As men get older, they often develop urinary symptoms due to prostate enlargement (or BPH).
Lower urinary tract symptoms (LUTS) may include
• difficulty starting a urinary flow
• slow urinary stream with interrupted flow
• incomplete bladder emptying, or
• frequent urination, a sensation of urgency and nocturia (needing to wake to pass urine during the night)
• urinary incontinence
What is Benign Prostatic Hyperplasia?
The prostate which is located just below the urinary bladder and is usually the size of a small fig, often grows with age. As the prostate enlarges, the flow of urine through the urethra (the tube that passes down through the centre of the prostate) is restricted and can cause urinary obstruction.
A Prostate assessment will include:
• Prostate Cancer risk assessment (PSA, prostate examination and possibly MRI Prostate)
• a urinary symptom score (IPSS) to assess severity of symptoms,
• Midstream Urine test (MSU) to exclude infection or haematuria
• urinary tract ultrasound (performed in your initial consultation) – to measure whether you are emptying your bladder, and make sure there are no complications of obstruction such as bladder stones or back pressure to your kidneys
Treatment Options
Observation
If your symptoms are mild or moderate and do not bother you (and your Prostate cancer risk is low), you probably don’t need treatment!
Bladder retraining
If your bladder is overactive, bladder retraining and/or medication may help. This can reduce your urinary frequency, sensation of urgency and urinary incontinence and can increase your functional bladder capacity.
Medication
Can improve your urinary flow by relaxing the muscles in the bladder neck and prostate and helping you to pass urine more easily, Some tablets can help shrink the prostate. Medication is usually the first line treatment for men with mild to moderate symptoms, but you need to keep taking the medication to get the benefit.
Prostate surgery
TURP (Trans-Urethral Resection of Prostate) or “rebore” is the gold standard for treatment for men with severe, bothersome symptoms or when medical treatment has not worked. Surgery is also needed for men with complications of obstruction, such as infection, bladder stones or kidney problems due to back-pressure from the prostate. Some men will need urgent surgery if they develop a complete blockage (acute retention).