Treating Prostate Problems - Options for Improving Your Health

A prostate problem can make you very uncomfortable and can be quite stressful. You may not be able to sleep through the night or sit through a movie because you have to make frequent trips to the bathroom. When you try to urinate, you may have trouble starting, experience a burning sensation, or have difficulty emptying your bladder completely. But you don't have to live with problems like these. Get the facts from the best source of information about prostate problems: your urologist. If a prostate problem is causing your symptoms, your urologist can tell you what the treatment options are, and what you can do to maintain your health after treatment.

FACT: SYMPTOMS CAUSED BY THE PROSTATE USUALLY DON'T MEAN CANCER.

Prostate cancer often doesn't cause symptoms. In fact, cancer can develop with or without other prostate problems.

FACT: PROSTATE SURGERY DOESN'T MAKE YOU PRONE TO PROSTATE CANCER.

Surgery doesn't cause or spread cancer. You're no more likely to develop prostate cancer after than before surgery.

FACT: PROSTATE SURGERY RARELY CAUSES IMPOTENCY OR INCONTINENCE.

Impotence or incontinence (urinary leakage) rarely occurs as a result of surgery. If it does, it can be treated.

FACT: SYMPTOMS CAN BE RELIEVED EVEN IF YOU HAVE OTHER MEDICAL PROBLEMS.

In most cases, you can be treated for prostate problems even if you have other medical problems.

WHAT ARE COMMON PROSTATE PROBLEMS?

Many men have problems with their prostate at some time in their lives, and these problems usually cause urinary symptoms. Younger men may develop an infection or inflammation of their prostate. In older men, the prostate enlarges and may obstruct the flow of urine from the bladder. By learning more about prostate anatomy, you can better understand how these problems may be treated.

NORMAL PROSTATE

The prostate is a gland about the size and shape of a walnut. Stimulated by the male hormone testosterone, which is produced by the testes along with sperm, the prostate produces part of the semen in which sperm travel.

• The seminal vesicles provide nutrients for sperm.
• The prostate capsule is a muscle layer surrounding the prostate.
• The urethra passes through the prostate, draining urine from the bladder.
• The bladder stores urine until it is full, then empties into the urethra.

ABNORMAL PROSTATE AND ITS EFFECTS

OBSTRUCTION

Beginning at about age 40 to 45, hormonal changes may result in prostatic enlargement, a condition called benign prostatic hyperplasia or BPH. Problems with urinating and discomfort start when new prostatic tissue grows toward your urethra, squeezing it like a clamp around a garden hose.

CANCER

If a cancerous tumor develops, it usually grows in the outer portion of the prostate. A cancerous tumor doesn't usually cause symptoms because it doesn't press on the urethra. Even though you may not have symptoms, this type of early stage tumor can usually be detected during a physical exam.

INFECTION AND INFLAMMATION

Your prostate can become infected (a condition called prostatitis). Either of these conditions can cause your prostate to swell. You may feel a burning sensation while urinating, or see what looks like pus in the urine.

EFFECTS ON THE BLADDER

As the urethra narrows, you have to push harder to urinate. This can cause the bladder walls to thicken and stretch out of shape, becoming less efficient. If urine stays in the bladder, infections can develop. Your kidneys may fail if they can't drain properly into the bladder because it's full.

If you can't empty your bladder completely, the pressure from the urine build-up may cause the bladder to leak.

HOW ARE PROSTATE PROBLEMS FIRST DIAGNOSED?

Your medical evaluation will include a medical history, physical exam, and preliminary tests to help your urologist pinpoint the cause of your problem. For example, your urinary symptoms may be caused by a urethral condition, not a prostate problem. Other causes of urinary symptoms, like bladder conditions and cancer, will also have to be ruled out.

RATING YOUR SYMPTOMS

Answer the questions in the Prostate Self-Test, then discuss your answers with your urologist. The more times you answer "yes", the more likely you may have prostate problems.

MEDICAL HISTORY

To help assess your general health, your urologist will ask you questions about your symptoms, other possible medical problems and your family's medical history. Your urologist may also ask you about medications that you are allergic to and about medications you are currently taking, since this information can influence your doctor's treatment recommendations.

PHYSICAL EXAM

A physical exam helps your urologist evaluate your general health. Your urologist will also assess your prostate with digital rectal exam, performed by inserting a finger into the rectum and feeling the prostate. This usually painless exam enables your urologist to detect an enlarged prostate or other abnormalities where they are most likely to occur.

LAB TESTS

Routine lab tests will be performed if you haven't already taken them. Based on the results, you may need to take additional tests.

Urinalysis

Substances in your urine can show whether you have a urinary tract infection instead of a prostate problem. A urine culture may be checked if an infection is suspected, or a urine specimen may be checked if cancer is suspected.

