High Post Void Residual and Kidney conditions - a link?

[albedo1]

I am 57 and more than 25 years ago I had a calcium oxalate kidney stone event (small, passed through urination). Since then, I have been drinking large amounts of (mainly) water and recollect events or high urgency and difficulty to retain.

In the mean time, while regularly consulting urologists, testing PSA, its velocity, doubling time and free %,, having lower abdomen scanning (CT and ultrasonography) I developed symptoms of BPH mainly shown as a very important post void residual (PVR, increasing from 100-200 to about 500mL). I am prescribed tamsulosin 0.4mg/d and doubling dose to 0.8mg/d but PVR remains very high and considering TURP or similar.

I also have a moderately high blood BUN/creatinine ratio but a very high (x10) ratio in the urine (spot).

I also had event of high uric acid in my blood test and while in the norm values tend to be high.

Questions:

- Could potentially be a link between my high PVR and my kidney stone event?
- Can my large fluid intake since so many years possibly caused some bladder dysfunction and high PVR?
- Could bladder stones (not detected though) be causative of the very high PVR?
- What can the high BUN/creatinine indicative of? Any kidney or bladder related dysfunctions?
- Is the jury out on the vitamins C and D as risk factors for kidney stones

I posted elsewhere in the Forums also some related:

http://www.medhelp.org/posts/Urology/High-Urea-Creatinine-Ratios-in-Blood-and-Urine/show/1793639

http://www.medhelp.org/posts/Prostate-Cancer/Sudden-PSA-Rise--Hormonal-changes/show/1781895

I realize this is probably not the right place to ask some of my questions but thank you in advance for any comment and recommendation you might have including eventually a different Forum.

[David Rudnick, M.D.]

High PVR not likely related to prior kidney stone or high fluid intake over the years.

A bladder stone would almost certainly have been seen by CT scan, so I doubt that is the cause of your voiding dysfunction.

You are quite young for such severe symptoms.  You might ask your urologist about cystoscopy to look for a urethral stricture and/or a urodynamic exam for "pressure-flow studies"  before committing to a TURP to test your bladder function.

[albedo1]

One/two questions: if I do an urodynamic test that is more complete than a cystoscopy right? Is is painful?

[albedo1]

sorry, I need to make a correction: i am "only" taking 2x0.4mg/d of tamsulosin

[albedo1]

Thank you Dr Rudnick for your reply!

Just to give an update (prior to additional visits in November) and possibly get your feeling on what might be possibly going wrong here ...

For an additional opinion I visited a good friend of mine also urologist. He performed an ultrasound scan of bladder prior and post voiding, measurement of flow peak/profile between the two and an DRE.

From about 1.5L pre-voiding (he asked to retain till the visit and I could do that for about 3-4 hours) I could only void 50% to about 0.7L post-void (PVR) ! He said, considering the historic, I might be suffering of a chronic retention and even the top dose of tamsulosin (2x0.8mg/d) does not seem to help.

However, the somewhat discordant fact is that, despite the (huge) PVR, the voiding profile and peak is reasonable (he was expecting much worse) and looks typical of BPH, the latter is from my own studies when looking at profiles such as BPH, stenosis etc .. Peak was not that too bad and despite profile irregularities and of course a longer than ideal time to void, he found it not terrible.

He said that even after a TURP it is not sure the condition of a bladder lacking tone could be solved. He mentioned training but I felt he was a bit skeptic. Do you know more about training?

He typically would recommend tamsulosin + finasteride for 6 months after which, if no effect, TURP would be the gold standard. I questioned about other methods such as TUBD, TUNA, TUMT, TUIP and laser such as Nd:YAG laser vaporization and more recently the green light photosensitive vaporization. He said greenlaser has the potential to replace long term TURP.

Bottom line I am not fully convinced of TURP and its potential side effects, mainly incontinence. What do you think about this?

I will return to my current urologist in a couple of months possibly for cystoscopy and/or urodynamic test as you kindly recommended.

I really do appreciate I can keep this conversation with you as I am very concerned.

[David Rudnick, M.D.]

If there is no obstruction and the bladder is not working, a TURP would do not good and should not be done.  In that case you might be instructed in how to pass a catheter into your bladder yourself to drain the urine a few times a day.  That is the "worst case" scenario, and may sound difficult, but is learned easily by many patients with poorly functioning bladders, including children born with spinal cord abnormalities.

[albedo1]

Thank you Dr Rudnick for your reply. I will surely do the tests you are recommending. In the case the bladder is not functioning correctly would the TURP help at all? And if not which would be the therapy?