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When your Prostate Protests Too Much
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By David Shafran, MDIf you’re a male over age 50, you’ll probably develop a love-hate relationship with your prostate. This gland, about the size of walnut at age 20, plays a key role in the male reproductive system, producing part of the milky fluid that carries sperm during an ejaculation. During middle age, as the prostate begins to grow larger, the gland is associated with symptoms that are usually bothersome and sometimes disabling. If you wake up two or three times at night to traipse to the toilet, your prostate may be at least partly to blame. If you can’t drive more than 50 miles down the highway without looking for a rest stop, then your prostate may be acting up. Benign prostatic hyperplasia (BPH) is an age-related enlargement of the prostate gland that produces symptoms by obstructing the flow of urine. The condition is very common, affecting about half of American men by age 60 and more than 90 percent by age 85. Prostate cancer, is also a common threat to older men, but it’s important to distinguish between the two. BPH is not cancerous and does not cause cancer. Location, Location, Location The prostate is located between the bladder and the urethra, the tube that carries urine from the bladder through the penis. Normally the diameter of a dime, the urethra, if compressed by the prostate, can become narrow and thus cause one to need to push or strain to get urine flowing. The stream may become interrupted several times and end with dribbling. These are the symptoms of obstruction that may result from an enlarged prostate. When you strain to urinate, the bladder works harder and, as a result, develops a thicker, more muscular wall that, in turn, decreases the bladder’s storage capacity. If the obstruction is severe enough, you may find it difficult to empty the bladder completely, even with straining. Bladder symptoms usually indicate that the obstruction has begun to effect the urinary system. These symptoms include: frequent urination; the feeling that the bladder is not quite empty after urination; awakening at night to urinate, and urgency, a sudden, strong desire to urinate. The latter is responsible for that feeling of panic when a bathroom is not in sight, and it can lead to accidents. If you have such symptoms and they bother you, you should see your doctor. Often the doctor will recommend watchful waiting, or no treatment at all but with regular checkups and attention to the signs of complications. While nighttime trips to the toilet are bothersome, most men can put up with the inconvenience. Symptoms most likely to lead to treatment are 1) progressive decrease in the force of the urinary stream and 2) incomplete emptying of the bladder. When urine is retained in the bladder, it can cause infections, bladder stones or kidney damage. Probably the most severe complication, acute urinary retention, involves the inability to urinate. What Can Be Done? What kind of treatment you need, if any, depends largely on your wishes and your lifestyle. Surgical procedures for BPH are not as common as they were even a decade ago, and patient preference is the guide to treatment. Symptoms can remain stable or even get better from time to time. Even about a third of men who required catheterization for acute urinary retention, one study found, were later able to urinate normally. In most cases, the first step is watchful waiting plus lifestyle changes to reduce urinary symptoms. These include:
Treatment options were expanded with the approval of two classes of medications. One works by altering the hormonal changes that trigger the growth of prostate cells. These drugs are recommended for men with the most swollen prostates because they can actually shrink the gland. About three to four percent of men taking these drugs experience sexual side effects, including decreased desire, ejaculation problems and difficulty with erections. Many men apparently are bothered no so much by the size of the prostate as by the contractions of the smooth muscle around the urethra. For these men, a second type of drug helps relax the smooth muscle tissue and get a better flow. The gold standard treatment, or the one to which all others are compared, is transurethral resection of the prostate (TURP). Using a small instrument passed through the penis into the bladder, a urologist removes excess prostate tissue. Other types of surgical procedures may also be used, plus some minimally invasive options such as: microwave heat therapy, high-intensity focused ultrasound, thermal therapy with small needles, laser treatments and insertion of Stents into the urethra to keep it open. Risk of surgery should be balanced against the severity of urinary symptoms and how much they interfere with daily life. A man who works at home may not be bothered by frequent trips to the bathroom. An executive who spend a lot of time on the road, on the other hand, may be willing to do almost anything to get normal urinary function again. For men over 55, transurethral resection of the prostate is the second most common surgical procedure. Even since 1987, however, TURP procedures have decreased by more than 50 percent. With new options available, men have a better chance of managing symptoms that are bothersome while getting definitive treatment for those that are truly disabling. Dr. David Shafran is board certified in Urology and practices at Commonwealth Urology. He is on the admitting staff of Pattie A. Clay Regional Medical Center. 9/02 Back to Newsroom |
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