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Why is my father having problem of frequent urination?

Q: My 60 years old father is having a problem of frequent urination for the last 15 years. The average frequency is 1.5 hours both during the day and night and average volume is 150 cc. Generally, the frequency is more at night. He is having diabetes since 15-20 years, but it is under control. His average fasting blood sugar level is 115 mg/dl and PP is 185 mg/dl. A preventive bypass surgery was done 7 years back. His ultrasound shows prostate of 32.7 gm and it is more or less same for the last 10-12 years. Also the PVR is 20-50cc. Both his kidneys are normal in shape and size. The doctors say that this could be due to a slightly enlarged prostate (BPH). For many years he took Hytrin daily and it helped slightly, initially. But after some time not much improvement was seen. Then for the last one year he has been taking Roliten and Alfusin. Recently, the doctor suggested that the problem could not be due to prostate since the size is almost normal. So he advised the following tests: uroflowmetry, RUG and MCU to ascertain any problem due to prostate. All the tests were normal. Now after seeing the reports the doctor has started the following medicines: Contiflow 0.4 mg 1OD, Urivoid 25 mg thrice daily, Minirin Nasal Spray 20 micro gm. He has been taking the above medicine for the last 2 weeks but he has not started the spray yet since it was not available. It has been more than 2 weeks that he has been using above treatment but there is no improvement.

  1. What could be the reason and possible treatment for my father’s problem?
  2. Can RUG and MCU result rule out any prostate related problem?
  3. Can Minirin be taken without any side-effects as I have read that for heart patients it should be taken with care?
Please help as he is having very disturbed life style because of this problem. There is no pain and burning sensation during passing urine, also there is no swelling on his feet.

A:Your father is a 60 years old diabetic with cardiac disease background, and is suffering from urinary frequency both during day and night. The prostate by sitting around bladder neck obstructs it, thus causing obstructing urinary symptoms. Urinary frequency, per se, is caused by either increased urinary output (increased fluid intake, use of diuretics in heart patients, decreased concentrating ability of the kidney) or smaller bladder capacity (acute diseases like urinary infection causing increased bladder sensitivity, chronic conditions decreasing bladder capacity like tuberculosis or functionally decreased bladder capacity with large residual urine). As you would understand prostate would cause urinary frequency only indirectly. RGU and MCU are done to exclude non-prostatic urethral obstruction, like stricture urethra, and do not help prove or disprove prostatic pathology. Unfortunately, size of prostate has no linear correlation with the symptoms it may cause. Small gland can cause significant obstruction and a large gland may be asymptomatic. There could be some patients with night frequency due to lack of normally active antidiuretic hormone (ADH) during sleeping hours. Diagnosis of such disorder is based on the specific gravity and osmolality of morning sample of urine. The nasal spray advised to your father contains ADH and would help some patients with this problem. Treatment of your father’s urinary frequency would depend on the cause and its precise treatment.

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