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Elderly male above the age of 50 may experience problems in urination, and some of the symptoms may include the following:
- Difficulty in initiating the urine flow / need to strain to urinate
- Weak stream
- Post micturition dribble
- Sense of incomplete emptying / urinary retention Increased frequency of urination
The commonest cause is benign prostate hypertrophy (BPH), another common cause is side effect of medications eg: anti depressants, anti parkinson agents, beta adrenoreceptor agonists.
Before arriving at this diagnosis, it is important to exclude prostate cancer, which can mimic BPH. To distinguish between these 2 conditions, the urologist will usually perform a physical body examination and some blood tests.
During the physical examination, the urologist will insert his gloved index finger into the anus to feel the size, shape and consistency of the prostate. This will help him to assess whether this enlargement is likely to be benign or cancerous.
This is often followed by a blood test detecting the level of Prostate Specific Antigen (PSA). PSA is a substance produced by the prostate gland. The level of PSA can help the urologist to gauge the likelihood of prostate cancer as opposed to BPH.
Once a preliminary diagnosis of BPH has been made, further tests are usually performed:
- ultrasound scan of the kidneys, ureters and bladder
- uroflow test to determine urinary flow
- urodynamics test to measure the bladder pressure
Treatment depends on severity.
In mild BPH, there is no significant blockage to the bladder outlet and the symptoms are not bothersome. Most of these patients can be managed without medication. Lifestyle modifications include the following:
- avoiding certain medications, esp OTC cough and cold medications
- avoid or reduce caffeine intake, especially prior to bed time.
- Avoid fluids before bedtime
- Urinate once there is an urge, do not try to hold and delay the release of urine.
- Double voiding – wait 30s after voiding and try to void again.
In moderate BPH, the blockage to the bladder outlet is not severe but there are bothersome symptoms. Medications are often prescribed to inhibit contraction of the muscle in the bladder neck or urethra; or facilitate to shrink the prostate, thereby helping to improve the flow of urine.
In severe BPH, the symptoms are usually severe and absolute indications for prostatectomy include deterioration in kidney function, development of upper urinary dilatation, urinary retentions and presence of bladder stones.
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