Benign Prostate Disorders
Benign Prostatic Hyperplasia (BPH)
Also known as benign prostate enlargement (BPE), this is a common age-related enlargement of the prostate gland which affects most men over the age of 50. Some urinary symptoms of reduced urine flow, hesitancy to void, frequency of voiding, nighttime voiding (nocturia) and incomplete emptying are commonly experienced. If these symptoms reach a bothersome level then treatment may be right for you. This may be investigated with physical examination, ultrasound scans, and sometimes cystoscopy (telescope examaintion inside the urethra). Treatments could be with prescription medicines to relax (prazosin, tamsulosin) or even shrink the prostate (dutasteride or finasteride).
In instances where more bother is occuring, surgery may be recommended. This may involve telescopic Saline PlasmaKinetic Vaporisation (PVK) Bipolar TransUrethral Vaporisation of the prostate (TUVP), which is more modern than visual laser ablation of the prostate (VLAP), or the lesser Bladder Neck Incision (BNI). Usual hospitalisation is 36 hours with a urinary catheter post op. In a TUVP, the middle core (transition zone) of the prostate is removed to improve flow and bladder emptying. The whole prostate is not removed. It is not by its nature a cancer-treating operation. Subsequent testing and monitoring for the possibility of prostate cancer at later ages is still advisable. Laser surgery has in my opinion the disadvantage of a relatively poor channel created compared to TUVP. The UroLift procedure to 'staple' the prostate open, can be suitable for minor dysfunction, but again does not achieve suitable unobstruction in significant bladder outlet obstruction.
"Prostatitis" and pelvic pain syndromes
A self limiting but sometime a problematic inflammation of the prostate, which may present with pelvic, rectal or perineal pain as well as urinary symptoms. Sexual function may or may not exacerbate the symptoms. Haemospermia may be present (see below). In an acute phase, the disorder is bacterial, but in a more drawn out or chronic phase, is usually non-bacterial, thus antibiotics are not usually helpful. Conservative treatments with salt baths, anti-inflammatories and herbal prostate treatments such as saw palmetto (serenoa) have been shown to alleviate symptoms, as can alpha blocker medication (prazosin or tamsulosin). Surgery such as TURP is ineffective in the management. Very occasionally a bladder neck incision may be useful, but only if there is proven co-existent bladder outlet obstruction.
Many ongoing pelvic, scrotal and perineal pains may originate in the pelvic and abdominal muscles , nerves and ligaments. The disorder seems to correlate with those men who have a sedentary high stress occupation with hypertonicity (high muscle tone) in the pelvic muscles, and often asymmetry of musculofascial tissues in the pelvis. These are best managed with a holistic assessment by a dedicated pelvic physiotherapist, as the lumbar and pelvic anatomy, muscles and trigger points can be identified and a balancing / relaxation pathway formed. I have often found the assessment at Sydney Men's Health Physiotherapy by Mr Stuart Baptist and Mr Matt Crawshaw, in Macquarie Street Sydney, and at Chatswood, very useful for these men.
The presence of fresh or old blood in the ejaculate fluid. While distressing to the observer / owner, very uncommonly does this signify anything like cancerous disease. It may relate to a physical strain and rupture of blood vessels within the prostate or adjacent seminal vesicles. It usually resolves over 6 or more weeks. A check of PSA blood test and a rectal glove examination are mandatory in the investigation of this symptom. Persisting or recurrent haemospermia will generally require an MRI scan and possibly a prostate biopsy to exclude cancer.