Man's Walnut Problem

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The prostate gland may be the size of a walnut,but it may grow in size and create some uncomfortable and even painful consequences.
The prostate gland is about half the size of a ball under normal circumstances in a healthy male.While we are still not exactly not sure of the reasons causing this,sometimes the prostate gland can enlarge,leading to a condition called beningn prostatic hyperplasia.



The prostate gland is located just underneath the bladder and it surrounds the urethra,the passage that allows urine to move from the bladder to be expelled when a man answers the call of nature.
When the prostate gland expands,it either squeezes the urethra tightly or causes the muscle in the urethra to contract.The man will be having difficulty to expel urine.

WHAT HAPPENS IF BPH REMAINS UNTREATED OVER TIME?

  • 15% cases,the problem resolves by itself without treatment
  • 30% remain stable
  • however,55% experience worsening symptoms over time.
These symptoms include:
  • they urinate more frequent espeacially during night
  • having difficulty in starting urnation
  • slow,intermittent(stops and starts) urine flow
  • recurrent urinary tract infections (UTI)


HOW COMMON IS BPH IN MALAYSIA?

Research in 2001 shown that
  • 39% of the participants surveyed showsymptoms of BPH
  • the most common bothersome symptoms are,frequent night urination or nocturia,frequent urination and incomplete emptying of the bladder during urination
  • 42% of men aged 50-59 ,65% for men aged 70 or more,90% of men aged 85 or more

TREATMENT OPTION

An urologist will conduct several diagnostic tests to confirm that the patient has BPH.Once diagnosed,the patient will receive appropriate treatment.Depending on the patient’s condition,the urologist may prescribed from the following medications.

 Alpha blockers
(doxazosin,alfusozin,terazosin,tamsulosin) which help to relax the smooth muscles of the prostate and bladder.By this way,the patient can improve the ability to urinate properly.

5 a-reductase inhibitors
This type of medication is for patient with enlarged prostates greater than 40 ml,(finasteride,dutasteride)may be given alongside alpha blockers.This group of medications helps to shrink the prostate gland.

If the symptoms are severe and affects the patient’s quality of life,surgery may be performed to remove the enlarged prostate.

In 2011,US Food and Drug Administration (FDA) approved the use of the medication tadalafil to treat BPH as well as erectile dysfunction.This is welcome news to many men with BPH,as one of the potential side effects of 5 a-reductase inhibitors is erectile dysfunction.With tadalafil,patients can address two problems with a  single pill.

Source:
Assoc Prof Dr Ong Teng Aik

Consultant Urologist

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