Got to go?

07 September 2019

September is Urology Awareness Month. Organised by The Urology Foundation, their aim is to raise awareness of urological conditions. Affecting men and women alike, it is estimated that half of us will be have a urological condition in our lifetime. 

Shahnaz Fraser of Spire Norwich Hospital discusses prostate enlargement with Consultant Urologist, Mr Mark Rochester and overactive bladders with Mr Sam Mukhopadhyay, Consultant Gynaecologist.

Mr Rochester, prostate enlargement is one of the most common diseases to affect men beyond middle age, what is the prostate?

“The prostate is a walnut-sized gland located below the bladder and just in front of the rectum. Enlargement of the prostate gland affects virtually all men over 50. The majority of men in their 60s have urinary difficulties due to this enlargement as it compresses the urethra, the pipe that lets urine flow out of the bladder.”

What are the common symptoms of an enlarged prostate?

“The common symptoms are increased frequency of urination during the day and at night, hesitancy (a delay in starting to pass urine), urgency, weak stream, a sensation of incomplete bladder emptying and straining to pass urine.”

And how would it be diagnosed?

“The diagnosis of an enlarged prostate is made by assessment of symptoms, rectal examination of the prostate gland, urine test, electronic measurement of urine flow called uroflowmetry and an ultrasound measurement of the post-void residual to assess bladder emptying.

In some cases an endoscopic examination of the bladder, called a flexible cystoscopy is required. In some select patients, bladder pressure and flow studies called uro-dynamic studies are useful.”

Mr Rochester continues: “Men with mild symptoms are managed with watchful waiting and offered lifestyle advice, such as avoiding excessive intake of caffeinated drinks. Patients suffering from moderate symptoms are treated with oral medication, many see a noticeable difference over three to six months.”

What other treatment is available for an enlarged prostate?

For patients with severe symptoms, or who’s symptoms have not responded to medication there are a range of procedures available.

  • Transurethral incision of prostate (TUIP) or Transurethral resection of prostate gland (TURP) – carried out under general anaesthetic (meaning you’ll be asleep during the procedure) and requires a stay in hospital of between two-three days.
  • Holmium laser enucleation of the prostate (HoLEP) – is a new procedure that allows tissue to be removed with less bleeding. In most cases this can be performed as a day case (with no overnight stay) and has a lower re-treatment rate than traditional TUIP and is suitable for all men and all sizes of prostate, and has an excellent impact on men’s quality of life.
  • Prostatic urethral lift implant (UroLift) – holds the prostate open rather than removing tissue to improve symptoms. This has the advantage of being performed under sedation or local anaesthetic, with quick recovery.
  • Rezum – a further new procedure where steam is used to reduce the prostate blockage.

Open removal of the prostate through an incision in the lower abdomen is only carried out in a very small minority of patients who have an extremely large prostate gland that cannot be treated by laser.”

Mr Mark Rochester concludes “If you have symptoms related to your prostate, bladder ageing, a urine infection or another causes for concern, it’s very important to discuss these with your GP. If necessary they will refer you on to a specialist for further investigation. It’s always best to check, rather than ignore symptoms, don’t take a ‘fingers crossed’ approach."

So, what is an overactive bladder, Mr Mukhopadhyay?

“An overactive bladder is not a disease, but often a treatable condition, distinguished by passing urine frequently – more than eight times in 24 hours, and more than one time at night, sudden urges to empty the bladder, and for some women incontinence.”

Mr Mukhopadhyay explains; “The bladder has elastic muscular walls that stretch easily as it fills with urine. The urine is held inside the bladder by a valve that stays closed until it’s time to “go”. The pelvic floor muscles below the bladder help to stop any leaks by tensing up when coughing or sneezing. Usually you would get some warning as the bladder becomes full allowing you to hold on.”

“So an overactive bladder is caused by an overactive bladder muscle – it tenses up when you don’t want it to, and even when the bladder isn’t full, leading to a sudden desperate urge to go. Other symptoms include having to go many times in the day and night even if you haven’t had much to drink. It can occur at any age in both men and women, but especially in women who have had previous pelvic operations”.

And what can be done about it?

“An overactive bladder may not be curable, but it can be controlled. Did you know that caffeine can make the symptoms worse? In addition, cutting down on fizzy drinks, alcohol and acidic fruit juices can help.”

“It may also be a good idea to keep a diary, making a note of the times you pass urine, and the amount that you pass each time; and also recording the amount of liquid you’re drinking; when you drink and what you’re drinking. Make a note of any times that you leak urine too. Keep an old measuring jug by the toilet so that you can measure the amount of urine you pass each time you go to the toilet. Your diary will be a great tool for your GP and other healthcare providers.”

“If self-help measures don’t alleviate your symptoms arrange an appointment with your doctor who may be able to refer you for physiotherapy and pelvic floor exercises. In 40% of cases physiotherapy is all that is needed to control an overactive bladder. Should physiotherapy prove unhelpful, further help is available. Your GP may try medication to help by making the bladder muscle less likely to tense up and research suggests that medication can work in most people.”

Mr Mukhopadhyay concludes “Anyone with concerns about urinary frequency or urgency shouldn’t feel embarrassed, I hope they feel reassured there are treatment options available to help improve their quality of life”.

Call 01603 255 614 to make an appointment or for further information.

 

All surgery carries an element of risk, and the content of this page is provided for general information only. It should not be treated as a substitute for the professional medical advice of your doctor or healthcare professional.

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