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Bladder conditions What's the most-common illness among men 50 and older? You might logically guess the common cold, but you'd be wrong. Though it's pretty much hush-hush beyond the urologist's office, trouble urinating is actually the most-common affliction of the aging male. How
common? Sometimes BPH is mild, merely sending you on multiple trips to the restroom at night. Occasionally it can be severe, obstructing urine flow completely or causing kidney damage.
But most often, though it's irritating and even embarrassing (when you spot your pants, for example), BPH isn't deadly. How
do you know if you have BPH?
What
can you do about BPH? Most of those operations are not necessary to correct this problem. They're elective. Unless tests reveal a dangerous complication of BPH, surgery is an extreme solution. Men choose TURP out of frustration; they're simply fed up with the hassle of BPH. But I'm convinced that many of them wouldn't if they knew about the alternatives. Mild BPH seldom justifies the inherent risks of surgery: anesthesia, transfusions (TURP can cause significant blood loss) and the rare complications of impotence and incontinence. There are less-risky, less-expensive options to try before facing a two- to four-day hospital stay, a month of recovery and an $8,000 to $12,000 bill. It appears we are doing everything to the prostate. Microwave, ultrasound, radio frequency waves, laser, and even injections of alcohol! Almost all of these can be done as an office procedure with local anesthesia, supplemented by oral medication. Most require a catheter for one or two days and can be associated with worsening of the symptoms prior to improvement. Recently a new type of laser (Green Light) has become quite popular. It was pioneered at the Mayo Clinic and the results are now approaching 10 years. The procedure is done under anesthesia at the hospital and takes about an hour. 90% of my patients are able to leave the hospital without a catheter and return to work within one or two days. For some of the patients, there is a worsening of the urgency and frequency prior to the symptoms disappearing. First try just waiting for a while. In one study at the Medical College of Wisconsin, 35 percent of men with mild BPH got better with a sham treatment—what we call watchful waiting. And for persistent mild-to-moderate symptoms, medical therapy is available. Since the prostate is made up of muscle and glandular tissue, there are two categories of medication. The first include muscle relaxants, Hytrin, Cardura, Uroxatral, and Flomax. Flomax currently has the majority of the market price because of no required dose escalation and fewer side effects than Cardura or Hytrin. Uroxatral is fairly similar but has not been out quite as long. The glandular tissue can be treated with either Proscar or Avodart. Both shrink the prostate by blocking the conversion of testosterone to an active ingredient. In my experience, and studies are showing, Avodart has a much more rapid onset of relieving symptoms than Proscar. In fact, although it is recommended daily, because of a half-life of excess of five weeks in the blood stream, I can even get my patients on a lower less than daily dose. Both types of medications are lifetime treatments. You may have heard about the “over-active bladder,” which is a fairly common condition occurring in women. This has also been shown to occur in men. It is associated with frequency, urgency, incontinence and getting up at night. This can be a result of BPH or a separate entity. There are a number of medications that are “muscle relaxants” (Detrol, Sanctura, Enablex, Vesicare, Ditropan XL and plain Ditropan) which have been shown to be effective for an over-active bladder in women. There has been concern in the past for urologist in regards to using it in men who may have an enlarged prostate. They fear that this could cause them to not be able to empty the bladder or not eliminate as much urine. Studies are now coming out show that this does not appear to be the case. For many men, they might not either be on one of the muscle relaxants mentioned above or medication to shrink the prostate and the bladder relaxant medicine as well. Side effects of the bladder relaxant medication include dry mouth, constipation, and cannot be taken with certain types of glaucoma.
If drugs don't do the job, simpler surgical alternatives may. For some men with moderate BPH troubles, stretching the prostate—called balloon dilation—can at least postpone TURP. And in some cases, a simple lengthwise slit in the wall of urethra—called transurethral incision of prostate, or TUIP—will ease urine flow. The best reason to postpone TURP, though, is what's on the horizon. Alternative BPH treatments are being introduced more rapidly now than at any time since I graduated from medical school. Prostate stents—expandable tubes that hold the prostate open—are being used successfully in Europe, though they're not yet approved by the U.S. Food and Drug Administration. When I sit down with a man these days to talk about BPH treatments, TURP is usually well down the list. I tell him we've got many other options to try first. And I tell him this: The choices are yours! In health. For
the past six months, my urine sometimes turns a sort of rusty color
that looks like blood. It doesn't seem to be much blood, and it doesn't
happen all the time. Should I be concerned? Although there are causes that aren't terribly serious, the number one worry is cancer of the kidneys, bladder, or (occasionally) prostate. Bloody urine is often an early sign of one of these cancers, and there's a good chance of curing it if you heed the warning. One of my patients didn't. It was a year before his wife discovered some blood he failed to clean up and made him see a doctor. I removed a cancer the size of a basketball. Unfortunately, it had already spread, and a year and half later, his cancer was back. Among the not "terribly serious" explanations are infection of a kidney, the bladder, or the prostate, which usually can be treated with antibiotics. Stones caught in a kidney or a ureter (the tubes that connect the kidneys to the bladder) can also be responsible. Less often, nonbacterial inflammation or enlargement of the prostate can release blood into the urinary tract. In fact, even the bouncing from running with any empty bladder can cause bleeding. Of all cancers, bladder cancer is by far the most common: it's the fifth most common cancer in men. We don't know all the causes, but we do know that men who use tobacco products or who are exposed to aniline dyes are more likely to get it. Fortunately, the rate of cure is very good for bladder cancers that are caught early. That's why I can't stress strongly enough how important it is not to ignore this problem. Blood in your urine is not the equivalent of a skinned knee. Don't "tough it out"—get help and live longer.
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