Does Chewing Tobacco Cause Kidney Stones - (2022)

Treatment And Medication Options For Kidney Stones

grade 4 diseases in stomach,liver and kidney

You may not always need treatment for a kidney stone. A small stone can pass through the urinary tract without intervention. But larger stones can block the ureter and cause pain and other symptoms.

Kidney stone pain can be severe at first and may require carefully administered narcotics for relief, says Ralph V. Clayman, MD, a professor in the department of urology at the University of California in Irvine. Subsequent pain can often be managed using nonsteroidal anti-inflammatory medication, he says.

Drinking a lot of water can help to pass the stone. In addition, doctors may prescribe tamsulosin, which is a medication that relaxes the muscles of the ureter, helping the stone pass, says Dr. Lesser.

If a stone is too big to pass or a patient has an intolerable amount of pain, doctors may intervene with procedures that either break up or remove the stones, says Lesser.

These procedures include:

Kidney stones call for conventional medical care, so dont try to treat kidney stones with alternative therapies.

Antibiotics continue to be the number one go-to treatment for urinary tract infections.

Quit Chewing Tobacco Today

Whatever the excuses you were using so far that chewing tobacco is safer than smoking, or that you, at least, wont get lung cancer its time to stop using them and to commit firmly to quitting. As you can see, chewing tobacco is not what its cracked up to be and carries a lot of health risks. There are a lot of sites out there with great information on how to kick that habit generally, if you follow the advice for smoking cessation, theres a good chance you will be able to get rid of tobacco chewing as well.

Of course, you could always try vaping to substitute for chewing tobacco nicotine intake. Are there any vapers here whove managed to get rid of their chewing habit with electronic cigarettes? Please share your experience with us, Im sure struggling chewers would be grateful!

Does Chewing Tobacco Cause High Blood Pressure

The reason why I wanted to take a closer separate look at whether or not chewing tobacco causes high blood pressure is simple high blood pressure is a very silent and sneaky killer.

Hypertension causes numerous health problems, with some being:

  • Increased risk of stroke and mini-stroke
  • Increased risk of heart attack
  • Damage to the arteries
  • Increased chances for an aneurysm
  • Enlarged left heart
  • Can cause kidney scarring and kidney failure
  • Has been linked to early onset dementia

Are you putting yourself at risk if you use chewing tobacco?

The answer is somewhat complicated. Some experimental trials have found that chewing tobacco will cause an acute elevation of systolic blood pressure, diastolic blood pressure, and pulse.

These studies are backed by a recent one done by a Mayo Clinic cardiologist, Dr.Virend Somers. This particular study followed 16 young men and measured their responses 30 minutes after using snuff. The results showed an increased heart rate , a rise in systolic blood pressure , and an increase in bloodstream adrenaline .

Up until recently, these effects were attributed to nicotine, which is logical considering that its a vasoconstrictor. However, new studies are producing some curious results, namely that pure nicotine actually lowers blood pressure. Further studies will be needed to determine the truth is nicotine responsible for high blood pressure or are other chemicals and compounds in chewing tobacco and cigarettes to be blamed?

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Smoking And Chronic Kidney Disease

For many decades, the U.S. Surgeon General has warned Americans about the ill effects from smoking. According to the Centers for Disease Control and Prevention, smoking harms nearly every organ of the body. Therefore, it is not surprising to learn that smoking also plays a role in the progression of chronic kidney disease . The first study that showed the connection between smoking and kidney disease was done in 1978. Since then many studies have supported this finding.

According to the Multiple Risk Factor Intervention Trial , smoking is one of the leading risk factors that can lead to end stage renal disease .

How smoking can harm kidneys

Here are some of the possible ways smoking is thought to harm kidneys:

  • Increases blood pressure and heart rate
  • Reduces blood flow in the kidneys
  • Increases production of angiotensin II
  • Narrows the blood vessels in the kidneys
  • Damages arterioles
  • Forms arteriosclerosis of the renal arteries
  • Accelerates loss of kidney function

In addition to tobacco, smoking allows other toxins into the body. And according to the American Association of Kidney Patients , studies have shown that smoking is harmful for the kidneys, and can cause kidney disease to progress and increases the risk for proteinuria .

Diabetes, high blood pressure and chronic kidney disease

Heart disease and smoking

For people with kidney disease who smoke, stopping may be the one most important thing they can do to slow the progression of both kidney and heart failure.

