A guide for men about their urinary symptoms
Contents
1. This publication was rescinded by National Health and Medical Research Council on 3 8 2006 and is available on the Internet ONLY for historical purposes Important Notice This notice is not to be erased and must be included on any printed version of this publication This publication was rescinded by the National Health and Medical Research Council on 8 3 2006 The National Health and Medical Research Council has made this publication available on its Internet Archives site as a service to the public for historical and research purposes ONLY Rescinded publications are publications that no longer represent the Council s position on the matters contained therein This means that the Council no longer endorses supports or approves these rescinded publications The National Health and Medical Research Council gives no assurance as to the accuracy or relevance of any of the information contained in this rescinded publication The National Health and Medical Research Council assumes no legal liability or responsibility for errors or omissions contained within this rescinded publication for any loss or damage incurred as a result of reliance on this publication Every user of this rescinded publication acknowledges that the information contained in it may not be accurate complete or of relevance to the user s purposes The user undertakes the responsibility for assessing the accuracy completeness and relevance of the contents of thi2. toilet scheduling sometimes it may be more convenient and comfortable for you to draw up atime table for visits to the toilet distraction techniques thinking of something else with the aim of extending the time between visits to the toilet wiping after urinating wipe any remaining urine with some toilet paper Pelvic floor exercises and bladder training programs may be recommended to alleviate your symptoms Appendix D contains details of publications giving more information about these Chapter EE M edication A number of drugs are available in Australia for the treatment of simple urinary symptoms The results of many trials of these drugs show that some men will respond to them and some will not Men who are moderately bothered by their urinary symptoms may prefer to try medication before surgery It is reported that 30 of men who take medication for their urinary symptoms experiencea reduction in the severity of their syrnptoms It is important that you obtain from your doctor specific instructions about the dose and side effects of any medication recommended The law also requires that all drugs have product information included with them so that you can make your awn assessment Product advice known as the Consumer Pharmaceutical Information CPI is also available from your pharmacist You may also like to check with your doctor on which drugs are available on the Pharmaceutical Benefit Scheme PBS
3. as these drugs may cost you less Alpha andrenergic blocking agents Drugs in this group act by blocking the nerve supply to the muscles of the bladder neck sphincter and prostate They alleviate symptoms by decreasing the muscular contraction of the prostate reducing resistance of the urethra This may increase the urine flow Prazosin has been used in the treatment of high blood pressure for over 20 years Its use for urinary symptoms is more recent and there have been very few scientific studies undertaken to determine its effectiveness Terazosin has also been used in the treatment of high blood pressure but is sold in Australia specifically for the treatment of urinary symptoms Scientific studies have demonstrated that in some men this drug can decrease the level of bother of urinary symptoms There is no way to predict who will have a good response to this drug Side effects There is a one in six chance that yeu will have undesirable side effects that may make you decide to stop the treatment They include headaches dizziness a stuffy nose and a feeling of being unwell You may also develop retrograde ejaculation see page 44 for as long as you take the drug If you are bothered by these problems you should stop the medication and visit your doctor If you choose to take these drugs and they work for you you can expect some improvement in symptoms within 6 weeks 5 alpha reductase inhibitor finasteride This drug block
4. Options 49 ADB8001IX68S a a u aiaiai i 51 A Working Party on Voiding Dysfunction in Men 51 Terms of Reference and Membership B Voiding Diary sesser ieee errre nnne 52 Cy Contacts ainai E p a p C 54 D Further Reading Fra SED New Wyuna Spa 55 Preface As men get cider itis very common for them to notice changes in the way they urinate pass water or pee Changes include waking frequently from sieep to urinate in the night a feeling of urgency to urinate during the day and at night occasionally having to wait before urine flow commences aweak urinary stream dribbling of urine after going to the toilet and a feeling of wanting to urinate again just after having done so About 40 of Australian men over 45 years of age report having these changes which doctors cali simple urinary symptoms Similar urinary symptoms occur in women in the same age group Simple urinary symptoms in men are caused by a combination of changes in bladder urethra w ater passage and prostate gland function The symptoms can affect daily activities such as work recreation and personal relationships Some men may also believe that there is something wrong with their health For these reasons they often consult their doctor This book provides the latest information about urinary symptoms in men based on the best medical evidence available Deciding on the type of treat
