Today’s men are aware of the importance of prostate disease. Prostate cancer is now the most commonly diagnosed male cancer and reassurance or early diagnosis can be offered by a series of simple tests and investigations. Benign prostatic enlargement (known as BPH) is an accompaniment of ageing, and most men can expect to develop some symptoms with their waterworks within their lifetime. Not all symptoms cause men bother and only a small percentage of men ever require a surgical operation.
Not all men present with the same set of symptoms, but if you notice weakness or slowing of your urinary stream, increased frequency by day or night or a feeling that you do not empty your bladder completely, you should seek advice. The prostate is not the sole cause of urinary problems. If you experience pain, incontinence or have blood in your urine, other causes need to be identified.
Frequently, prostatic enlargement causes no difficulty or symptoms. For many men urinary symptoms are inconvenient but of no threat to health. Men with larger prostates or who have more severe symptoms are at greater risk of developing urinary retention or of ultimately needing surgery to help their conditions. Recurrrent urinary infections, incontinence and the risk of kidney damage are much less frequently seen complications.
Many men are reassured after visiting their doctor, and if their symptoms cause little bother then simple observation may suffice. If symptoms are more troublesome, your doctor may advocate simple measures initially regarding your fluid intake, avoidance of caffeine, alcohol and nicotine and may recommend simple techniques to train or “re-educate” your bladder. If these do not improve things, medication may be offered or referral to a specialist may be made. If you have experienced urinary infections as a result of your prostate enlargement, or have suffered episodes of retention, surgery may be indicated. Your specialist will discuss the relevant types of surgery for your particular problem
PSA (prostate specific antigen) is a substance produced by the prostate and detectable in the bloodstream. As we get older or our prostate enlarges, our PSA level rises. Prostate cancer, which is also more common with age can cause the PSA to become elevated. PSA is not a diagnostic test for cancer, but if it is elevated and your doctor feels that examination of your prostate suggests an abnormality then you may be referred for specialist investigation to exclude cancer.
Waterworks problems, though frequently related to prostate enlargement, are not universally so. Other common conditions such as diabetes and overactive bladder need to be distinguished from issues related to the prostate. Similarly, a range of commonly taken prescribed medications can impact on bladder function.
In general terms, incontinence (the involuntary loss of urine) can be related to a variety of disorders which affect the bladder muscle or the sphincter muscle which acts as a control valve. Additionally, other medical conditions, prescribed medications and poor mobility can contribute to the problem. Male incontinence is much less common than in women. The following conditions need to be considered:
Once the cause of incontinence has been determined, appropriate treatment can be offered. Many patients can be improved by regimens which do not include the need for medication or surgery. Specially trained physiotherapists will help in bladder retraining programmes, pelvic floor muscle therapy and other lifestyle advice. A variety of drugs can also be used if required. In a small percentage of patients, particularly those with complex or post-surgical incontinence, more invasive procedures may be an option.
Haematuria signifies the presence of blood in the urine. This may be either visible or non-visible (found on a urine test). Your doctor will always refer you urgently for further investigation of haematuria. One in 5 adults with visible haematuria are subsequently found to have bladder cancer and one in twelve with non-visible haematuria are diagnosed. The most common cause of blood in the urine however is infection in the urine (cystitis). Younger people, or those with a single finding of blood in the urine on testing usually do not require investigation.
You will have a full medical history and examination performed. This includes a rectal examination to assess the prostate. Urine will be sent to look for infections and blood taken to check on kidney function. A PSA test is also usually performed. Most of these tests will be done by your referring G.P. A specialist will arrange a scan of your urinary system (either a CT scan or ultrasound) and will suggest a cystoscopy (telescopic investigation of the bladder) which can be done either under local or general anaesthetic.