| Benign
Prostatic Hyperplasia (BPH) |
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The prostate is the most common cause of health problems
that men face over the course of their lives. There are many
treatments now available - the majority not involving surgery.
So men should seek help and have a PROSTATE CHECK!
Organs
Bladder
This is the organ where urine is stored until it is convenient to micturate.
Prostate
Small gland that sits at the base of the bladder and produces most of a man’s ejaculate.
Urethra
The tubular structure through which the urine and semen pass. It passes through the middle of the prostate.
Glans
The “head” of the penis. It lies underneath the foreskin and is the bulbous region at the end of the penis where the urine emerges.
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The Anatomy
The prostate is a small, almond-shaped gland that sits at
the base of the bladder. Its main function is to produce the
majority of fluid that a man ejaculates, but it is not essential
for life.
It enlarges throughout a man’s life, and can commonly
cause problems with a man’s “waterworks”. As can be seen
from the diagram the urethra passes through the middle of
the prostate, and as it grows it compresses this tubular
structure. This compression in turns leads to the difficulty
men often experience in passing urine as they get older.
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[View larger image]
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Basic Terms
Micturation
The process of passing urine - also known as urination.
LUTS
Lower Urinary Tract Symptoms - the common term used to refer to symptoms from the prostate.
Frequency
The need to pass urine often.
Nocturia
The need to get up at night to pass urine.
Dysuria
A “burning” feeling in the urethra when passing urine.
BPH
Benign Prostatic Hyperplasia - the normal enlargement of the prostate that most men experience.
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Common Symptoms
Symptoms caused by problems with the prostate are often known collectively as “lower urinary tract symptoms” or LUTS.
Symptoms and signs of prostate problems include:
• a delay before starting to pass urine - hesitancy
• poor stream - slow, may stop & start
• the need to strain to keep urine flowing
• passing urine often - frequency
• needing to pass urine at night - nocturia
• the need to rush to pass urine urgently -
urgency
• dribbling urine onto underpants after finishing
urination - post-micturition dribbling
• the feeling the bladder is not empty
• burning pain when passing urine - dysuria
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LUTS are rarely caused by cancer, though when you are investigated the Urologist will often seek to exclude this possibility (more later). The most common prostate problem that causes these symptoms is BPH (Benign Prostatic Hyperplasia).
BPH occurs in all men - prostates enlarge throughout adult life. The size of the prostate does not correlate well with the occurrence of symptoms. Many men with large prostate have few symptoms, whilst conversely some men with small prostates may experience quite severe LUTS.
The diagram to the left demonstrates how the prostate can block the bladder (BOO = Bladder Outlet Obstruction) as it enlarges. Treating the prostate for enlargement does not result in incontinence, as the prostate sits above the urinary sphincter and is separate from that structure. |
IPSS
International Prostate Symptom Score - a simple questionnaire about your symptoms.
DRE
Digital Rectal Examination of the prostate.
MSU
Mid Stream Urine - standard urine pathology test to look for infection.
FBC
Full Blood Count
U / E / Cr
Urea, Electrolytes, Creatinine - these are the standard renal (kidney) function tests.
PSA
Prostate Specific Antigen - a blood test designed to help in the diagnosis of prostate cancer.
U/S (or US)
Short hand for ultrasound. |
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The Diagnosis - how is it made?
You will find that some or all of the following may be required to make an accurate diagnosis of LUTS caused by your prostate:
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History - your medical history, including
medications, past problems or previous
surgery.
• Symptom Score - a simple questionnaire that
can help in judging the severity of your s
symptoms and your response to any
treatments.
• Examination - especially a digital rectal
examination (DRE) of the prostate. Abdomen &
genitals are often examined as well.
The DRE should not cause you any 
anxiety. It is not painful (though perhaps a little embarrassing)
and is performed with you laying on your left side or standing whilst bending over. This examination allows the doctor to obtain an indication of the size of your
prostate as well as the presence of any lumps or nodules, etc.