5. change or a trial of medication or if you are severely bothered by your urinary symptoms you may wish to consider an operation z a d C hoosing a specialist Your doctor may ask if you wish to see aparticular urologist or may recommend one to you You are encouraged to discuss this selection with your doctor You may be unwitiing to travel and so be quite happy to see the specialist w ho is ciosest to where you live On the other hand you might opt to travel some distance to see the urologist of your choice This may be across the city or from a smaller town to a large city where there are various urologists to select from It sometimes comes down to finding the balance between convenience accessibility cost expertise and compatibility Types of surgery There are three standard operations used to treat urinary symptoms transurethral resection of tne prostate TURP transurethral incision of the prostate TUIP open prostatectomy Which one is the best for you depends on factors such as the size of your prostate and any specific medical problems that you may have Because surgery could have complications some of which might be permanent you should give serious thought to your decision Problems that might worry you after suroery There are always risks associated with surgery The major comptications which might arise following surgery for urinary symptoms are as follows retrograde eiaculation
6. in normal ejaculation semen is expelled down the urethra and through the tip of the penis Retrograde eyacuiation occurs when the semen is ejaculated back into the bladder It may result in infertility urinary incontinence or the loss of bladder control impotence the inability to establish or maintain an erection delayed bleeding pain on passing urine retreatment some men may need more treatment after surgery either because of complications or a recurrence of the original symptoms urinary retention inability to pass any urine because of bleeding or other causes scarring surgery may cause scarring to the blauder neck and urethra and a consequent narrowing of the water passage This may require further surgical treatment Research has shown that undergoing surgery for urinary symptoms neither increases nor decreases the risk of prostate cancer developing in subsequent years Transurethral resection ofthe prostate TURP This is the inost common surgical procedure used to treat urinary symptomsin men A resectoscope is passed along the urethra and into the bladder An electric current passed through a wire loop on the end of the resectoscope is used to cut the prostate tissue one piece at atime The pieces of tissue are then flushed out with fluid through the resectoscove The procedure is usualiy performed under a spinal anaesthetic and the operation takes about an nour depending on the siz
7. lifesyle changes SF Satetaciory ove ehn bo dodor sym ypbie Women or change DECIDING HOW TO DEALW ITH YO UR URIN ARY SYMPTO MS bodor offers managerient Surgicd oplions oplions drug In alrnenl sdeded disus wilh GF of suger Drug inantrneri oplan sadede You consider oulcorne unsolistad or Unaceplable side feiz andor ro inproverent in amiploms bu dedde on Surgery Symploms improve Size of prostate gland You dedde fo discon ine medicali on You have a Kal proclale gand You dedde lo conlinue medalion You have a very large sod oe gland Rehm bo doibr F sym ploms I woren or change Open Foch doy To find out the cost and likely out of pocket expenses for any of these treatments ask your general practitioner or specialist You should aiso be aware that you may have some improvement in symptonis without any treatment Even though you are not excessively bothered by your symptoms you might be inclined to opt for surgery because you feel it is better to get it over with now rather than when you are older and perhaps not as fit You should be aware that the risks of surgery for simple urinary symptoms increase only slightly as you get older Chapter Advice and Lifestyle Change If you decide that your urinary symptoms are not causing you much bother and you feel that vou can quite happily live with them then there will be no need for furthe