When Life Hands You Kidney Stones

Does Chewing Tobacco Cause Kidney Stones - (1)

And as the saying goes, “make lemonade.” It’s important to consider dietary remedies alongside prescription medications.

Next time you drive past a lemonade stand, consider your kidneys. Chronic kidney stones are often treated with an alkali citrate, such as potassium citrate to help prevent certain stones, if urine citrate is low and urine pH levels are too low . Citrus juices do contain citrate , but large amounts might be needed. Also, be careful of sugar. Lemon juice concentrate mixed with water can be considered. Alkali citrate can be prescribed and is available over-the-counter. Alkali citrate can be given with a mineral, such as sodium, potassium or magnesium to help prevent stone formation. The aim is to increase urine citrate and increase urine pH . The goal is to keep pH in balance. Speak with a doctor or other healthcare professional about which treatment options are right for you, including over-the-counter products and home remedies. People with kidney disease may need to watch their intake of sodium, potassium or other minerals, depending on the stage of kidney disease or other factors.

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Calcium Is Not The Enemy

But it tends to get a bad rap! Most likely due to its name and composition, many are under the impression that calcium is the main culprit in calcium-oxalate stones. “I still see patients who wonder why they are getting recurring stones despite cutting down on their calcium intake,” said Dr. Jhagroo. “I’ve even had patients say that their doctors told them to reduce their calcium intake.” A diet low in calcium actually increases one’s risk of developing kidney stones.

Don’t reduce the calcium. Work to cut back on the sodium in your diet and to pair calcium-rich foods with oxalate-rich foods.

Chewing Tobacco And Diabetes: Learn Why The Two Do Not Mix

  • References:

Something everyone concerned with their health should know is that chewing tobacco and diabetes do not mix. This is because chewing tobacco makes diabetes worse than it already is. Most people are not inclined to quit chewing tobacco if they are already doing so. Hopefully, this article will convince at least some people how this substance aggravates nearly all of the complications of diabetes.

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History Of Chewing Tobacco

Chewing tobacco has a long and interesting history that dates back to the Native peoples of the Americas. They would chew the bitter leaves of the tobacco plant, often unprocessed and unrefined, to extract nicotine. Whether it was feeding an addiction or a religious practice, its difficult to say. Native Americans did use smoking in religious ceremonies, but we cant really link chewing tobacco with that.

Chewing tobacco spread worldwide with the arrival of the first colonists. They refined the process because they didnt like the taste of raw tobacco leaves. Their tobacco was smoke-dried and spices and sugar were added to it to make it more palatable. The recipe has remained pretty much the same since then, with different manufacturers adding their own proprietary twists.

Quickly after that, the chewing practice spread across the world. Soldiers, sports players , dignitaries well, we can say that they are partly to blame for popularizing it. Today, its known by many names, such as chaw, daps, dip, chew, and others.

In recent years, weve been seeing a rise in the use of snuff tobacco as well. While not chewing tobacco, it falls under the broad umbrella of smokeless tobacco. Snuff is basically finely ground tobacco leaf that the users inhale, or snuff, through their nose.

Chronic Smokeless Tobacco Consumption Contributes To The Development Of Renal Diseases In The Human Male Volunteers

How to get rid of unwanted substances in your body

S Fareeda Begum, G Nagajothi, K Swarnalatha, C Suresh Kumar, Narendra Maddu

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Citation: Begum SF, Nagajothi G, Swarnalatha K. Chronic smokeless tobacco consumption contributes to the development of renal diseases in the human male volunteers. J Anal Pharm Res. 2018 7:652-662. DOI: 10.15406/japlr.2018.07.00297

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Don’t Underestimate Your Sweat

Saunas, hot yoga and heavy exercise may be good for your health, but they also may lead to kidney stones. Why? Loss of water through sweating – whether due to these activities or just the heat of summerleads to less urine production. The more you sweat, the less you urinate, which allows for stone-causing minerals to settle and bond in the kidneys and urinary tract.

One of the best measures you can take to avoid kidney stones is to drink plenty of water, leading you to urinate a lot. So, be sure to keep well hydrated, especially when engaging in exercise or activities that cause a lot of sweating.

