creams also help in the stretching of the foreskin and opening of the tight foreskin
Circumcision: In this procedure is the removal of excessive foreskin from the penis.it is done for the tight foreskin(if the local application of creams are not helping), phimosis, recurrent infection of the glans and prepuce, cancer of the foreskin.
Meatal dilatation: The narrow meatus is dilated using various dilators and meatus becomes wide allowing the urine flow to be unobstructed.
Meatoplasty: In this procedure the meatus is surgically divided and again sutured to increase the calibre of the meatus.
Optical urethrotomy (OIU): In this procedure the narrowed urethra (strictured urethra) is divided using endoscopic microknife leading to the increase of the calibre of the urinary tract but it is usually successful in narrowing (stricture of small length).
Urethroplasty: this is the procedure where the short lumen/caliber of urethra is increased using the various tissues from the body eg buccal mucosa,skin of various areas of the body.
Medical management for the enlarged prostate: Whenever there is obstruction to the urinary flow due to enlarged prostate, this blockade can be decreased using various medications which increase the urinary calibre after relaxing the muscles and by decreasing the size of the prostate.
TURP: When the symptoms because of enlarged prostate cannot be relieved by the medical treatment, the prostate gland is resected endoscopically and the passage is widened by this endoscopic procedure called TURP.
BNI : whenever the symptoms of obstruction is due to enlarged bladder neck then bladder neck is widened endoscopically using microknife.
Cystolithotripsy: When the obstruction is due to bladder stone then the stone can be broken using a lithotripter and broken fragments can be taken out to relieve the obstruction.
CIC:Clean intermittent catheterisation (CIC) is a simple procedure to empty the bladder. It involves passing a small tube called a catheter up the urethra (waterpipe) into the bladder to allow the urine to empty. The type of catheter used is called a Nelaton catheter. CIC may be undertaken on a short or long-term basis.