Benign Prostatic Hypertrophy

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Benign Prostatic Hypertrophy (BPH) or non-cancerous prostate enlargement is the most common benign tumour in males above the age of 40[1]. Research has found the prevalence of BPH increases with age[2]. The prostate or prostate gland is an important part of the male reproductive system secreting fluid keeping sperm healthy and alive.

In BPH, over time the prostate enlarges slowly causing increasing pressure on the urethra (the tube connecting the urinary bladder to the penis) and the base of the bladder[3].

Common symptoms of BPH are:

1. ‘Urinary frequency’ (the increase of urination during the day)

2. ‘Terminal dribbling’ (urine dribbling after urination) and

3. ‘Urinary urgency’ (the sensation of needing to go again soon after urinating)[4].

The treatment of BPH depends on the severity of the symptoms with management ranging from observation to medical therapy to more invasive options such as endoscopic or open surgery[5].

References

[1] Royal Australian College of General Practitioners (2018, July) Review and update of benign prostatic hyperplasia in general practice. Australian Journal of General PracticeVol 47 (7) doi: 10.31128/AFP-08-17-4292

[2] Lim, K (2017, July) Epidemiology of clinical benign prostatic hyperplasia. Asian Journal of Urology Vol 4 (3) 148-15. doi: 10.1016/j.ajur.2017.06.004

[3] Health Direct (2018, July) Benign prostate hypertrophy. healthdirect.gov.au/benign-prostate-hypertrophy

[4] Better Health Channel (2018, December) Prostate disease. betterhealth.vic.gov.au/health/ConditionsAndTreatments/prostate-disease

[5] Jiwrajka, M et al (2018, Oct) Drugs for benign prostatic hypertrophy. Australian Prescriber Vol 45 (5) 150-153. doi: 10.18773/austprescr.2018.045

Lower Urinary Tract Syndrome (LUTS)

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Lower urinary tract syndrome or LUTS is a nonspecific condition in males related to problems with the lower urinary tract[1]. This includes the bladder, the prostate and the urethra. LUTS becomes more common in older males but is not exclusive and can occur in younger individuals.

Symptoms of LUTS are associated with storing or passing urine and include[2]:

Dribbling after urination has finished
Urine stream that stops and starts
Hesitancy
Sudden and intense urge to urinate
Increased frequency to urinate especially during the night
A weak stream

LUTS have many causes and are often multifactorial. LUTS may be caused by:

Urinary tract infection
Infection and inflammation of the prostate gland (prostatitis)
Overactive bladder
Underlying chronic medical condition such as obesity, diabetes, hypertension (high blood pressure) or obstructive sleep apnoea
Enlarged prostate gland (Benign Prostatic Hypertrophy- BPH)
Some medications

Treatment for LUTS typically begins with a change in diet, behaviour and lifestyle. For example, being more active, managing weight and reducing the amount of refined carbohydrates[2]. In other instances, pharmacological therapy as well as surgery may be considered under guidance from a medical practitioner[3].

References

[1] McVary et al (2018, December) Lower urinary tract symptoms in men uptodate.com/contents/lower-urinary-tract-symptoms-in-men

[2] Healthy Male – Andrology Australia. Urinary Problems (LUTS) healthymale.org.au/mens-health/urinary-problems-luts

[3] The Royal Australian College of General Practitioners (2011, October) Lower urinary tract symptoms – current management in older men racgp.org.au/download/documents/AFP/2011/October/201110arianayagam.pdf

Prostate Cancer

Prostate cancer is the most commonly diagnosed cancer in Australian men[1]. As the risk of developing prostate cancer increases with age, the Prostate Cancer Foundation of Australia recommends all men over 50 to discuss prostate testing with your GP. More importantly, as the symptoms of prostate cancer are very similar to those in BPH and prostatitis, it is important to visit your medical practitioner if you notice any changes or symptoms.

Common symptoms include[1]:

Problems with passing urine including a slow or weak stream
Needing to urinate frequently especially throughout the night
Difficulty getting an erection or having a painful erection
Problems with holding back urine/loss of bladder control
Pain in hips, lower back and chest

Prognosis of prostate cancer is generally good if the cancer is detected early with treatment including removing the prostate, hormone therapy and radiotherapy to kill the cancerous cells[2].

References

[1] Prostate Conditions Education Council. Prostate Cancer prostateconditions.org/about-prostate-conditions/prostate-cancer

[2] Health Direct (2018, August) Prostate cancer healthdirect.gov.au/prostate-cancer

Prostate Conditions

Prostate Skin Treatment Dr Justin Lim Dr Selina Lim Professor Yoland Lim Health Care Laser JUVEFACE

The prostate is a small walnut-shaped gland found in males that help produce semen. The prostate is located just below the bladder and wraps around the urethra (the tube that carries urine and semen out of the body). Active surveillance of the prostate is important as it has a tendency to grow as you age and if too large, can cause a number of health issues[1].