8. sa pagsasalin Translating at pagpakahuluganan Interpreting ay magagamit sa foob ng 24 na oras tumawag sa 131 450 131 450 numaral telefonu arayarak g n n 24 saati vazil1 ve s zl eviri hizmetlerinden yararlanabilirsiniz C s n Dich Vu Phi n Dich v Th ng Ng n trong 24 gi di n thoai 131 450 Contents FOre U AMN riceatinccdtesauanvesiannceanceeasilituanidadsueaiantenen 3 Preface N N uu SG aa aqasha aa aiei ada aani 7 i eee The Urinary System n 9 Sphincter muscles peivic floor muscles prostate gland simple urinary symptoms urinary retention causes of simple urinary symptoms urinary symptoms and conditions requiring different treatment other medical conditions factei s which increase the severity of urinary symptoms P re Bothersome Symptoms Mosse Ch error ee 17 3 meu Visiting the Doctor l n na 19 Making your decision explaining your symptoms anxiety about prostate cancer Prostate Specific Antigen PSA testing need a second opinion Alpha andrenergic blocking agents 5 alpha reductase inhipitor anticholinergics non pharmaceutical products 8 MT JETTY Ku N ansa aqawan beder needed haqa 41 Choosing aspeciaiist problems that might worry you after surgery transurethral resection of the prostate transurethral incision of che prostate open prostatectorny surgery aiid orostate cancer Q ians Emerging Treatment
9. Health and Medical Research Council documents are prepared by panels of experts draw n from appropriate Australian academic professional community and government organisations NHMRC is grateful to these people for the excellent work they do on its behalf This work is usually performed on an honorary basis and in addition to their usual work commitments Foreword This consumer s guide to simple urinary symptoms in men has been written to assist you in consultation with your doctor to identify simple urinary symptoms which bother you to the point where they are affecting your quaiity of life It has been written by the National Health and Medical Research Council NHMRC through its Standing Committee on the Quality of Care arid Healtii Outcome s QCHOC Working Party on Voiding Dysfunction in Men The NHMRC has also written Clinical Practice Guidelines for the management of lower urinary tract symptoms in men which has been distributed to interested health professionals and organisations involved in the management of urinary symptems The Consumer s Guide to urinary symptoms is amodified version of that clinical guide Both publications are based on the current medical evidence for the management of urinary symptoms Where the evidence for a course of action is particularly strong it has been highlignted Those who would prefer more information or who wish to check the references from which this information was drawn c
10. Tel 03 9419 2163 These are national bodies If you call them they will give you local contacts Appendix Further Reading Clinicai practice guidelines for the management of uncomplicated low er urinary symptomsin men Publications Office National Health amp Medical Research Council Mail Drop 50 GPO Box 9848 Canberra ACT 2601 Prostate Cancer Screening Questions and Answers Australian Health Technology Advisory Committee Mail Drop 107 GPO Box 9848 Canberra ACT 2601 Fact sheets Pelvic Floor Exercises for Men Bladder Training Good Bladder Habits Bladder Problems amp the Prostate e WhatisUrinary Incontinence Continence Foundation of Australia GPO Box 9919 in your capital city
11. Transurethralincision ofthe prostate T U IP TUIP isthe most suitable operation for small prostate glands Larger glands require a TURP A TUIP is aiso performed with aresectoscope One or two cuts are made into the bladder neck and prostate to widen the urinary passage TUIP does not involve removal of any of the prostate The operation can be done as a day procedure or a stay in hospital of 1 2 days may be Involved The operation takes about 20 minutes and is usually performed under general anaesthetic You may need a catheter for 24 hours to ensure urine drainage from the bladder Most men are hack to full activities within 10 days Follow up studies have shown that 70 of men who have a TUIP report asuccessful outcome The average risks of various complications that may occur following TUIP are retrograde ejaculation ejaculation back into the bladder 25 incontinence loss of bladder contro 0 2 impotence inability to have an erection Although tnere is no recent information on the incidence of this complication it seems very unlikely that impotence will occur up to 15 of men who have aTUIP will need retreatment within 5 years of their surgery bladder neck scarring leading to further urinary problems 0 4 Patients surveyed 10 years after surgery reported asimilar reduction of symptoms whether they had undergone TURP or TUIP TUIP is aquicker and simpler procedure requiring less time in hospi
