The first sign of urological ageing

However, around 50 years of age, many men might start to feel the very first sign of urological ageing with modification of urination. This is known as Benign Prostatic Hyperplasia (BPH) – or prostate gland enlargement - and is considered the most frequent benign tumor in men. In a study involving 2,000 men over 50 years, 60 per cent had mild symptoms, 15 per cent moderate and 5 per cent severe signs. Only 20 per cent did not complain of any symptoms. While this condition usually remains benign, it may lead to some complications including an acute event that requires an emergency procedure. 

The prostate is a walnut-sized organ that produces the seminal fluid nourishing the sperm. It is found underneath the bladder. The urethra, the tube that allows the urine to pass from the bladder out to the penis, goes through the centre of the prostate. Hence any enlargement of the prostate constricts the urethra, leading to a restriction of urine flow. The causes of BPH are not completely understood and it is thought to be linked to hormonal changes, especially the production of androgens with ageing. 

The most frequent symptom is increased frequency of urination both during the day and at night with too little quantity of urine being passed every time. Other symptoms include difficulty in starting urination, weaker urine flow, urgent need to urinate and the feeling that bladder is not properly emptied.

The condition progressively worsens for most men but 20 to 25 per cent may see some marked improvement in their symptoms, which justifies an initial active surveillance of the problem. In the long term and left untreated, BPH may often lead to complications linked to the consequences of partial urine retention, among them urinary tract infections, bladder stones, bladder muscle damage and even serious kidney disease. In addition, total urinary retention may occasionally occur with the inability to pass urine. In such cases, emergency treatment is sometimes required to relieve the pressure inside the urinary tract. This sudden complication may be triggered by the use of decongestant drugs, which contract the urethra muscular cells.

When symptoms begin to significantly affect daily life, it is necessary to seek a specialist opinion to confirm the diagnosis, rule out other illnesses (such as cancer of the prostate) and possibly receive treatment. The specialist or urologist first reviews the characteristic of your symptoms, conducts a clinical exam that includes a digital rectal examination and suggests several tests depending on your condition. First line investigations may include urine analysis, PSA (Prostatic Specific Antigen) test and lower abdominal ultrasound. The treatment, if needed, will be based on the intensity of the symptoms, the impact on quality of life and the outcomes of the investigations. There are many therapeutic options, starting from medications to various open or minimally invasive surgical techniques using various types of laser procedures. Medications are usually proposed first and work well for a majority of patients for many years.

Alternative medicine with herbal preparations such as the Saw palmetto extract may provide some minor benefits although the American Urological Association does not recommend any herbal therapy due to inconsistent evidence. 

Home remedies can be useful in limiting the impact of the symptoms and include restricting beverages in the evening, avoiding excess caffeine and alcohol, passing the urine as soon as you feel the need or scheduling urination at precise times to retrain the bladder muscle and practicing regular physical exercise.

 

Dr Gerard Lalande is managing director of CEO-Health, which provides medical referrals for expatriates and customised executive medical check-ups in Thailand. He can be contacted at [email protected].