Are You Ready To Quit Smokeless Tobacco

Are you thinking you might be ready to quit smokeless tobacco? Great- that is the first step to success! What are your personal motivations to quit? Write them down and refer to them when things get tough. Quitting is not easy, but you are not alone- many people want to quit, and many are successful. Surveys show that most people who use snuff or chew would like to quit. Find a community or a buddy that has been successful to be your support person to call when needed.

There are several reasons why quitting is important. First and most importantly, quitting will improve your health and lower your chances of developing a tobacco-related cancer or heart disease. Your risk of these diseases decreases the longer you dont use smokeless tobacco. A tobacco habit is costly, and by quitting you will have extra money to put towards other things. Mouth sores will heal soon after quitting, and you will be rid of bad breath and stained teeth. The stains from tobacco juice on your clothes and in your car will be a thing of the past. Additionally, you will be setting a good example for those around you, especially if you have children in your life.

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Another Danger For Smokers: Kidney Disease

Oct. 16, 2000 — Doctors have known for a while now that smoking may increase the risk of kidney disease in people with diabetes. Now, a study shows that smoking may lead to potentially dangerous changes in kidney function even in otherwise healthy people.

For the study, which appears in the Annals of Internal Medicine, a group of researchers from the Netherlands studied urine and blood samples from more than 7,000 people ages 28 to 75. The participants were divided into three groups: nonsmokers, current smokers, and former smokers .

Compared with nonsmokers, the current and former smokers had higher levels in their urine of a substance called albumin, and their bodies were slower to excrete another substance called creatinine. Higher albumin in urine and delayed creatinine excretion are early signs of abnormal kidney function, but since these conditions don’t usually cause symptoms, most people don’t know they may be starting to have kidney problems.

Other studies have shown that people with diabetes have similar changes in their kidney function if they smoke, but the study authors say their research is the first to demonstrate that smoking can have bad effects on your kidneys even if you have no other diseases. They suggest that certain toxic substances in tobacco smoke may be to blame.

The study, he says, is yet another warning to smokers that continuing their habit is hazardous to their health.

The Effects Of Chewing Tobacco On Diabetes

Does Chewing Tobacco Cause Kidney Stones - (2)

Tobacco raises blood sugar levels, making your diabetes harder to manage. This is because tobacco products interfere with your bodyâs ability to use insulin. Chewing tobacco is especially dangerous because it is high in sugar.

Diabetics often have problems with their eyes. High blood sugar levels cause retinopathy, a condition where tiny blood vessels in the eyes become blocked, weakening the eye. Tobacco products make this condition worse, leaving you with less healthy eyes.

Chewing tobacco and diabetes make a poor combination when it comes to teeth and gums. Diabetics, especially, need to keep their teeth and gums healthy because they are at a higher risk of getting infections, gum disease and plaque buildup. However, chewing tobacco only makes the situation worse, putting patients at a higher risk of getting these conditions.

Chewing tobacco also accentuates nerve damage that occurs as a result of diabetes. This is because tobacco products keep oxygen and nutrients from traveling to nerves by damaging vital blood vessels. Numbness and pain are common symptoms that occur as a result of this. In addition, males may experience a loss of sensation in their genitals from a combination of chewing tobacco and diabetes related nerve damage.

Chewing tobacco is also bad for your kidneys. This is true whether your are diabetic or not. However, in people who are diabetic and take ACE inhibitors to preserve kidney function, chewing tobacco may counteract the ACE inhibitor.

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Does Creatine Cause Kidney Stones

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Smokeless Tobacco And Health Risks

Smokeless tobacco products are known by many names, including: dip, chew, spit, oral and spitless tobacco, and dry and moist snuff . Smokeless tobacco is not a safe alternative to cigarettes.

The facts about smokeless tobacco:

  • It is just as addictive as cigarette smoking.
  • One can of snuff contains the same amount of nicotine as 4 packs of cigarettes.
  • Dipping 8 to 10 times a day introduces as much nicotine into the body as smoking 30-40 cigarettes.
  • The amount of nicotine in the bloodstream after using smokeless tobacco may be higher than that of a cigarette smoker because nicotine is easily and quickly absorbed through the lining of the mouth.
  • Nicotine stays in the bloodstream longer with smokeless tobacco than with cigarettes.