12. also have an effect on the diagnosis A physical examination will also be required Your doctor will examine your abdomen to see if you have a distended bladder Your genitals may be checked for abnormalities which can affect your ability to urinate Your prostate gland may be examined This examination is called a digital rectal examination DRE and involves your doctor sliding a lubricated gloved finger into your rectum to feel the shape and texture of your prostate gland Ina digital redial examination your dodor fedstheshapeand isxture of your prostatedand with hisfinger through theredum Your urine will be tested to see if you have aurinary tract infection and to check for protein sugar white and red blood cells these may indicate that you have another medical condition The doctor may ask you to keep avoiding diary for the nextfew days You will be asked to record the time and volume of fluid intake and time and volume of urine output Any episodes of incontinence should also be recorded You may choose to keep a voiding diary Appendix B of this booklet gives an example before your initial consultation Your doctor witi discuss the results of your examination with you If you are at ail unsure about what the test results mean don t hesitate to ask more questions Anxiety about prostete cancer Anxiety about prostate caricer is becoming a major reason why men consult a doctor This anxiety may oe yours alone or shared or
13. an get acopy of the full guidelines by contacting NHMRC Publications Maii Drop 50 GPO Box 9848 Canberra ACT 2601 hope that you find this consumer s guide to simple urinary symptoms in men informative and helpful Professor Richard Smallwood Chairman of Council Arabic Chinese Croatian Greck Italian Khmer Macedonian Malaysian Polish Portuguese Russian Serbian Spanish Tagalog Turkish Vietnamese aS dl e hail dels Y dig udtlig in GSI doa il Las sit 131 450 al OSIRIS RS 24 SHEARS 64 131 450855 Slu ba prevoditelja i tuma a raspolo iva je 24 sata nazovite 131 450 LATIDEVTAL umrnogo e HETOPQAOT V xat eguyv wv 24 MOE TO ELKOOLTETOMOO THAEPWVO 131 450 Servizi tracuttori ed interpreti disponibili 24 ore su 24 teleronare al 13 450 goal pian ShontpTMAN OPA Ann ningning mmi gina grata emo Geo 4 IIpeBgenypauKara ciyx6a BH CTOM Ha pacnonararbe 24 uaca Temedcounpajte na 131 450 Perkhidmatari penterjemahan dan jurubahasa disediakan 24 jam sehari telefonlah 131 450 T umaczenia ustn pisemne 24 godziny na dobe tel 131 450 Encontra se disponivei servico de int rpretes e tradu es durante 24 horas pele telefone 131 450 KpyriocyTouHble yenyru nepeBoganKoBb Tenedou 131 450 Ciryxk6a rmpeBonuJtana H TYMAYA CTOjM BAM Ha pacnosaraby 24 uaca Ha3opure 131 450 Para obtener servicio de int rpretes y traductores las 24 horas telefonee al 131 450 Ang mga paglilingkod
14. anal problems or for hernias Developing urinary retention does not necessarily mean that you will need an operation C auses of simple urinary symptoms For along time the sole cause of simple urinary symptoms was believed to be enlargement of the prostate gland It was thought that the enlarged prostate pressed on the urethra obstructing the urine flow and creating the urinary symptoms Itis now known that this is not the only explanation Simple urinary symptoins are caused by a combination of changes in bladder urethra and prostate function some of which are likely to be related to age For example obstruction to the flow of urine may be caused by over activity of the muscles in the prostate and symptoms of frequency urgency and even urge incontinence may be due to over activity of the bladaer muscle Increase in the size of the prostate is known as benign prostatic hyperplasia BPH Thedegreeof enlargement variesfrom man to man andisoflitileimportanceasressarch hasshown thatthereisno dearconnedion between theszeoftheprodateand thetypeand severity ofurinary symptoms If alt you have are simple urinary symptoms and no other condition it is extremely unlikely that you have any serious problem which could cause any health threat to you either now or in the future You may feel nevertheless that your symptoms interfere with your quality of life Urinary symptoms and conditions requiring different treatment There are other
15. e options and treatments There is strong evidence to suggest that people who are very botherea have a better chance of achieving a good result from treatment if you are not very bothered you may find the result of treatment is no better or even worse than your current condition Chapter Visiting the Doctor Making your decision You may decide that the information in this book is sufficient to permit you to make your own decision regarding any further management of your urinary symptorns If you decide that your urinary symptoms are best discussed further with your doctor then this guide may help you to ask the most appropriate questions This should ensure that you will be adequately informed about your condition and its treatment Your decisions wiil be more effective if you understand more about the problem Some men have found that talking to other men who have had similar experiences has helped them to make up tneir minds Appendix C gives information about such support groups Explaining your symptoms If you decide to visit your doctor you need to explain your symptoms and how severe they are and if you have had these or similar symptoms in the past You will also be asked about your general health any specific medical problems any previous operations and any medications that you may be taking Your doctor will also be interested in any social or psychological problems that you might have as these may