Blood Tests

Blood tests can provide information about your general health. In addition, abnormally high levels of substances in your blood can show if an enlarged prostate has caused urine to back up to your kidneys. High levels of PSA (prostate specific antigen) may suggest cancer of the prostate.

WHAT OTHER TESTS MAY BE NEEDED?

No single exam or test can provide a complete picture of your health. After a preliminary diagnosis has been made, additional tests can help your urologist further evaluate your condition. Once a final diagnosis has been made, you and your urologist will discuss a treatment program.

DIAGNOSTIC TESTS

You may be asked to take one or more state-of-the-art tests to help pinpoint the cause of your symptoms. These tests may also be used during future exams as guides for identifying changes in your condition and for keeping track of how you respond to treatment. Many of these tests cause no or minimal discomfort; for other tests, you may receive a sedative or local anesthetic.

• Urine Flow - Metering how quickly or slowly your urine flows can show a blockage. In some instances, your bladder pressure may be measured during urination, too.
• Ultrasound - Ultrasound uses soundwaves to create a "three dimensional" image of your prostate, bladder or kidneys. It can help check for tumors and kidney disease.
• IVP - An IVP (intravenous pyelogram) is an x-ray of your kidneys. This test is often used to check the kidneys and other parts of the urinary tract for abnormalities.
• Biopsy - A biopsy may be done to evaluate the prostate tissue. A thin needle, often guided by ultrasound, is used to remove one or more tissue samples.
• Cystoscopy - By looking through a small tube, which is inserted through the penis opening, your urologist can view any obstruction caused by the prostate.

Your Treatment Plan

After studying the results of your tests, your urologist will discuss your treatment options with you. Remember: the sooner you get treated, the sooner your symptoms can be relieved.

Infection and Inflammation

For a prostate infection, your urologist may prescribe antibiotics such as tetracycline. For an inflammation, your urologist may recommend anti-inflammatory medications or muscle relaxants.

Obstruction

Depending on how much your symptoms are bothering you, and whether or not your kidneys are being affected, you may be able to manage your condition without medications or surgery. Try urinating as soon as you feel the urge. Avoid drinking too much liquid at one time, and before going to bed. Keep in mind that coffee, tea, and alcohol can also make you urinate often. If your symptoms worsen, your urologist may recommend surgery to relieve the obstruction. Or, depending on your general health and type of obstruction, your urologist may suggest nonsurgical treatments to relax your muscles, shrink your prostate, or push prostate tissue away from your urethra.

Cancer

If cancer is suspected, your urologist may recommend additional tests to confirm the diagnosis and determine the best course of treatment. When prostate cancer is diagnosed in its early stages, chances for a cure are excellent. If detected in its later stages, cancer can usually be controlled.

WHAT IF I NEED SURGERY?

Your urologist may recommend surgery to treat your prostate problem. Once the pressure on your urethra is relieved, your should be able to urinate more comfortably and normally. Depending on the size and position of your prostate and any other medical problems you may have, your urologist will decide which surgical procedure is best for you.

Before Surgery

You'll enter the hospital the day before or the day of surgery. You may talk with an anesthesiologist who will discuss the type of anesthetic that will be used to help keep you comfortable during surgery. Your urologist will probably ask you not to eat or drink anything after midnight the night before surgery, and may ask you to take an enema or a laxative. Just before surgery, you'll be given a sedative to relax you.

During Surgery

When you're taken to the operating room, you'll be given an anesthetic. An IV tube will provide nutrition and medication. Throughout surgery, which takes about an hour, your blood pressure, pulse, and breathing will be monitored.

Removing Excess Tissue

There are two types of surgery to remove excess prostate tissue. A transurethral resection of the prostate (TURP) is the most common. During this procedure, an instrument is inserted through the penis opening to allow your urologist to see and remove any tissue blocking your urethra and bladder. Water is then passed through the instrument to flush the prostate clean.

An open prostatectomy is usually used when a large amount of tissue must be removed or when the size, shape, or position of the prostate makes it necessary. An incision is made in the abdomen or the area between the anus and scrotum, and the excess tissue is removed.

Stretching to Remove Pressure

As abnormal tissue grows inside the prostate, the capsule surrounding it remains stiff. By making incisions in the prostate and its capsule (a transurethral incision or TUI), the capsule can stretch outward, relieving the pressure on the urethra that block your urine flow.

Risks and Complications

With any surgery, there are always risks and possible complications. Depending on the procedure used, one risk is retrograde ejaculation. After surgery, you may notice a difference in the way you ejaculate. During surgery, a muscle that is involved in ejaculation may be cut. If this happens, semen may travel backward into the bladder during an orgasm, instead of traveling out of the body through the urethra. The feeling of orgasm is the same, however, as during normal ejaculation.

