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.

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.

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.

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.

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

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.

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:

• 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 symptoms and your response

   to any treatments.

•  Examination - especially a digital rectal examination

   (DRE) of the prostate. Abdomen & genitals are often

   examined as well.

• 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.

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

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.

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.

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.

• 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.

• 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