Prostate conditions include:

1. Benign Prostatic Hypertrophy (BPH)- ie prostate enlargement

2. Prostatitis (inflammation of the prostate gland)

3. Prostate cancer

References

[1] National Institute on Aging (2016, July) Prostate Problems nia.nih.gov/health/prostate-problems

Prostatitis

Prostatitis (inflammation of the prostate gland) is caused by bacteria and can affect men of any age. Typically prostatitis is characterised by the prostate becoming swollen, tender or inflamed.

Symptoms of prostatitis can include[1]:

Lower back pain
Blood in urine
Pain when urinating or after ejaculation
A feeling of heaviness behind the scrotum
Needing to urinate more frequently

There are two broad categories of prostatitis: chronic and bacterial[2]. In the cases of bacterial prostatitis, treatment primarily involves a course of antibiotics to kill the bacteria causing prostatitis. In chronic prostatitis as the exact cause is unknown, treatment involves strategies to lessen pain, discomfort and inflammation such as medications called alpha-blockers aimed to relax the muscles in the prostate.

References

[1] Queensland Health – Queensland Government (2019, April) Everything you need to know about your prostate health.qld.gov.au/news-events/news/prostate-facts-awareness-enlarged-testing-cancer-symptoms

[2] National Institute of Diabetes and Digestive and Kidney Diseases

Renal stones

Renal stones, also known as kidney stones, are solid deposits that form in the kidney over time due to high concentrations of substances such as calcium, oxalate, cystine or uric acid found in urine[1]. However, kidney stones can still form if not enough urine is being produced. The risk of developing kidney stones is quite high with 4-8% of the Australian population being affected with a higher prevalence in females than males[2]. Furthermore, not only is there a genetic and ageing predisposition but studies have highlighted approximately 30-50% of people will develop a second kidney stone within five years of their first[3].

Applying effective strategies is crucial for prevention and consists of lifestyle changes such as reducing coffee intake, staying hydrated, reducing salt and processed food intake and reducing the intake of drinks containing phosphoric acid such as carbonated drinks1.

Detection and diagnosis of kidney stones may include urine tests, ultrasounds, CT scans and blood tests ordered by Professor Yoland Lim Health Care doctors.

Common symptoms as a result of the formation of kidney stones includes:

pain just below the ribs
blood in the urine
shivers
sweating
fever
nausea
vomiting
urgent feeling of needing to urinate[2]

In the majority of cases, kidney stones do not require medical treatment (with the exception of analgesia to alleviate pain) and will pass by themselves. However in some cases where kidney stones do not pass by themselves or is causing severe infection or bleeding, medical treatment is required. These can include invasive techniques such as endoscopy and percutaneous nephrolithotomy or non-invasive techniques like extracorporeal shock-wave lithotripsy[1].

References

[1] Better Health Channel. Kidney stones. betterhealth.vic.gov.au/health/conditionsandtreatments/kidney-stones

[2] Kidney Health Australia . Kidney stones. kidney.org.au/your-kidneys/detect/kidney-stones

[3] Royal Australian College of General Practitioners (2017, September). Urolithiasis – Ten things every general practitioner should know. Urology Vol 46 (9) 648-652.

Urinary Tract Infection (UTI)

UTI Skin Treatment Dr Justin Lim Dr Selina Lim Professor Yoland Lim Health Care Laser JUVEFACE skin

Urinary tract infection (UTI) is an infection caused by bacteria entering the urinary system. The urinary system consists of the kidneys, the ureters (the tubes connecting the kidney to the bladder), the bladder and the urethra (the tube where urine exits the body). UTIs can occur in any one of these locations or a combination of both[1]. The urinary system is an important system of the body helping to minimise the risk of infection in the kidneys by preventing urine from flowing back up into the kidneys from the bladder[2].

Although UTIs are very common and can affect anyone, UTIs are more prevalent in females with around 1 in 2 females and 1 in 20 males being affected[2]. This is primarily due to females having shorter urethras than men resulting in a shorter distance for bacteria to travel from outside the body to inside.

Common symptoms of UTIs include[3]:

Feeling pain or a burning sensation when urinating
Passing urine more frequently than usual and with urgency
Feeling the bladder is still full after urination
Urine that is cloudy, bloody or dark

Broadly, it is thought there are two types of UTIs: simple and complicated[4]. In the case of simple UTIs, treatment typically consists of a short course of antibiotic medications. If the UTI is complicated, generally a longer course of antibiotics is prescribed but in more severe cases, intravenous (IV) antibiotic therapy in the hospital may be required. It is important to treat UTIs as if untreated; UTIs can lead to kidney infection.

References

[1] SA Health – Government of South Australia. Urinary tract infection (UTI) – including symptoms, treatment and prevention. sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/health+topics/health+conditions+prevention+and+treatment/infectious+diseases/urinary+tract+infection/urinary+tract+infection+uti+-+including+symptoms+treatment+and+prevention

[2] Better Health Channel (2018, May) Urinary tract infections (UTI) betterhealth.vic.gov.au/health/conditionsandtreatments/urinary-tract-infections-uti

[3] Health Direct (2017, December) Urinary tract infection (UTI) healthdirect.gov.au/urinary-tract-infection-uti

[4] Urology Care Foundation (2019, April) Urinary Tract Infections in Adults urologyhealth.org/urologic-conditions/urinary-tract-infections-in-adults