Chris DeWald: Urology/enlarged prostate

In past issues, we have been leading on my yellow (no pun) brick road to ascertain why I had hematuria (blood in the urine). A urologist commented on the previous article, and please listen to his note. I shall add that a man after the age of 40 should get his prostate checked every year. If you have symptoms, of what I am going to write about, you need to see your urologist immediately. Some of you may have to go to your general physician for a referral, and I suggest you do first in any case. This maintains the contact with your general physician and your specialist. You need everyone on the same page to get you healthy and maintain you in good health.

Now I am going to use me again to prevent that you do not get a false sense of security. I was feeling very poorly for months. My stroke issues blend in with many other health issues that come along. Therefore, it is not unusual for me to have phantom pains, muscle contractions and other weird ailments that go along with my deficits. So if you or a loved one has had a stroke, you must advocate for them. Think outside the box for them. Now I have been tested, as a result of my fistula, on my prostate.

From that angle of examination, it appeared my prostate was fine. A blood test used for initial screening for my prostate was in the normal value ranges with a local hospital check and also with the Veterans Hospital. The Veterans Hospital was the one that detected the hematuria.

This then leads to my articles on hematuria and urology. Please notice that despite all these exams, my prostate was fine. It was not until Dr. William Jones III, from Blue Ridge Urological, performed a cystoscopy. It was then discovered that I was now the proud owner of another ailment.

By now, you know I have sense of humor. I have seen all these TV commercials that sell their product to assist in reducing the enlargement of the prostate. Most are comical, and we giggle and make light of the sometimes comedic point on the commercials. I did and I am in my 50s without a great understanding of the prostate, and it won’t happen to me.

It is a subject not talked about the dinner table and most partners. To me, I believe most men have an adversity to discuss it. Having the ability to not discuss it, we tend to brush it off and not know what or why. Therefore, if you want to cringe a little and read this, it may save your life. But then again, it won’t happen to you. I said it because we are “men,” right? Being brave enough to admit you have an issue and to rectify it is being a man. People out there love you and want you healthy.

I have went to many websites that I believe “fluff” the eerie feeling of dealing with this mans issue. The best resource I found was from the National Institute of Health. According to http://kidney.niddk.nih.gov/kudiseases/pubs/prostateenlargement/, the prostate is a walnut-sized gland that forms part of the male reproductive system. The gland is made of two lobes, or regions, enclosed by an outer layer of tissue. As the diagrams show, the prostate is located in front of the rectum and just below the bladder, where urine is stored. The prostate also surrounds the urethra, the canal through which urine passes out of the body.

Scientists do not know all the prostate’s functions. One of its main roles, though, is to squeeze fluid into the urethra as sperm move through during sexual climax. This fluid, which helps make up semen, energizes the sperm and makes the vaginal canal less acidic.

OK, take a breath. Whew, that made me shudder. It is common for the prostate gland to become enlarged as a man ages. Doctors call this condition benign prostatic hyperplasia (BPH), or benign prostatic hypertrophy. OK, its common folks.

Though the prostate continues to grow during most of a man’s life, the enlargement doesn’t usually cause problems until late in life. BPH rarely causes symptoms before age 40, but more than half of men in their sixties and as many as 90 percent in their 70s and 80s have some symptoms of BPH.

As the prostate enlarges, the layer of tissue surrounding it stops it from expanding, causing the gland to press against the urethra like a clamp on a garden hose. The bladder wall becomes thicker and irritable. The bladder begins to contract even when it contains small amounts of urine, causing more frequent urination. Eventually, the bladder weakens and loses the ability to empty itself, so some of the urine remains in the bladder. The narrowing of the urethra and partial emptying of the bladder cause many of the problems associated with BPH.

Many people feel uncomfortable talking about the prostate, since the gland plays a role in both sex and urination. Still, prostate enlargement is as common a part of aging as gray hair. As life expectancy rises, so does the occurrence of BPH. In the United States in 2000, there were 4.5 million visits to physicians for BPH. I told you this was a good site. I was one of the many that feel this is a taboo speaking issue. There are many theories about why this happens in older men and if you need to see it, please go to that website I listed.

