Health and Prostate

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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 as infection, stone or tumor will also lead to frequency. A patient with an indwelling catheter develops a significant inflammatory response in the bladder and upon removal of the catheter will be cured with frequency until the secondary inflammation disappears. In particular, patients with chronic prostatitis (bacterial or not) will present with frequency secondary to irritation. These cases are often very difficult to differentiate from true prostatic hypertrophy and obstruction, since on rectal examination the prostate may feel somewhat enlarged.

However, most patients with frequency from irritation usually have associated dysuria, which is not a common finding in patients with pure obstruction, unless their residual urine has been contaminated. Polyuria may also lead to frequency; it is often seen in patients taking diuretics and those having chronic renal tubular diseases with poor concentrating ability. Late onset diabetes may also initially present with frequency secondary to the osmatic diuretic affect of glycosuria. A neurogenic bladder can also lead to frequency, as in a diabetic with neuropathy and a secondary-type neurogenic bladder. This patient often does not appreciate bladder fullness until he notes abdominal discomfort. As a result, he leaves behind a large residual urine even though he initially has relatively normal muscular activity.

Prostatism also includes the symptoms of hesitancy and a small stream. Both of these symptoms may not be as obvious to the patient as one might expect. The decreasing stream occurs over a long period of time and most patients accept this simply as a symptom of old age. Hesitancy also develops over a long period of time and often has to be quite dramatic before the patient will actually volunteer this complaint.

Urgency and urgency incontinence often bring the patient to his physician, because they will interrupt his normal daily routine. Incontinence can be associated with overflow in a patient in chronic retention, or may consist simply of persistent post-void dribbling.

Beware, however, of ’silent’ prostatism, where symptoms may be absent or minimal in the face of far advanced bladder decompensation — the patient may present with symptoms related to renal failure and other sequelae of long standing obstruction.

It is important to obtain details of the patient’s drug intake, in particular anticholinergics or tranquillizers which may inhibit the bladder, leading to some of the above mentioned symptoms.

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