Having trouble urinating? You may have BPH

Men are blessed with a truly phenomenal organ. It provides great joy during the first half of a man’s life, but can cause serious distress during and after middle age. What organ am I talking about? The prostate of course! Deep inside a man’s pelvis lives this glandular organ that wraps around the urethra, is just beneath the bladder, and adjacent to the rectum.

Most Important Function

The prostate is a reproductive organ. Its most important function is to produce prostate fluid, a primary component of what makes up a man’s ejaculate. The muscles of the prostate also ensure that the semen is forced into the urethra and outward during ejaculation. Without a prostate, pregnancy is not feasible. The prostate, seminal vesicles, and testicles all take part in making the fluid that is emitted when a man orgasms during sex, hence it is essential when it comes to reproduction and having children.

The penis gets smaller and the prostate gets bigger as we get older

Unfortunately, the prostate can start to cause trouble as men age. This usually presents as voiding dysfunction starting around a man’s 4th or 5th decade of life and is caused by prostate enlargement that continues with age. The saying in my office is the penis gets smaller and the prostate gets larger as we get older. Although meant to be funny, there is a lot of truth to that statement, and BPH or Benign Prostatic Hypertrophy, is a reality of life that comes with aging.
As the prostate grows it can begin to obstruct urine flow from the bladder causing some or all of the following symptoms:

• • Weak urine stream
  • Urine retention and leakage
  • Urinary frequency and urgency
  • Waking up at night to void
  • Recurring urinary tract infections
  • Pain with urination

These symptoms may cause serious distress to a man’s quality of life and worse, it can cause more serious medical problems such as kidney damage and depression.

BPH is probably the most common cause for male urinary dysfunction and the most common ailment treated by a general urologist. The Good News: BPH is very manageable and proper treatment can relieve urinary symptoms.

Let’s Fix It!

There are several effective medications available to treat BPH. They work by either shrinking or relaxing the prostate. These medications are usually very tolerable and work quite well after just a few weeks of treatment.

Alpha Blockers relax the muscles of the prostate and the neck of the bladder to relieve symptoms, including alfuzosin (Uroxatral^®), doxazosin (Cardura^®), tamsulosin (Flomax^®).

5-Alpha reductase inhibitors help shrink the prostate and prevent additional growth, including dutasteride (Avodart^®) and finasteride (Proscar^®).

We also use tadalafil (Cialis^®) or sildenafil (Viagra^®), to treat this very annoying and frustrating medical problem, carrying the world’s greatest side effect: better erections.

When Meds Aren’t Enough

Sometimes medications are not enough and surgical intervention is necessary. Again, the main purpose of these therapies is improvement in a man’s urinary symptoms which in turn improves quality of life. These procedures involve either shaving the prostate, melting the prostate, placing clips in the prostate, embolization of the blood supply to the prostate, and sometimes removal of the prostate. Most of these procedures are ambulatory surgeries with the man going home within 24-hours of having had the procedure. Like the oral medications for reliving the symptoms of BPH, these interventions are safe, effective, and well-tolerated.

Prostate cancer screening is an incredibly important part of maintaining a man’s good health

Now, prostate cancer is one of the most common cancers that men get, second only to skin cancer. Like BPH, prostate cancer may present similar urinary symptoms. A tumor may press on, and constrict the urethra, inhibiting the flow of urine. Other symptoms of prostate cancer may include blood in the urine or ejaculate, pain or burning during urination, and new onset of erectile dysfunction.
Prostate cancer screening is an incredibly important part of maintaining a man’s good health, especially for men entering middle age. Men over 40 should have prostate work-ups annually. This involves a digital rectal exam and a blood test called the PSA.

What Is Your MD Feeling For?

The digital rectal exam (DRE) is still a major part of the initial workup when it comes to assessing and evaluating prostate health. This is for both benign and malignant processes. When a medical practitioner performs this during the physical exam they are looking for size of the prostate, nodules, masses, bogginess and asymmetry, to name a few findings. As an adjunct, imaging studies can also be obtained. This provides further detail and information regarding prostate health and is quickly becoming standard of care to evaluate for tumors or lesions in the prostate.
So next time you are wondering why you have been having so much trouble urinating, remember these facts:

1. You are not alone
2. You may have BPH
3. You need to see a Urologist

BPH is very manageable and seeing your urologist will not only make sure you are not dying of cancer, they can help improve your quality of life with some very safe, affordable, and highly effective treatment options. Do not suffer in silence. Tell your doctor about that plumbing problem you recently noticed, because you may have BPH.

Author:

Daniel R. Martinez, M.D.

Urology Specialty Care/Vital M.D.
Chief of Urology, Baptist Hospital Main
Sexual Medicine, Andrology, Male Infertility at Miami Cancer Institute
Clinical Instructor, F.I.U. Wertheim College of Medicine

7600 SW 87 Ave., Suite 206
Miami, FL 33173
Phone: (305) 275-5525
Fax. (305) 275-0662