Symptoms

Many symptoms of BPH stem from obstruction of the urethra and gradual loss of bladder function, which results in incomplete emptying of the bladder. The symptoms of BPH vary, but the most common ones involve changes or problems with urination, such as

a hesitant, interrupted, weak stream

urgency and leaking or dribbling

more frequent urination, especially at night

The size of the prostate does not always determine how severe the obstruction or the symptoms will be. Some men with greatly enlarged glands have little obstruction and few symptoms while others, whose glands are less enlarged, have more blockage and greater problems.

Sometimes a man may not know he has any obstruction until he suddenly finds himself unable to urinate at all. This condition, called acute urinary retention, may be triggered by taking over-the-counter cold or allergy medicines. Such medicines contain a decongestant drug, known as a sympathomimetic. A potential side effect of this drug may prevent the bladder opening from relaxing and allowing urine to empty. When partial obstruction is present, urinary retention also can be brought on by alcohol, cold temperatures, or a long period of immobility.

It is important to tell your doctor about urinary problems such as those described above. In eight out of 10 cases, these symptoms suggest BPH, but they also can signal other, more serious conditions that require prompt treatment. These conditions, including prostate cancer, can be ruled out only by a doctor’s examination.

Severe BPH can cause serious problems over time. Urine retention and strain on the bladder can lead to urinary tract infections, bladder or kidney damage, bladder stones, and incontinence—the inability to control urination. If the bladder is permanently damaged, treatment for BPH may be ineffective. When BPH is found in its earlier stages, there is a lower risk of developing such complications.

OK, folks, did you see that detection at an early stage is beneficial. I shrugged it off because who wants to talk about it. I felt that my manhood was somehow challenged. Don’t be a Crusty Old Man. See the doc!

Treatment

Men who have BPH with symptoms usually need some kind of treatment at some time. However, a number of researchers have questioned the need for early treatment when the gland is just mildly enlarged. The results of their studies indicate that early treatment may not be needed because the symptoms of BPH clear up without treatment in as many as one-third of all mild cases. Instead of immediate treatment, they suggest regular checkups to watch for early problems. If the condition begins to pose a danger to the patient’s health or causes a major inconvenience to him, treatment is usually recommended.

Since BPH can cause urinary tract infections, a doctor will usually clear up any infection with antibiotics before treating the BPH itself. Although the need for treatment is not usually urgent, doctors generally advise going ahead with treatment once the problems become bothersome or present a health risk.

Drug treatment

Over the years, researchers have tried to find a way to shrink or at least stop the growth of the prostate without using surgery. The FDA has approved six drugs to relieve common symptoms associated with an enlarged prostate.

Finasteride (Proscar), FDA-approved in 1992, and dutasteride (Avodart), FDA-approved in 2001, inhibit production of the hormone DHT, which is involved with prostate enlargement. The use of either of these drugs can either prevent progression of growth of the prostate or actually shrink the prostate in some men. There are other medications but I am trying to make the article palatable.

I am writing this article as a preventable option. If it is a severe case, it can lead to surgery. Now, would you rather take a small pill or have your not talk able area under the surgical knife? This is in the article about surgery. You want to shiver now, read it. If not, check out the symptoms, Is this you? See a doctor now before a surgical knife dices and slices. If you have to undergo a knife, remember it is to save your life. I am at the Finasteride level currently. Surgery is not an option due to my current medical condition that has left me with a constant need for blood thinners. A blood thinner? This prevents the ability of the blood to form clots. Clots are used to prevent your body from bleeding out due to an incision or cut.

I have no after affects of my medication and consider it a great pastel blue color. As always, you are stronger if you are in the know. You either are an advocate for someone or advocate yourself. It is a fact of life for men after 40 years old. Knowing it may be possible, keep you healthy, smile and don’t let things medically get out of control. Hug your doctor, and in turn, they will make sure you can go on hugging.
 
 

Column by Chris DeWald


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