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What
is the prostate?
The prostate is a fleshy organ which is wrapped around the neck of
the bladder like a ring doughnut or like a thick collar open at the front.
It is made of glands and muscle. When a man has an orgasm, the prostate
muscle squeezes fluid from the glands into the semen where it seems to
energise the sperm.
Why do men get prostate trouble?
In boys and young men the prostate is tiny but for reasons which we do
not know it gets larger later in life. The amount of enlargement varies
from man to man as do the problems which it causes.
In most men this is an entirely benign process which is so common that
it can almost be considered a normal part of getting older. In only a
very small number of men is there a cancerous growth of the prostate.
Because of its position, the enlarging prostate can throttle the outlet
from the bladder (like tightening a collar) until it interferes with the
flow of urine through the bladder outlet (urethra).
Illustration reproduced with permission from "Urinary
Incontinence" by Julian Shah and Gary Leach,
published in their "Fast Facts" series by Healthpress
Ltd Oxford
How will I know if my prostate is causing trouble?
Sometimes the first thing you notice is difficulty in actually passing
water. The flow is slow and it may be troublesome to get started, especially
if you have delayed going to the toilet. You can find yourself waiting
several minutes for the flow to begin and even straining produces only
a feeble dribble. It is often worse at night.
Another sign of prostate trouble is the "jumpy" bladder. The urge to go
comes more and more often. Your friends begin to remark on your frequent
visits to the Gents. Turning on a tap, turning the key in the door on
returning home and getting up in the morning may trigger the bladder so
strongly that it leaks before you can get to the lavatory. Your sleep
is increasingly disturbed by the need to pass water and your activity
may be restricted by the need to be in constant reach of the loo. If the
bladder is really full it may overflow at night, so that you wet the bed
and it may cause problems by back pressure on the kidneys. You may even
get a complete blockage (retention) and need emergency treatment - a painful
and alarming way to find that you have prostate trouble!
What should I do?
The first thing you need to do is, with your doctor, to find our how much
trouble you have. If things are not too bad, he may suggest bladder retraining
or pelvic floor exercises or both. On the other hand, if you have symptoms
which are interfering with your life, or the bladder is really failing
to empty, it is probably best to have something done.
Your doctor will decide if you should see a urologist, a doctor who specialises
in "waterworks" problems.
What will the urologist do?
The urologist will want to find out the extent of prostate trouble. The
story you give and a medical examination will provide a lot of help but
most of the useful information comes from a set of routine tests.
These usually include a urine test (to look for infection), an X-ray or
ultrasound scan (to check how well the bladder and kidneys are coping),
blood tests, and a urine flow test
to see how fast you pass your water.
When these tests are done the urologist will usually be able to tell you
whether you need treatment for your prostate and whether there is any
hint of more serious trouble (like the rare cancerous growth of the prostate
- for more details about this see the relevant part of the Imperial
Cancer Research Fund website). Sometimes some more complicated tests
are needed to give all the answers: if they are, do not hesitate to ask
for them to be explained. Always remember that your doctors are there
to help you!
If I do need treatment, what can I expect?
Your GP, even after checks by a urologist, may well decide not to
prescribe any treatment, but simply to ask you to come back after a certain
period for a check up. But if your symptoms become more troublesome during
this time, you should go back to your GP.
If he decides treatment is advisable, the exact treatment that you receive
will depend on the severity of your symptoms, and the degree to which
they bother you.
Problems from an enlarged prostate can often be relieved by medicines,
and there are several drugs that your GP can prescribe. These will work
in one of two ways: by relaxing the muscle surrounding the prostate, bladder
and urethra, or by gradually reducing the size of the prostate. Both have
the effect of widening the urethra, thereby allowing urine to flow more
freely.
Will I need an operation?
If your symptoms are severe the urologist may recommend that you have
an operation. The procedure is straightforward and involves removing part
of the enlarged prostate gland. The old-fashioned cutting operation has
been largely replaced by using tiny telescopes passed through the penis
(you have an anaesthetic, of course!). The most popular operation is called
Trans Urethral Resection of the Prostate (TURP), which is suitable for
all but the largest prostate.
Newer treatments using microwaves and lasers are still being tested and
no-one yet knows how well they will work in the long term. You need to
talk to your doctor to see if one of these new treatments might suit you.
Don’t think that because something is new and is in the papers, it is
necessarily better.
What happens after a TURP operation?
There is usually some bleeding from the bladder after a TURP and you will
need to be in hospital for three to four days until it stops. When you
get home you may feel shaky for a while as, although there is not much
to see on the outside, you will have had a major operation. You will need
to take it easy for two weeks and not overdo things for another two weeks
after that. Remember that the older you are, the longer you may need to
recover from surgery.
The hospital will warn you what to look out for when you get home. The
most common problems are infection and bleeding. Your doctor will want
to know if you have a temperature, soreness passing water or a sudden
show of blood in your water. Usually plenty to drink and some antibiotics
will put both problems right but just occasionally another visit to the
hospital is needed.
The operation is very good at curing blockage symptoms but the jumpy bladder
may take much longer to settle. Things may even be worse for a while just
after the operation. Be patient - it may be up to six months before you
see the full benefit. Your District Nurse or local continence service
can give you advice on coping with this. If you are unhappy with the outcome,
do talk to your doctor and ask to see the surgeon again.
Will a TURP stop my sex life?
Not necessarily. Nearly all men who can have erections before the operation
will do so after it. However, most men who have a prostate operation find
that when they have an orgasm nothing comes out of the penis. This is
because the sperm is going back into the bladder instead of outwards in
the usual way. It is a harmless side effect, but is does mean that it
is difficult to father children after a TURP.
What happens if I get a blockage?
If you get a blockage and can’t pass urine at all, it is painful
and you'll need help quickly. This usually means that you might have to
call your GP or go to a hospital casualty department where they can put
a small catheter tube through the bladder outlet into the bladder. Don't
worry. The catheter shouldn't hurt and it will relieve the blockage straight
away.
More detail on recovery from a prostate operation
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[Revised 1 March 2001]
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