Prostate LUTS-BPH

WHAT IS PROSTATE?

The prostate is a small gland, the size of a small walnut that sits at the base of the bladder surrounding the urethra (the tube that takes the urine from the bladder through the penis). It is part of the male reproductive tract and produces fluid that contributes to the semen and nourishes the sperms. Women do not have prostate.

WHAT IS BPH?

As men grow older, the prostate can enlarge in size and squeeze the urethra, causing symptoms. These are typically referred to as lower urinary tract symptoms or LUTS. It must be remembered though that prostatic size does not always correlate with presence or absence of LUTS. For example, somebody with a very large prostate need not have any symptoms at all, whilst someone with a very small prostate can suffer quite badly.

WHAT IS LUTS?

The lower urinary tract consists of the bladder, prostate and urethra. Urinary symptoms refer to problems related to the urinary tract, and in this instance, when related to the lower urinary tract, are referred to as LUTS. In addition to BPH, LUTS can be caused by a variety of conditions including cancer in the prostate, urinary infection, urethral stricture, stone or tumour in the bladder or a weakly contracting bladder. LUTS are quite common and affect about a third of men over the age of 50, although it can affect men even at an earlier age. Although there can be a wide range of symptoms, they fall into two broad categories – voiding and storage.

These refer to difficulties with passing urine. Voiding symptoms include:

Poor or weak urinary stream
Straining to void
Hesitancy (waiting for a while before the urine starts coming or difficulty starting)
Stopping and starting
Sensation of incomplete emptying
Complete inability to pass urine (this is usually painful and is termed acute retention of urine)

Storage symptoms refer to difficulty with storing urine in the bladder. These symptoms can be caused by a variety of causes both benign and malignant. Storage symptoms include:

Frequency
Nocturia (frequent urination at night)
Urgency (feeling of a sudden need to urinate)
Urge incontinence (involuntary loss of urine related to urgency)
Stress incontinence (involuntary loss of urine related to straining eg. lifting a heavy object or sneezing or coughing)

HOW IS BPH / LUTS MANAGED BY THE UROLOGIST?

After taking your medical history, the urologist will perform a clinical examination including a digital rectal examination (DRE) to evaluate your prostate.
You may be asked to fill out a chart of the number of times you pass urine and / or the amounts passed each time (frequency / volume chart).

Following this he/she may order some tests, which may include some or all of the following:
Urine analysis and bacterial culture tests (the urologist might refer to this as an MSU for m/c/s – mid-stream urine for microscopy/culture/sensitivity)
Uroflow test – to assess your urinary flow – you will be asked to void into a machine which records the flow of urine against time (flow rate)
Bladder scan to assess your bladder emptying (post-void residue – PVR)
PSA (Prostate Specific Antigen – see PSA – pt guide)
Creatinine and electrolytes (this is to evaluate your kidney function)
Ultrasound scan of your kidneys and bladder (USS-KUB)
Flexible cystoscopy (see CYSTOSCOPY – pt guide)
Transrectal ultrasound guided biopsies of the prostate in case your PSA is elevated (see TRUS-PROSTATIC BIOPSIES – pt guide)
Urodynamics – this is a functional study of the bladder

Following review of the test results, you are likely to be recommended one or more of the following:
Lifestyle modification eg. restricting fluids / avoiding caffeinated drinks
Pelvic floor exercises
Medications
Surgery (see TURP – pt guide)
If PSA is elevated and biopsies confirm prostate cancer (see PROSTATE CANCER – pt guide) your urologist will discuss about management options for this.