16. e of the prostate Aresectoscope and thesurgeon s view through it during TURPBeforethe operation A theprostateis enlarged Thesurgeon usesthe cuttingdeviceot the resectoscopeto removepieces of enlarged prostate B Attheend oftheoperation O theenlarged prostate hasbeen cored out Following the operation a catheter will be inserted through the openingin your penisfor 24 72 hoursdepending on the amount of bleeding It is used to drain urine and wash out blood from your bladder Once the catheter is removed you should be able to pass water easily The hospital stay for TURP is generally 2 4 days and you could exnect to be back to full activities within 4 weeks Follow up studies nave shown that 75 of men who have a TURP report asuccessfu outcome The average risks of various complications that may occur following TURP are retrograde ejaculation ejaculation back into the bladder 80 incontinence loss of biadder control 3 impotence inability to have an erection up to 14 The chance that this will occur may cepend on the man s level of potency before surgery Some men s potency may improve after an operation in many there is no change and in some it deteriorates up to 10 of men who havea TURP wil need retreatment within 5 years of their surgery post operative bleeding sometimes with urinary retention up to 13 bladder neck scarring leading to further urinary problems 2
17. ealth Outcomes Committee s draft first edition of Guidelines for the development and implementation of clinical practice guidelines Provide advice and present clinical practice guidelines to the Quality of Care and Health Outcome Committee Membership Dr Geoffrey Hirst Chair Urologist Dr James Butler Health economist Dr Veronique Lajoie General practitioner Dr Peter Maher Urologist Professor Villis Marshall Urologist Dr Michael Sladden General practitioner Mr Anthony Walsh Consumer representative Dr Jeanette Ward Methodologist Health services representative Ann Burgess Freelance writer Appendix 3 SEEPS Voiding Diary TIME WOLUKLE CHAR Courtesy Continence Foundation of Australia TIME VOLUME CHART ton i LL LL lt 5 lt lt s Ht u INTAKE pe ne ee wana S Appendix HEPES AEE Contacts Council on the Ageing Australia Carers Association of Australia Level 2 3 Bowen Crescent Cnr Hilder and Gritten Streets Melbourne VIC 3004 Weston ACT 2611 Tel 03 9654 4443 PO Box 3717 Weston ACT 2611 Tel 06 288 4877 Australian Cancer Society Level 9 140 Williams St Continence Foundation of Australia Woolloomooloo NSW 2011 GPO Box 9919 in your capital city Tel 02 9358 2066 rreecail 1800 069 789 Australian Kidney Foundation USTOO Australia prostate disease 1st Floor 82 Melbourne St support groups for men North Adelaide SA 5006 59 Victoria Parade Tel 08 8267 4555 Cetiingwood VIC 3066
18. essive quantity of urine medications Many of these problems can be overcome to reduce tne severity of the urinary symptoms In addition to your doctor you can seek assistance from health professionals such as nurses physiotherapists and occupational therapists who can help make your symptoms ess bothersome Chapter EE Bothersome Symptoms This book uses the term bother or bothersome to describe your concernsabout urinary symptoms There may be anumper of reasons why you become concerned or bothered by your urinary symptoms You may find that the severity of some or all of your symptoms interferes with your quality of life On the other hand you may not be particularly bothered about this aspect of the symptoms nstead you or your partner may be worried that the symptoms may indicate a more serious underlying problem You should think about how concerned vou are about your symptoms You might start by asking yourself whether the symptoms bother you sufficiently to consider finding out what treatment is available You may like to discuss this with your doctor or assess the degree of bother by choosing from the followina list the option which best matches how you feel am not at all bothered am bothered just a little bit am moderately bothered and would like to consider the options before deciding if want any treatment and if so which type am very bothered and definitely want to consider th
19. even initiated by others close to you such as your partner family member or friends While the anxiety may be caused by urinary symptoms it may also be heightened by other factors such as publicity given to prostate cancer Keep in mind the following facts Most men do not develop prostate cancer Only 1 in every 18 men will be founda to have prostate cancer during their lifetime and only 1 in 70 will die of the disease Of all the men with prostate cancer only one in three die of the disease itself and the other two from some other cause Prostate Specific Antigen PSA testing This is a blood test to see if there is any likelihood that you might have prostate cancer but remember that it is not specific for this disease It is important for you to make your own decision about whether you wish to be tested for prostate cancer To decide you need to know the following The test uses asample of your blood to measure the level of prostate specific antigen in your body Normal test results fall between 0 and 4 nanograms a nanogram is a billionth of a gram If your test result is normal this does not completely rule out the possibility that you have prostate cancer It does suggest however that the chance of you having it is quite slight On the other hand araised level does not automatically mean that you have prostate cancer he likelihood that you have cancer will depend to some extent on the level of PSA If it is below 10 nanog