Oral tobacco contains at least 28 chemicals known to cause cancer . The most harmful of these are tobacco-specific nitrosamines, which are known to cause lung cancer. The juice from smokeless tobacco causes sores and white patches in the mouth that can lead to cancer. People who use smokeless tobacco have a higher risk of cancers of the mouth, throat , esophagus , stomach, and pancreas. Other effects of using spit tobacco include chronic bad breath, stained teeth and fillings, gum disease, tooth decay, and loss, and break-down of bone in the jaw. Studies show that users of smokeless tobacco also have an increased risk of heart disease, heart attacks, and stroke.

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Cure For Renal Stone And Foods To Avoid

  • Diet is an essential factor that impacts the formation of kidney stones. A diet high in fats, meat, sodium and low in vegetables, carbohydrates increases the risk of developing kidney stones.
  • Intake of water also determines the formation of kidney stone. Lack of water results in high concentration of the urine with waste products. This is why it is recommended to ensure that one drinks about three liters of water each day, to flush out toxins and ensure that the renal functions are adequate.
  • Reduce the intake of proteins in your diet. Uric acid is the by product of protein metabolism and known to cause kidney stones. Further it can result in other complications like gout and arthritis.
  • The Effects Of Nicotine On Kidneys

    Health risks of tobacco use | Dr Ramesh Parimi, Pace Hospitals

    Nicotine can cause many health problems. It can temporarily raise blood pressure and heart rate because it causes blood vessels to narrow. Nicotine can also make the blood more likely to clot and block an artery, and it can cause damage to the lungs and make breathing difficult. Nicotine in the body is first processed by the liver and then excreted by the kidneys. Over time nicotine can have negative effects on the kidneys.

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    Why Is It So Hard To Quit

    It’s just as hard to quit smokeless tobacco as it is to quit smoking. Quitting tobacco is hard because your body craves the nicotine. Giving it up is more than just kicking a bad habit. Your body has to stop the cravings. That’s why you may feel grouchy or restless or have a hard time concentrating for the first 2 to 3 weeks after you quit. For some people, these feelings can last several weeks. Nicotine gum, lozenges, patches, and other medicines can help reduce the cravings.

    But it’s not just the nicotine that makes it hard to quit. It’s the habit of using smokeless tobacco. It’s part of your daily routine. You enjoy it. You may use it to deal with stress. And when you quit, you have to give all that up .

    Quitting chew or snuff isn’t easy, but you can do it. Just thinking about quitting is the first step.


    Does eating tobacco cause kidney stones? ›

    Avoid alcohol and cigarettes: Alcohol and smoking does not directly cause kidney stones. But it can disturb hormonal control that influences the kidney function. Also, if you have had kidney stones in the past, it can increase your risk of recurring stones.

    How does tobacco affect your kidney? ›

    In addition to tobacco, smoking allows other toxins into the body. And according to the American Association of Kidney Patients (AAKP), studies have shown that smoking is harmful for the kidneys, and can cause kidney disease to progress and increases the risk for proteinuria (excessive amount of protein in the urine).

    What substance causes kidney stones? ›

    Kidney stones form when your urine contains more crystal-forming substances — such as calcium, oxalate and uric acid — than the fluid in your urine can dilute.

    What is most likely to cause kidney stones? ›

    Possible causes include drinking too little water, exercise (too much or too little), obesity, weight loss surgery, or eating food with too much salt or sugar. Infections and family history might be important in some people. Eating too much fructose correlates with increasing risk of developing a kidney stone.

    How long does chewing tobacco stay in your system? ›

    Generally, nicotine will leaves your blood within 1 to 3 days after you stop using tobacco, and cotinine will be gone after 1 to 10 days. Neither nicotine nor cotinine will be detectable in your urine after 3 to 4 days of stopping tobacco products.

    Does nicotine hurt your kidneys? ›

    Nicotine Can Damage Kidney Cells in Smokers, According to New Miller School Study. Nicotine can damage kidney cells and contribute to the progression of diabetic nephropathy in people who smoke, according to a new study by the University of Miami Miller School of Medicine and several New York City academic institutions ...

    How do you keep your kidney healthy? ›

    What can I do to keep my kidneys healthy?
    1. Make healthy food choices. ...
    2. Make physical activity part of your routine. ...
    3. Aim for a healthy weight. ...
    4. Get enough sleep. ...
    5. Stop smoking. ...
    6. Limit alcohol intake link. ...
    7. Explore stress-reducing activities. ...
    8. Manage diabetes, high blood pressure, and heart disease.

