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Q: I am 60 years old and have been having various urinary symptoms for some time. I recently went to the doctor, who did a physical exam and told me that I had benign prostate hypertrophy. He also gave me a medicine and told me that my symptoms should be improving. He was right and my urinary problems are actually much better. Could you please tell me something as to which are the urinary symptoms expected in benign prostate hypertrophy and about the diagnosis and treatment of this disease?
A: Typical manifestations of an abnormal functioning prostate include hesitancy (which is the inability to quickly start a urinary stream of sufficient force), urinary tenesmus (the feeling that one has not sufficiently emptied the bladder), dribbling (urine continues to leak out after urination), frequency (frequent urination), nocturia (frequent urination at night) and dysuria(a burning sensation during urination). In particular, in the case of an infection, dysuria, hematuria (blood in the urine), and pyuria (white blood cells in the urine) are typically also present. Although many of these symptoms occur in the presence of benign prostate hypertrophy or prostatitis (inflammation of the prostate), they can also occur in the presence of an apparently normal prostate (prostatodynia) with normal bladder, or an abnormally functioning bladder with a normal prostate.
The diagnosis of benign prostate hypertrophy is made by means of a rectal exam. On rectal examination, the prostate gland is enlarged in the case of benign prostate hypertrophy or tender in the case of prostatitis. In addition, the urinary bladder may be distended with urine due to the accompanying urinary obstruction. Typically, up to about 50cc of urine may be left in the bladder after urination. On the other hand, larger urine volumes may remain in the bladder due to obstruction. In addition to the rectal exam, the prostate specific antigen (PSA) may also be measured in blood. However, measurement of PSA is optional since, although PSA testing increases the probability of detection of prostate cancer, there is, however, considerable overlap in the PSA values measured in patients with prostate cancer and patients with benign prostate hypertrophy. In the case of prostatodynia, no abnormalities are found on physical exam. Also, in the case of an improperly functioning bladder, no abnormalities are found on the physical exam itself, but, rather, only when certain diagnostic tests are performed, such as measuring of the urinary flow pressures.
Treatment of prostatitis is with antibiotics. Treatment of the symptoms due to benign prostate hypertrophy is either medical or surgical. Of course, medical treatment should first be attempted, and surgery should be reserved for more severe cases, which do not respond to medical therapy. The contractile properties of the prostate and bladder neck are mediated by certain receptors, referred to as alpha receptors. Also, male hormone levels (androgens) play a role in this regard. Thus, by giving substances which block the alpha receptors ( alpha blockers) and/or substances which reduce the androgen hormone levels, the obstruction symptoms due to an abnormal prostate may be improved. Interestingly, even in case of prostatodynia, symptoms improve in about 80% of the cases when alpha blockers are employed for treatment. In severe cases of obstruction due to an enlarged prostate, surgical treatment, which consists of removal of part of the prostate, can be either accomplished directly or through the urethra. However, complications may occur following surgical procedures, so that, like any surgery, it should only be performed when necessary. It is of interest to note that removal of prostate tissue through the urethra is the second most common surgical procedure in men over 60 years of age.
Updated: 06/13/99
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