20. he best efforts of you and your doctor you are unable to get all the information or advice you fee you need to make your decisions Whenever such a situation arises you should think about a second opinion Having a second opinion can heip clear up any questions in your mind can assist you in deciding which doctor you prefer to manage your treatment and can help you dacide which course of treatment to follow While some pecpie are embarrassed to tell their doctor that they wish to have another opinion it may be in your best interest to do so If you decide to take this step ask that all the information already known about your condition be forwarded to the next doctor This will save you time and effort Chapter SEEPS Urinary Tests Traditionally there have heen a number of tests which have been performed on rnen with urinery symptoms These have been done on the presumption that the findings may help the doctor to advise you what the probable course of your symptoms is likely to be particularly if you decide against immediate treatment and help to predictthe outcome o treatment in your specific case Unfortunately there is no strong scientific evidence that any of these tests are particularly useful in helping to predict the need for or the likely outcome of treatment for simple urinary syinotoms On the other hand there may be some specific feature of your history or examination findings which suggests that one or m
21. ment for urinary symptoms can be difficult Men in consultation with their doctor can use the information in this book to help decide what treatment if any they should have Mary men believe that urinary symptoms might indicate prostate cancer Prostate caricer and its treatment fall outside the scope of these guidelines which are about simpleurinary symptoms This is not a book you need to sit down and read from cover to cover It can be read in one go or different sections can be read as the need arises It may be of extra help to you if you discuss the information in the book with adoctor family members or a friend Chapter EEE The Urinary System As your blood passes through your kidneys it is filtered of excess water and waste substances The waste produced is urine From each kidney the urine flows down a tube the ureter and enters the bladder which acts as a reservoir until you to go to the toilet Your bladder is able to store urine by expanding in response to an ever increasing volume The dlaader will usually comfortably hold from 350 mL to 500 mL equivalent te about a small can of soft drink Most people need to empty their bladdei four to six times a day Sphincter muscles The sphincter muscles in males are located at the neck of the bladder encircling the urethra w ater passage While the bladder is storing urine the muscles contract keeping the urethra and bladder neck closed When you are about to
22. n you need to pass urine They may also help control urge incontinence All of these drugs reduce the contractility of the bladder and might Cause an increase in the difficulty in passing urine This could in turn induce urinary retention Urinary retention is usually reversible when the effects of the drug wear off after 1 2 days It will require a catheter being oassed through your penis into your bladder to remove the urine For this reason it is advisable to start off with a very low dose and gradually increase it until there is a desirable result without an adverse effect If these agents work for you you should expect an improvement in your symptoms after two weeks of treatment Side effects Besides urinary retention side effects of the anti cholinergics include a dry mouth constipation and possibly blurred vision In some men they may also cause drowsiness and unsteadiness making them more prone to accidents and falls N on pharmaceutical products Most of the medications included under this heading are made of olant extracts and are known as phytotherapeutic agents Very few of these products have been subjected to the same testing as required of other drug therapies and there is limited information about any toxic side effects T his does not mean that they should not be used in the treatment of urinary symptoms but consumers should be aware of their status Chapter Surgery If you have received no benefit from lifestyle