    How does tobacco affect the body? ›

    Smoking causes cancer, heart disease, stroke, lung diseases, diabetes, and chronic obstructive pulmonary disease (COPD), which includes emphysema and chronic bronchitis. Smoking also increases risk for tuberculosis, certain eye diseases, and problems of the immune system, including rheumatoid arthritis.

    What are the signs of kidney disease? ›

    • Nausea.
    • Vomiting.
    • Loss of appetite.
    • Fatigue and weakness.
    • Sleep problems.
    • Urinating more or less.
    • Decreased mental sharpness.
    • Muscle cramps.
    Sep 3, 2021

    What is the fastest way to dissolve a kidney stone? ›

    Apple cider vinegar as kidney stones remedy

    If you're looking to dissolve kidney stones fast, you can rely on apple cider vinegar. Made from fermenting apples and endowed with phosphoric, citric and acetic acids, apple cider vinegar makes urine acidic and helps to dissolve most types of kidney stones quickly.

    How can I permanently get rid of kidney stones? ›

    be very painful.
    1. Stay hydrated. When it comes to kidney stone prevention, drinking plenty of fluids is generally recommended. ...
    2. Increase your citric acid intake. ...
    3. Limit foods high in oxalates. ...
    4. Don't take high doses of vitamin C. ...
    5. Get enough calcium. ...
    6. Cut back on salt. ...
    7. Increase your magnesium intake. ...
    8. Eat less animal protein.
    3 days ago

    Which painkiller is best for kidney stones? ›

    Pain relievers.

    Passing a small stone can cause some discomfort. To relieve mild pain, your doctor may recommend pain relievers such as ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve).

    What should you not drink with kidney stones? ›

    Tart drinks like lemonade, limeade, and fruit juices are naturally high in citrate that helps keep kidney stones at bay. But hold back on foods and drinks flavored with sugar or, especially, high-fructose corn syrup. They can lead to stones.

    Is Cranberry juice Good for kidney stones? ›

    Although cranberry juice can help prevent urinary tract infections (UTIs), it doesn't help with kidney stones.

    Can chewing tobacco cause high blood sugar? ›

    Using spit tobacco (chew or snuff) or e- cigarettes is not a safe alternative to smoking. Tobacco use can raise your blood glucose (sugar) and reduce your body's ability to use insulin, making it harder to control your diabetes. Even one cigarette, e-cigarette or small amount of chewing tobacco is harmful.

    Does chewing tobacco affect life insurance? ›

    You'll qualify for life insurance if you use chewing tobacco, but you'll likely pay higher rates. A few insurers may be more flexible toward smokeless tobacco use.

    How many cigarettes are equal to a can of dip? ›

    According to the National Spit Tobacco Education Program (NSTEP), the nicotine content in a can of dip or snuff is approximately 144 milligrams, which is equal to about 80 cigarettes — or four packs of cigarettes.

    Can nicotine affect your bladder? ›

    The nicotine in tobacco has been shown to irritate the muscle that controls the bladder (Wyman, Burgio, & Newman, 2009). Smokers are also likely to have a chronic cough which can create more pressure on the bladder and pelvic floor.

    Does chewing tobacco have potassium? ›

    Chewing tobacco contains a significant amount of potassium. In this first report of the effect of chewing tobacco use on serum potassium levels in a patient with end-stage renal disease, improved potassium levels occurred once the tobacco was eliminated.

    What is harmful to kidneys? ›

    Diabetes and high blood pressure are the most common risk factors for kidney disease. However, obesity, smoking, genetics, gender, and age can also increase the risk ( 3 ). Uncontrolled blood sugar and high blood pressure cause damage to blood vessels in the kidneys, reducing their ability to function optimally ( 4 ).

    What vitamin is good for kidneys? ›

    The kidneys are an important part of helping the body use vitamin D. Vitamin D comes from two sources in people. It could either be exposure to the sun's ultraviolet B radiation. Or, it is absorbed from food or food supplements.

    What is the best exercise for kidney? ›

    Choose continuous activity such as walking, swimming, bicycling (indoors or out), skiing, aerobic dancing or any other activities in which you need to move large muscle groups continuously. Low-level strengthening exercises may also be beneficial as part of your program.