Your urologist will discuss this risk with you as well as other possible complications, including the following:

• Infection
• Pneumonia
• Blood Clots
• Excessive Bleeding
• Loss of bladder control
• Impotence

What Can I Expect After Surgery?

It's natural to be concerned about how you'll feel and what your physical limitations might be after surgery. Your prostate is likely to be sore, limiting some of your normal activities for a while. Depending on which procedure was used, you may feel tired for a few days or several weeks as you regain your strength. Take things easy, and follow your urologist's advice while you heal.

IN THE HOSPTIAL

Your IV will be taken out when you can eat and drink again, usually four to six hours after surgery. Depending on which surgical procedure was performed, a catheter, which drains urine out of your bladder into a sterile bag, may stay in place one to three days. You're likely to be given medications to control pain an bladder spasms and stool softener so you don't have to strain and risk tearing scabs from your prostate as it heals.

Your Role in Recovery

Don't be alarmed if your urine is bloody: this is natural after surgery. Your urologist may advise you to drink plenty of liquids to help wash out any clots.

At Home

Your doctor will let you know when you can go home, usually in one to four days. Your may have trouble holding your urine for the first few days, and it may take a while before you can control your bladder entirely. You may also continue to see blood in your urine as scabs break off from the surgical area. If you have stitches that weren't removed in the hospital, they'll be removed in one to two weeks. You'll also see your urologist in one to two weeks for a postoperative checkup.

Your Role in Recovery

Call Your Doctor If:

• You have excessive bleeding.
• You have fever or chills.
• You have trouble urinating, or don't urinate completely.
• You strain during daily bowel movements, even with the help of stool softeners and mild laxatives.

WHAT ARE THE NONSURGICAL TREATMENTS?

While surgery is the best way to relieve an obstruction, there are nonsurgical treatments that may relieve your symptoms. These treatments work by relaxing the muscles of the prostate, by blocking hormones that cause prostatic tissue to grow, or by moving tissue away from the urethra. Although not everyone can benefit from these procedures, your urologist may recommend one of these treatments for you.

MUSCLE RELAXANTS

When you're tense, the muscles that make up the capsule surrounding your prostate may also tense, causing your prostate to squeeze your urethra. Sometimes, medications can relax prostatic muscles and help you urinate better. These medications, usually taken daily by pill, may have side effects, including low blood pressure, dizziness, or weakness.

HORMONE TREATMENTS

Prostate growth is stimulated by the hormone testosterone. Other hormones can keep testosterone from acting on the prostate, allowing your prostate to shrink just enough to relieve your symptoms. Taken regularly by pill or injection, hormone treatments may have side effects, including cardiovascular problems, hot flashes, breast enlargement and impotence.

BALLOON DILATATION

A thin tube containing equipment to inflate a tiny balloon is passed through the urethra. When the balloon is inflated, it pushes prostate tissue away from the urethra. After the balloon is deflated and removed, the tissue should remain in its new position. If the tissue moves back and presses on the urethra again, the procedure may have to be repeated.

HOW CAN I RETURN TO NORMAL?

Once your problem has been treated, you can start returning to your usual lifestyle. Your should begin to notice a marked improvement in your urinating patterns. You can resume intimate relations with no change in your sexual enjoyment. And by getting regular check ups and maintaining your health, you can give yourself to best chance for a full recovery.

HAVE REGULAR PHYSICAL EXAMS

Because you still have your prostate, it's important to schedule an annual exam to check for the growth of new prostatic tissue or cancer. You'll be given a rectal exam, laboratory tests, and other diagnostic tests when necessary.

ENJOY YOUR SEXUALITY

You can enjoy the same intimate relations after treatment as you did before treatment. Your sexual desire and ability won't be affected, even if you experience retrograde ejaculation. The feeling of orgasm is the same as during normal ejaculation.

MAINTAIN YOUR HEALTH

Following a healthy lifestyle can help you recover more quickly, and help you live life to its fullest. Good nutrition helps your body rebuild itself. Do your body a favor by choosing a diet with lots of fresh fruits and vegetables. Limit your intake of foods containing too much fat and cholesterol, such as whole milk products, eggs, and red meat. Exercise can increase your endurance, lower blood pressure and blood cholesterol, relieve stress, and help you control your weight. Stress reduction techniques can help keep your cardiovascular system healthy. Try the following: visualization (picturing yourself in a peaceful setting), muscle relaxation (relaxing one group of muscles at a time), and deep breathing (inhaling slowly through your nose and exhaling slowly through pursed lips).

WHY WAIT TO RELIEVE YOUR SYMPTOMS?

By getting your prostate problem treated now, soon you should be able to sleep better through the night. You should be able to enjoy recreational activities without repeated trips to the bathroom. And you should be able to enjoy the same intimate relations you had prior to treatment. In fact, as you recover, you may wonder why you waited as long as you did to have your symptoms relieved.

If you would like more information on this topic, please contact us.

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