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Lower Urinary Tract

Around 40% (4 in 10) of men aged 60 years or over will suffer from annoying urinary symptoms, some of which will significantly affect their quality of life. The risk of getting such symptoms increases with age and is usually caused by enlargement of the prostate (known as benign prostatatic hyperplasia BPH). You will see from the diagram that the urethra (waterpipe) passes through the prostate so that as the gland enlarges the flow of urine is blocked. To overcome this, the bladder muscle works harder than normal to force the urine out. This leads to some or all of the symptoms listed below. It also makes it more difficult for a man to empty his bladder completely.

Symptoms associated with an enlarged prostate:

  • A weak stream of urine.
  • Difficulty starting the flow of urine and needing to strain.
  • Frequent visits to the toilet to pass urine.
  • Stopping and starting during the flow.
  • Urgency – needing to rush to the toilet and being unable to hold on.
  • Getting up frequently during the night to pass urine.

Investigations

Here are some of the key investigations that may be recommended to you if you suffer from troublesome urinary symptoms.

Flow test

This is performed in clinic to measure urinary flow. Following the flow a bladder scan is often performed to measure the amount of urine left in the bladder. The flow machine is situated in the toilet so you can pass urine in privacy.

PSA test

This is a blood test. PSA is a natural protein that leaks out of the prostate into the bloodstream and is raised in the presence of infection, if you have a urinary catheter. Sometimes it just appears for no particular reason which may be normal for you.

Other investigations that may be suggested

Transrectal ultrasound and biopsy (prostate biopsies)

If a patient is found to have an unexplained high PSA reading we will recommend this test to check whether you might have prosate cancer. It involves passing a narrow lubricated tube into the back passage, to allow measurements of the prostate and the taking of biopsies (tiny pieces of tissue) under local anaesthetic.

Flexible Cystoscopy

This is a day case procedure and involves passing a narrow flexible telescope down the urethra (waterpipe) into the bladder under local anaesthetic

Rigid Cystoscopy

This is similar to the flexible cystoscopy, but uses a wider rigid telescope and is performed under general anaesthetic allowing any additional procedures to be done at the same time such as taking bladder biopsies.

Videourodynamics

This test investigates the function of the bladder – what happens as it fills and empties. It is performed in the Spinal X-ray department and involves passing very small tubes into the bladder and back passage under local anaesthetic and slowly filling the bladder with fluid while the pressures in your bladder are measured. Once you are full you are asked to pass the fluid out around the tube

Treatment

  1. Sometimes simple life-style changes are enough to improve your symptoms. Under ‘General Urology Advice’ you will find some useful tips about keeping your bladder healthy.
  2. Medication – Depending on how bad your symptoms are, your urologist may offer you tablets to help relax the prostate or to shrink it. In some cases a combination of both of these may be recommended
  3. Surgery – If medication has not worked or if your symptoms are severe, your urologist may recommend an operation called Transurethral Resection of Prostate. This is an operation to remove the central part of the prostate that is obstructing the passage of urine. Like the rigid cystoscopy already described, it involves passing a rigid telescope through the urethra and into the bladder. The stay in hospital is usually 1 – 2 days.