    What are 5 benefits of being tobacco free? ›

    10 Benefits of Quitting Smoking
    • You'll feel accomplished. ...
    • Your heart rate will lower. ...
    • You'll save money. ...
    • Your senses will improve. ...
    • You'll have a brighter smile & clearer skin. ...
    • You'll protect your family. ...
    • You'll cough less. ...
    • You'll smell better.

    How does tobacco affect your brain? ›

    As with drugs such as cocaine and heroin, nicotine activates the brain's reward circuits and also increases levels of the chemical messenger dopamine, which reinforces rewarding behaviors. Studies suggest that other chemicals in tobacco smoke, such as acetaldehyde, may enhance nicotine's effects on the brain.

    How do you clean tar out of your lungs? ›

    Breathing in air pollution, cigarette smoke, and other irritants can damage the lungs and even cause health conditions.
    Ways to clear the lungs
    1. Steam therapy. ...
    2. Controlled coughing. ...
    3. Draining mucus from the lungs. ...
    4. Exercise. ...
    5. Green tea. ...
    6. Anti-inflammatory foods. ...
    7. Chest percussion.

    What are the symptoms of stage 1 kidney disease? ›

    Signs and symptoms of Stage 1 CKD include:
    • High blood pressure.
    • Swelling in your hands or feet.
    • Urinary tract infections.
    • Protein in your urine.
    • Blood in your urine (also called hematuria)
    • Kidney damage that shows up in an ultrasound, CT scan, MRI, or kidney biopsy.

    What color is urine when your kidneys are failing? ›

    Light-brown or tea-colored urine can be a sign of kidney disease/failure or muscle breakdown.

    How long can you have kidney disease without knowing? ›

    Around 90 percent of people who have this condition are unaware they have it. 2 out of 5 adults who have CKD don't know they have severe chronic kidney disease. People with CKD can live for years without knowing, as it doesn't always have the most clearly defined symptoms.

    How long does it take apple cider vinegar to remove kidney stones? ›

    Stones smaller than 4 millimeters (mm) pass on their own 80 percent of the time. They take an average of 31 days to pass. Stones that are 4–6 mm are more likely to require some sort of treatment, but around 60 percent pass naturally. This takes an average of 45 days.

    How much apple cider vinegar should I drink to dissolve kidney stones? ›

    Drink apple cider vinegar

    The acetic acid in apple cider vinegar helps kidney stones dissolve. Add 2 tablespoons to 6-8 ounces of water and drink it throughout the day to reap the benefits.

    Does anything dissolve kidney stones? ›

    Uric acid stones are the only type of kidney stones that can sometimes be dissolved with the help of medication. Alkaline citrate salts or sodium bicarbonate are considered for this purpose, and sometimes allopurinol.

    Can stress cause kidney stones? ›

    Can stress cause kidney stones? Especially when combined with chronic dehydration, stress can trigger the formation of kidney stones. Stress overall can affect your kidneys. Stress can result in high blood pressure and high blood sugar, which can both affect the health of your heart and the kidneys.

    Can I smoke if I have kidney stones? ›

    This can be a very painful process and many people who have had a kidney stone will do everything they can to avoid experiencing that again. Unfortunately, if you smoke, you're putting yourself at a high risk for developing kidney stones.

    How can I avoid getting kidney stones? ›

    How to prevent kidney stones naturally
    1. Stay hydrated. Drinking more water is the best way to prevent kidney stones. ...
    2. Eat more calcium-rich foods. ...
    3. Eat less sodium. ...
    4. Eat fewer oxalate-rich foods. ...
    5. Eat less animal protein. ...
    6. Avoid vitamin C supplements. ...
    7. Explore herbal remedies.

    Will alcohol cause kidney stones? ›

    Alcohol affects the kidneys' ability to keep the correct balance of water and electrolytes in the body. This leads to impaired function of the kidneys and increases the risk of developing kidney stones.

    How long does it take to pass a kidney stone? ›

    A stone that's smaller than 4 mm (millimeters) may pass within one to two weeks. A stone that's larger than 4 mm could take about two to three weeks to completely pass. Once the stone reaches the bladder, it typically passes within a few days, but may take longer, especially in an older man with a large prostate.

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