Grade 1 BPH Treatment: Does a 206 mL Residual Mean Surgery?

Hello Mohan,

The improvement you describe is encouraging, but I would not decide your prognosis or need for surgery from the words “Grade 1 BPH” alone. In your case, the most important finding is the amount of urine remaining in your bladder after you urinate.

What Does “Grade 1 BPH” Mean?

Some ultrasound reports use terms such as Grade 1, Grade 2 or Grade 3 enlargement. These descriptions can be useful locally, but they are not a universal treatment scale and should not be used by themselves to decide whether a man needs medication or surgery.

Doctors usually make treatment decisions using the whole clinical picture, including:

• how bothersome the urinary symptoms are;
• measured prostate size or volume;
• urine flow;
• post-void residual urine;
• PSA when clinically appropriate;
• kidney function;
• urinary infections or bladder stones;
• episodes of urinary retention; and
• response to conservative or medical treatment.

If you would like a broader explanation of the condition, see my guide to enlarged prostate / benign prostatic hyperplasia.

Is 206 mL of Residual Urine Important?

Yes. The urine left in the bladder after urination is called the post-void residual (PVR).

A single PVR measurement does not automatically tell us why the bladder is not emptying completely, and there is no single number that by itself determines the need for surgery. However, 206 mL is a meaningful residual volume that deserves reassessment, especially if it persists.

Possible reasons include:

• bladder outlet obstruction from an enlarged prostate;
• reduced strength of the bladder muscle;
• medication effects;
• neurological problems; or
• a combination of prostate obstruction and bladder dysfunction.

Specialist assessment of lower urinary tract symptoms commonly includes both urine flow measurement and post-void residual measurement.

What Does a 5 mm Bladder Wall Thickness Mean?

A bladder wall that appears thickened on ultrasound can sometimes be seen when the bladder has been working against increased outlet resistance for a long time.

However, bladder wall thickness depends partly on how full the bladder was when the measurement was made and on the ultrasound technique. A measurement of 5 mm should therefore be interpreted together with bladder volume, urinary symptoms, PVR and urine flow rather than treated as a diagnosis on its own.

What Is Tamdura Doing?

Tamdura combines tamsulosin 0.4 mg and dutasteride 0.5 mg.

This combination may explain why you feel that urination and bladder emptying have improved. Dutasteride, however, is a slow-acting medicine, so its benefit is usually assessed over months rather than days.

For more detail, see BPH medications and how they work.

What Is Levoday 500 mg?

Levoday 500 mg is a brand of levofloxacin, an antibiotic. It is not a routine long-term treatment for uncomplicated BPH.

Levofloxacin may be prescribed when a doctor suspects or confirms a bacterial infection, including certain urinary tract infections or bacterial prostatitis. Its dose and duration should depend on the infection being treated, your kidney function and your doctor’s assessment.

Do You Need Surgery?

Based only on the information in your question, I cannot say that you definitely need surgery, but I also would not say that surgery is unnecessary simply because you currently feel better.

Current BPH guidance generally reserves surgery for men with severe or persistent symptoms that do not respond adequately to conservative or medical treatment, or for men who develop important complications.

Examples include:

• recurrent or refractory urinary retention;
• recurrent urinary tract infections related to obstruction;
• recurrent bladder stones;
• persistent visible bleeding attributed to BPH;
• dilation of the upper urinary tract or kidney impairment related to obstruction; or
• continued troublesome symptoms or high residual urine despite appropriate treatment.

This is why the next step should be a follow-up assessment, not an automatic decision for or against surgery.

What Should Be Rechecked?

At follow-up, I would want your treating doctor or urologist to look at several pieces of information together:

• repeat post-void residual urine;
• urine flow rate;
• prostate volume rather than grade alone;
• your symptom score, such as the IPSS;
• urinalysis and urine culture if infection is suspected;
• PSA if clinically appropriate;
• kidney function if there is concern about retention or obstruction; and
• whether bladder function may also be contributing to the residual urine.

You can read more about this assessment in prostate tests used when evaluating BPH.

What Lifestyle Changes Can Help?

Lifestyle measures can help some men manage urinary symptoms, but they should be presented realistically. They do not replace treatment when there is significant obstruction or persistent retention.

Useful measures may include:

• avoiding excessive fluid intake late in the evening;
• reducing caffeine or alcohol if they worsen urgency or frequency;
• reviewing medicines that may affect urination with your doctor;
• maintaining regular physical activity and a healthy weight; and
• avoiding constipation, which can sometimes worsen urinary symptoms.

I would not recommend herbs on the basis that they have been proven to shrink the prostate. Evidence for many prostate supplements is limited or inconsistent, and they should not replace appropriate follow-up when residual urine is elevated.

When Should You Seek Prompt Medical Care?