23. ore of these tests might be helpful The tests for urinary symptoms include Serum creatinine a blood test for kidney function that identifies a substance called creatinine which is excreted by your kidneys Unner urinary tract imaging use of ultrasound or x rays for imagirig the kidneys and bladder Post void residual urine estimation PVR estimating the volume of urine remaining in the bladder after you have finished passing urine This is usually done using an ultrasound examination of your lower abdomen or by passing a catnecer into your bladder cystoscopy passing an iristrument through your urethra to look at your prostate and bladder urodynamic studies studies using equipment that measures how fast you passurine aurine flow rate and the pressure in your biadder If you have symptoms other than the sirnple urinary symptoms listedon page 11 then some of the above tests may be necessary to determine their cause Chapter REEE EEEE EEEE EEEE Options for Treatment You will by now have discussed with your doctor the nature and severity of all the symptoms which are bothering you You should also have reported any other concerns such as a fear that you might havecancer or some other serious problem Your doctor will in turn have examined you and tested your urine It wiil now be time for the two of you to discuss your problem If you have heen reassured that you do not have any serio
24. pass urine the sphincter muscies relax opening the bladder neck and taking tension off the urethra The muscles of the bladder wall then contract expeiting all the urine in your bladder Pelvic floor muscles The pelvic floor muscles play an important role in bladder control The floor of the pelvis is made up of layers of muscle and other tissue that stretch like ahammock from the tail bone at the back of your oody to the pubic bone at the front These muscles support your bladder and bow el The urethra and rectum back passage pass between the peivic floor muscles wr kidney ureter TC Vas _ Diagram oftheurinary system in men Thekidneysfilter excess weterandwasie substances from theblood Thesethen passdown theureters to thekadde wher they arestored until voided through theurethra Theprostategland suivounds theurethra just below theneck of thebladdeThe rectum whichisthetinal part of thedigestivesystem islocated to therear of thebladde prostateand urethra Thevascarry sperm from thetestidesto theurethra Prostate gland The prostate gland is found only in men About the size of awalnut it surrounds the urethra just below the neck of the bladder Its job is to secrete a milky fluid which becomes part of the semen and nourishes the sperm Simpie urinary symptoms Urinary symiotoms usually occur with increasing frequency as you get older They are most likely a normal part of ageing These s
25. r action This does not suggest that you should never see your doctor again You should seek further assistance from your doctor if there isa change in your symptoms you become more bothered by your existing symptoms Your doctor may ask you to keep a urine voiding diary for a few days This is a record of your fluid intake anu urine output detailing volumes and times It may be helpful in identifying factors in your lifestyle or medical care which may easily be changed A sample of a voiding diary can be found in Appendix B Simple lifestyle changes that your doctor may advise you to make to minimise the impact of your symptoms on your life include fluidintake change the timing of your fluid consumption so that you drink more in the morning and less in the afternoon and evening This should reduce the volume of urine you produce during the night Do not cut down on the amount of fluid you are required to drink in a day alcohol and caffeine avoid alcohol and caffeine drinks such as cotfee tea and cola They are diuretics and make you pass more urine and more often medication some drugs are also diuretic increasing the amount of urine you make naturally Your doctor will need to advise you about beneficial changes you might make to your medication schedule urethral stripping for after dribble starting behind your scrotum run your finger alona the length of your water passage stripping the urine out
26. rams the chances are from 25 to 30 If the result is above 10 nanograms the risk of having cancer risesto 50 or more depending on the exact value In other words even if the level is raised there is at least atwo in three chance that you wil not have cancer To be more certain you would need to have a siopsy of the prostate which is usually done under ultrasound contrai In 2 of biopsies serious complications arise Even if you were found to have prostate cancer tne Australian Health Technology Advisory Committee AHTAC Report on Screening for Prostate Cancer advises that early intervention and treatment for localised prostate cancer using either surgery or radiotherapy has not been demonstrated to reduce complications of the disease or improve the 10 year survival rate There is no strong evidence that these treatments are better than not having any immediate treatment Whether you personally would benefit from treatment of prostate cancer issomething only you could decide after considerable testing and extensive discussion between you and your urologist Inthe end only you can make the decision whether you wish to be tested for prostate cancer If you would like more information about this you can obtain a copy of the AHTAC Report by writing to AHTAC Mail Drop 107 GPO Box 9848 Canberra ACT 2601 Need a second opinion If you have any questions you should ask your doctor There may be times where you find that despite t
