Updated: Feb 17, 2020
Monday, 23 Dec 2019 04:15 PM MYT
BY PROF DR CHRISTOPHER HO CHEE KONG
KUALA LUMPUR, December 23 — Lower urinary tract symptoms (LUTS) are complaints expressed by men.
These include problems such as letting the urine out with a poor stream of urine (poor flow), the need to wait for a while before the urine flows out (hesitancy), exerting pressure to force the urine out (straining), interrupted urine flow (intermittency) and urine flow too slowly without pressure causing it to dribble and wet the pants or shoes (terminal dribbling).
LUTS can also present other symptoms, including storage of urine such as incomplete bladder emptying, frequency of urination (needing to go to the toilet more than eight times a day), nocturia (needing to wake up to pee while sleeping at night) and overflow incontinence (unable to control urination).
Why do all these problems occur?
With ageing, men’s prostate continues to grow and urine will flow from the bladder through the prostate.
Growth of the prostate inwards will eventually narrow the opening where urine flows through.
This will cause obstruction; giving rise to poor flow and the need to strain to push the urine out.
When urine flow is weak, there will be intermittent flow and terminal dribbling.
The resistance posed by the narrowed prostate impedes emptying of the bladder causing residual urine in the bladder even after urination.
Therefore the bladder fills up very quickly giving rise to the need to go to the toilet frequently during the day and at night.
When the retained urine in the bladder continues to increase, it will reach a maximal capacity before it flows out of control causing incontinence.
In men, these symptoms or complaints commonly indicate a problem with the prostate.
In older men, it is usually due to the normal enlargement of the prostate (benign prostate hyperplasia) and in some cases, prostate cancer.
Enlargement of the prostate is a natural progression in men as testosterone stimulates the growth of the prostate.
Eunuchs usually do not have this problem.
Growth of the prostate is also influenced by what is known as metabolic syndrome – a myriad of diseases including hypertension, diabetes, hyperlipidaemia, ischaemic heart disease.
Sometimes, the prostate size may be normal but the elasticity of the prostate – caused by the smooth muscle – is abnormal causing the opening in the prostate to be narrowed.
The most disturbing symptom is nocturia as it disturbs the sleep and also that of their spouse.
Besides that, LUTS is also associated with sexual problems like erectile dysfunction.
If left untreated, complications may occur.
These include bleeding of the prostate seen in the urine (haematuria), bladder stone formation, urine infection and increased pressure in the bladder due to the retained urine, impeding the flow of urine from the kidney which will then lead to swollen kidneys (hydronephrosis) and eventually kidney failure.
Fret not as men with this problem can be helped.
Treatment can come in the form of medication or surgery.
Alpha-blocker drugs including, tamsulosin, alfuzosin, doxazosin, terazosin relaxes the muscles in the prostate and therefore widens the opening in the prostate to
ensure smooth flow of urine.
On the other hand, 5-alpha reductase inhibitor drugs (dutasteride, finasteride) may help shrink the prostate.
Surgery is an option for those who do not want medication, or if the medication does not work and causes problems.
Surgical procedures are also considered when the prostate enlargement is so bad that it causes complications like retention of urine, stones, infection or bleeding.
The gold standard in terms of treatment is the minimally invasive transurethral resection of the prostate (TURP) where a scope (small tube) is inserted into the penis to reach the prostate and the prostate is sliced from within its opening, to widen it.
There are other options like using laser, microwave, water jet and steam, but the most widely practised is still the TURP.
Can prostate enlargement or LUTS be prevented?
The risk can be reduced.
The western diet is a culprit and therefore intake of a well-balanced diet, high in vegetables and fruits will help, while protein and fat should be reduced.
Other lifestyle modifications have also been shown to reduce the risks of prostate enlargement.
Such changes include moderate exercise (30 minutes three times a week), maintenance of the ideal body weight, reduction of alcohol intake and cessation of smoking.
LUTS and prostate enlargement is quite a common problem as men grow older.
In men above 50, the incidence is almost 50 per cent and this figure increases with age.
Unfortunately, many men, despite being bogged down by this problem, refuse to seek medical help which could be due to the lack of awareness, lackadaisical attitude or just the ego of men in denial.
It is hoped that with better awareness more men will come forward to address the issue.