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• Urine tests: to look for infection, blood, sugar, etc.
• Blood tests: general blood count and kidney
function tests.
• PSA - Prostate Specific Antigen: this is a blood
test that is designed to assist in the diagnosis
of prostate cancer. It is not always required but
you should feel free to discuss this test with
your doctor.
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[View larger image]
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Other Investigations
You may be required to have one or all of the following tests as well:
• Ultrasound - to image the kidneys & bladder
• Post-void Residual - usually performed at
the same time as the US
• Cystoscopy - a telescopic inspection of the
bladder
• Urodynamic Study - a computer-based test
of your bladder function
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Treatment Options
There are many treatment options for BPH that do not involve surgery. Once “dangerous” conditions such as prostate cancer, bladder cancer, kidney disease, bladder stones etc have been excluded, the need for any treatment depends on how bothered you are by your LUTS.
You will have noticed the so-called bother score you provided if you completed an IPSS questionnaire. Some of the treatment options are listed below. |
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Risks
The main risk men face when suffering from LUTS due to prostatic enlargement is acute urinary retention. This is the medical term for when a person cannot urinate - they usually suffer severe pain and need to go to hospital to have a catheter inserted in the bladder.
The other risks faced are urinary tract infections and more rarely kidney failure and bladder stones.
What you can do for yourself - lifestyle changes
You may decide you do not wish any specific medical treatment at this point in time. Some of the following tips may help make some of your symptoms more bearable.
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• drink a little less fluid in the evening
• some drinks such as tea, coffee and alcohol can exacerbate the
symptoms
• some medications (such as diuretics) make you pass more
urine - a consultation with your local doctor may enable these
drugs to be taken in the morning
• “urethral milking” - after passing urine run your finger from
behind the scrotum forward to push out those last few drops of
urine that often stain the underwear
• “herbal” remedies that can be bought over the counter can often
improve symptoms e.g. Saw palmetto & Trinovan
• sometimes pelvic floor exercises help - download a pamphlet if
you like (or ask for one) |
You should have an annual prostate check as back-up to ensure you are not developing any hidden problems.
Medications
If your symptoms are causing you a moderate amount of bother you may elect to try some of the available medications.
• Alpha Blockers
These drugs block the nerves to the muscles of the prostate. This relaxes the prostate and allows easier passing of the urine. Symptoms improve 2-4 weeks after commencing the drugs.
Prazosin (Minipress or Pressin) is relatively nonspecific and in larger doses is used as a blood pressure tablet. Its big advantage is that it a PBS listed drug.
Tamsulosin (Flomax) a prostate-specific alpha-blocker that works more rapidly and often with more effect, but at this time is only on the Repatriation PBS scheme - therefore for most people it costs about $50 per script.
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• 5 Alpha-Reductase Inhibitors
These drugs - the one available in Australia is Finasteride = Proscar - reduce some of the hormonal activities of testosterone in the prostate causing it to shrink. It is not commonly used in Australia as it is very expensive and less than 30% of men who try it find it provides them any relief of their symptoms.
Surgical Options
When your symptoms are severe, you do not respond to medication, or the prostate enlargement is putting you at risk, then surgical options may need to be explored. Your Urologist will explain these in detail.
Options range from the minimally-invasive to open surgery (though this is highly unlikely to be required today) and include:
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• TUNA - Trans-Urethral Needle Ablation of the
prostate - the prostate shrinks over the following
months
• TUMT - Trans-Urethral Microwave Therapy - uses
microwave energy to achieve the same result as
TUNA
• TURP - traditional endoscopic (no cuts) removal of
the central part of the prostate. This is the basic
operation that all the laser forms of surgery attempt
to emulate e.g. Greenlight laser; Holmium, etc.
• Open Prostatectomy - involves formal surgical
removal of the inner prostate (i.e. an oldfashioned
style of operation) - highly unlikely to be required
these days |
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