Health and Prostate

The indications for surgery in benign prostatic hypertrophy are essentially the symptoms confirmed by signs of prostatism. More absolute indications are those of secondary renal failure, recurrent infection, and of course, urinary retention. These factors must be considered in conjunction with the patient's age and state of health.' I think it important that the family physician understand some aspects of the surgical technique and possible complications, in order to reassure both patient and family at the time of referral and in subsequent follow-up. Essentially, the surgical techniques are either transurethral or open (supra-pubic or retropubic) and both procedures remove the adenoma down to the level of the capsule if properly performed. The transurethral procedure is preferable, but the open technique may be necessary in the presence of a particularly large adenoma. The urologist must decide on the basis of his own ability whether or not he can adequately resect the gland transurethrally within the allotted time. If he feels the gland is too big for this, it should be approached via the open Read more [...]

Initial management of a patient in the prostatic age group presenting in urinary retention involves insertion of a urinary catheter. However, certain preventive measures might be kept in mind when dealing with a patient in this age group. Many of these patients get along reasonably well in bladder balance until some situation tips them over into retention. This may be a sudden increase in fluid intake (i.e. a drinking bout or diuretics) which results in rapid bladder filling, distending the bladder beyond the critical diameter to generate the pressure necessary to overcome the increased outlet resistance associated with prostatic obstruction (Laplace's Law). Prolonged car trips or other situations which delay voiding, allowing the bladder to distend beyond that critical volume, may also result in urinary retention. The use of belladonna derivatives such as Atropine or Probanthine may inhibit the detrussor muscle, resulting in retention. As well, other drugs such as sedatives, which decrease the patient's ability to respond to a full bladder, result in retention. By keeping these situations in mind Read more [...]

Having obtained the symptoms suggestive of outlet obstruction, the diagnosis should then be confirmed by the signs of outlet obstruction. On physical examination, the bladder may or may not be palpable. Rectal examination should normally reveal an enlarged prostate. However, it is the periurethral portion of the gland which initially enlarges; it is possible for this to cause very little overall enlargement of the gland. Usually, enlarged glands are more likely to be associated with obstruction, but it is possible to have significant outlet obstruction in the presence of a relatively small gland palpable rectally. If the symptoms suggest prostation, the patient should be further investigated. Urinalysis and urine culture should always be performed to rule out infection, diabetes and other renal and bladder problems which might contribute to the symptoms mentioned above. Blood work should consist of indices of renal failure such as BUN and creatinine, plus serum acid and alkaline phosphatase. An elevated serum acid phosphatase in the absence of Paget's disease or other problems associated Read more [...]

The commonest symptom associated with prostatism is frequency and in particular, nocturia. The most objective of these is nocturia, since every patient remembers getting up at night and exactly how many times. It is usually this which brings him to his doctor. Day time frequency is less objective, since it often relates to other influences such as lunch hours and coffee breaks, and is less likely to inconvenience the patient. Frequency of prostatic hypertrophy is related to a relative decrease in functioning bladder capacity. The patient carries a large residual urine which actually gives him an increased bladder capacity, but because most of the urine remains behind as a residual, the functioning capacity is quite small. If the bladder does not empty completely, it does not take as long to fill up again and give the patient the urge to void. Many other situations, however, can also lead to frequency and may be confused with prostatic hypertrophy. A small contracted bladder, as seen with radiotherapy or tuberculosis, will produce frequency. Bladder irritability secondary to inflammation such Read more [...]

Prostatism is the clinical syndrome consisting of the symptoms associated with outlet obstruction at the bladder neck. By far the commonest cause of this syndrome is benign prostatic hypertrophy, but other entities such as bladder neck stenosis and urethral strictures can produce these symptoms as well. Prostatic hypertrophy is in fact a hyperplasia of epithelial and fibromuscular elements arranged in multicentric nodules and originating in the periurethral part of the gland. As the hyperplastic process continues, the nodules coalesce into lobes which compress the outer prostate into a false or 'surgical' capsule. The surgery for benign prostatic disease (open or transurethral) involves removal of these lobes down to the level of this capsule, but does leave the outer prostate behind and therefore does not prevent subsequent development of carcinoma. Although eight anatomic types of prostatic obstruction have been described, for practical purposes most obstruction consists of lateral lobe hypertrophy plus or minus median lobe involvement. Cystoscopically, this is visualized as two large lobes Read more [...]