Lower urinary tract symptoms (LUTS) are a very frequent issue for both men and women and unfortunately become more common with age. In men the most likely cause is developing obstruction thanks to non-cancerous growth of the prostate gland (BPH), however, the symptoms may also relate to problems with bladder function and this too may affect women.
Therefore, typically, LUTS are described as being either
Filling or storage symptoms, which include
Voiding or obstructive symptoms, including
All these symptoms are very common and are actually very unlikely to relate to prostate cancer.
A useful tool in assessing the severity of LUTS in men is the International Prostate Symptom Score (IPSS)
The IPSS is an eight question, (7 symptom and 1 quality of life) questionnaire used to derive a score (0-35) and determine the management of Benign Prostatic Hyperplasia (BPH). You can determine your IPSS by visiting http://www.usrf.org/questionnaires/AUA_SymptomScore.html
Typically a score of 0-7 indicates mild symptoms, 8-19 moderate symptoms and 20-35 severe symptoms. Higher scores indicate more severe symptoms. Scores less than seven are considered mild and generally do not warrant treatment. Regardless of your score, if your symptoms are bothersome, you should consult with your doctor.
PSA is not a diagnostic test, it is rather an indicator that there is a risk of prostate cancer. If raised, there are a number of routes which our consultants may follow. Read more about them under the prostate cancer diagnosis section.
When Prostate cancer is diagnosed it can be described as 'early', locally advanced or 'late'. It starts with changes in the cells of the prostate. The cells form a lump which may eventually be felt in a physical examination. When prostate biopsies are taken they are examined by a pathologist who will report the grade of cancer present in the cells. The Gleason system is used to grade prostate cancer and describe how aggressive the cancer is.
A Gleason score of 2 - 4 is least aggressive, a score of 5 - 7 is moderately aggressive and a score of 8 - 10 is the most aggressive.
This is a common condition affecting young and middle aged men. It is often neglected and overlooked as a potential diagnosis, particularly as it can present with a wide range of symptoms ranging from vague aches and pains to a serious acute infection.
Prostatitis literally translated means inflammation of the prostate gland but it describes a spectrum of symptoms. In the majority of cases it is not caused by bacterial infection but a small proportion of men will develop an acute severe infection with a fever and pain and may require a period of time in Hospital. Symptoms of chronic prostatitis often develop slowly and are less severe. It is not always possible to cure prostatitis but it will often settle on it’s own after a period of time. Nevertheless, review by a Urologist is recommended if the symptoms are in any way troublesome.
There are 4 categories of prostatitis which are listed below:
Acute bacterial prostatitis (uncommon - type I)
This tends to declare itself quite quickly with a fever and flu-like symptoms with pain in the genital area including penis and lower back. It can also cause troublesome urinary symptoms and pain with ejaculation. This is a serious condition requiring prompt review by a Doctor.
Chronic bacterial prostatitis (type II)
The symptoms and signs with this type of problem tend to come on gradually and are less severe and often intermittent. The symptoms may respond to a prolonged course of antibiotic treatment. Symptoms include troublesome urinary symptoms including a burning pain when urinating. Discomfort in the prostate and genital area as well as the lower back and abdomen is possible. It can be more difficult to pass water and ejaculation can be painful and there can be blood present. Bladder infections and cystitis can also develop.
Chronic prostatitis and chronic pelvic pain syndrome the most common – type III)
This is by far and away the most common type and tends to cause similar symptoms to type II. It would be very uncommon to have a fever or have any bacteria detected in the urine or ejaculatory fluid although there may be signs of inflammation (some types do show inflammation and others don’t).
Inflammatory prostatitis without symptoms
This isn’t important really as it doesn’t require treatment
There is a lot that we don’t understand with regards to both bacterial and non-bacterial prostatitis. Chronic bacterial infection may follow an acute prostate infection or instrumentation such as catheterisaton. It may also develop following infections elsewhere in the urinary tract or other parts of the body.
The possible risk factors or triggers for non-bacterial chronic prostatitis are listed below:
Stones in the urinary tract are common, between 8-15% of people will get a stone in their lifetime. They can occur at any point along the urinary tract, but they are most commonly found in the kidney, ureter and bladder. Bladder stones will be discussed separately under Bladder Stones.
Stones are formed in the kidney. From the kidney they may gradually grow and then move from the kidney into the ureter (pipe connecting the kidney to the bladder).
The mainstay of treatment for localized kidney cancers is surgical removal and in the vast majority of cases this should involve minimally invasive approaches i.e key hole or laparoscopic surgery or now robotic assisted surgery using the Da Vinci Robot System, rather than open surgery that can result in larger, painful and occasionally disfiguring wounds.Recent times have seen an increase in small (less than 4cm) incidentally discovered tumours thanks to the greater number of scans (ultrasound or CT) performed for other reasons. The aim of surgery should be to remove the tumour with minimum impact upon overall kidney function. This is known as nephron sparing surgery, the nephron being the functioning unit of the kidney. Most often this means a partial nephrectomy (excision of only the tumour mass) although there are other ablative options to kill the tumour e.g cryoablation or freezing of the tumour.
Loss of desire? Difficulties gaining or maintaining an erection? These common problems can be effectively treated.
Although often a difficult topic for men and women to discuss, problems in the area of sexual function are very common in our society and perhaps unsurprisingly are more of an issue the older we get. Such difficulties can relate purely to a loss of interest and desire in sex, i.e. loss of libido.
This may be linked to a decline in production of the male hormone (testosterone) with increasing age. This association has been referred to as the ‘male menopause’ or andropause, although its more accurate label is probably ‘Testosterone Deficiency Syndrome’ (TDS). In such cases, carefully managed testosterone replacement can be extremely effective.
Impotence or erectile dysfunction, i.e. the inability to gain or maintain an erection sufficient for sexual intercourse, is a very common problem in men. It is estimated that over 50% of men aged 40 to 70 years have erectile difficulties.
There are numerous approaches in treating this distressing problem. However, effective treatment requires a more holistic approach than simply prescribing tablets, for erectile difficulties are often multi-factorial.
Urology Partners believe that problems of this nature should be approached as part of a global assessment of male health and through this approach provide the most appropriate and effective treatment regime for each individual.