FOR MEN AGED 40 YEARS OLD AND ABOVE

Prostate gland and urinary problems

The prostate gland is a male reproductive organ. Many men experience urinary changes as they age, which may be caused by inflammation or enlargement of the prostate gland. An enlarged prostate gland, however, does not always cause urinary problems. Troublesome urinary symptoms are rarely symptoms of prostate cancer.

The prostate gland is about the size of a walnut and is found at the base of the bladder. A thin tube that allows the passage of urine out of the penis (urethra) runs through the prostate gland. Fluid produced by this gland helps to nourish and support sperm, which come from the seminal vesicles via the ejaculatory ducts into the urethra.




How the prostate gland develops

The prostate undergoes two main growth spurts. The first is triggered by sex hormones made by the testicles during puberty. This prompts the gland to reach an average weight of 20g. The second growth spurt begins when men are in their 40s.

Urinary changes are common as men age

Many men experience urinary symptoms as they age, which may be caused by inflammation of the prostate gland (prostatitis). In the older male, symptoms may be the result of a blockage in the tubes due to a benign (non-cancerous) enlargement of the prostate gland (benign prostatic hyperplasia). The most common symptom is difficulty emptying your bladder.

Urinary symptoms may become sufficiently difficult that they require treatment.

Common urinary symptoms associated with aging

Not all urinary symptoms are due to changes to the prostate. Also, some men have enlarged prostates and yet experience few, if any, symptoms.

Urinary symptoms commonly experienced include:

* The need to urinate frequently during the night
* Urinating more often during the day
* Urinary urgency – the urge to urinate can be so strong and sudden that the toilet may not be reached in time
* The urine stream is slow to start
* Urine dribbling some time after finishing urination
* A sensation that the bladder isn’t fully emptied after urination
* Lack of force to the urine flow, which makes directing the stream difficult
* The sensation of needing to go again soon after urinating.




Although these symptoms often do not need treatment, you should see your doctor if they are particularly difficult as they can be successfully treated.

Symptoms that should be followed up

See your urologist if you have the following symptoms:

* Inability to urinate
* Painful urination
* Any blood in the urine at all
* Any discharge from the penis
* Continuous or severe urinary incontinence (you can’t hold your urine).

Inflammation of the prostate

Bacteria sometimes cause prostatitis (inflammation of the prostate). More commonly, however, the underlying cause is uncertain. If the following symptoms are present, you should consult your urologist promptly:

* Fever
* Low back pain
* Pain in the groin
* Urgent and frequent urination.

Antibiotic treatment is essential for acute bacterial prostatitis. Admission to hospital is often necessary and, as with chronic prostatitis, specific antibacterial drugs are required for a long time.

Enlargement of the prostate
Benign prostatic hyperplasia (BPH) causes enlargement of the prostate, which may cause troublesome symptoms. BPH is more common as men get older.

The prostate gland goes around the urethra, so men may have problems urinating if the enlarged gland restricts the flow of urine. If the flow stops completely, a catheter is required to empty the bladder. It is rare for this form of acute urinary retention to cause kidney damage.



An enlarged prostate doesn’t always cause urinary problems. Studies indicate that the size of a man’s prostate gland has little influence on the type or severity of his urination problems. BPH is just one possible cause of urinary symptoms.


Diagnosis
If you are troubled by urination problems, you should see a urologist – no matter what your age. If your doctor agrees that your symptoms need further evaluation and treatment, you may need to undergo a few tests. These may include:

* Physical examination – including digital rectal examination (DRE) to check the size and shape of the prostate gland.
* A urine check – to ensure the prostate is not infected.
* An ultrasound examination – to assess if the bladder is emptying completely and to examine the appearances of your kidneys.


Digital Rectal Exam(DRE)

Treatment

If your urinary problems are caused by infection or enlargement of the prostate gland, treatment options include:

* For prostatitis – a prolonged course of antibacterial drugs. Because infection is difficult to eradicate, they will need to be taken for many weeks.

* For obstruction caused by an enlarged prostate

a) Medical treatment: medications to relax the muscles of the urethra to facilitate passage of urine

b) Surgical treatment: Transurethral incision of the prostate (TUIP), Transurethral resection of the prostate (TURP), open prostatectomy (for very large prostate glands)


TRANSURETHRAL RESECTION OF THE PROSTATE (TURP)


OPEN PROSTATECTOMY

Things to remember

* The prostate gland is a male reproductive organ that contributes fluids to nourish sperm cells in the ejaculate.
* Many men experience urinary changes as they age. In many cases, these changes do not need specific treatment.
* When urinary changes cause problems, they can be treated successfully by lifestyle changes, medication, surgery or both.
* For problems such as blood in the urine, pain on urination, inability to urinate or uncontrollable urine flow, you should see your urologist promptly.