27. s rescinded publication including seeking independent verification of Information sought to be relied upon for the user s purposes Every user of this rescinded publication is responsible for ensuring that each printed version contains this disclaimer notice including the date of recision and the date of downloading the archived Internet version or not to pee A guide for men about their urinary symptoms NHMRC National Health and Medical Research Council Commonwealth ofAustralia 1997 0644397764 This work iscopyright It may be reproduced in whole or in part for study or training purposes subject to tne inciusion of an acknowledgment of the source and no commercial sale or use Regroduction ror purposes other than those listed above requires the written permission of tneAustralian Government Publishing Service GPO Box 84 Canberra ACT 2601 The strategic intent of NEMRC is to work with others for the health of all Australians by promoting informed debate or ethicsand policy providing know ledge based advice fostering a high quality and internationaliy recognised research base and applying research rigour to health issues This document is a general guide to appropriate practice to be follow ed only subject to aclinician s judgment in each individual case The guidelinesare designed to provide information to assist decision making based on the best information available at the time of publication National
28. s the transformation of the male hormone testosterone into its active ingredient in the prostate It has no effect on the tevel of testosterone in the rest of the body only in the prostate Scientific studies have shown that only men with large prostates may benefit from treatinent with finasteride Research shows that they can experience amild reduction in the severity of their urinary symptoms Before taking this drug prostate size should be established by a transrectal ultrasound Medicare rebates for this test are available only if it is recommended following evaluation of a man s prostate by a urologist It can take up to 6 months for the effect of finasteride to become apparent and you must continue to take the drug to maintain the effect Finasteride should be prescribed only after an assessment by aurologist Side effects About 1 in 10 men experience some side effects which include a reduction in sexual interest or an inability to maintain an erection It is recommended that if you take finasteride you snould be assessed at three and six month intervals after commencing treatment If there is no improvement in your symptoms after 6 months there is little point in continuing treatment Anticholinergcs The drugs propantheline and oxybutynin and the trycyclic antidepressant agents imipramine nortriptyline and amitriptyline are anticholinergic agents They can help the bladder store more urine and therefore reduce how ofte
29. tal and off work O pen prostatectomy Open prostatectomy is usuelly needed only for exceedingly large glands The enlarged portion of the prostate is removed during the operation which isperformed through an incision in the abdomen You may need to bein hospital for up to 7 days but should be back to full activities within 4 weeks It is important to realise that this is not the same operation as the surgery for cancer confined to the nrostate an operation known as radical or total prostatectomy You should be aware that the risks and complications that may occur following open prostatectomy are retrograde ejaculation ejaculation pack into the bladder up to 100 incontinence loss of bladder control 2 5 impotence inability to have an erection Tnere is no recent information on how frequently this occurs but some older reports suggest it may be as high as 30 need for retreatment 3 bladder neck scarring leading to further urinary problems 2 RER Surgery and prostate cancer None of these operations removes all of the prostate Because of this none of them protects you from the possibility of developing prostate cancer in the future Chapter Emerging Treatment O ptions There are some surgical procedures for the treatment of urinary symptoms which have yet to be proven fully effective New and different options not covered in this book will continue to be developed If yo
30. u are considering these options you should ensure that you are fully informed about the potential benefits risks and costs before you agree to any such procedure Most of the procedures act by heating the prostatic tissue turning it to vapour causing it to die or resulting in other ir determinate changes The heating methods used include lasers for example visual laser assisted prostatectomy VLAP microwaves for example transurethral microwave thermotherapy TUMT radio frequencies for example transurethral needle ablation TUNA If you choose to undergo any of these treatments you should be aware of the following facts After heating the prostate by laser the tissue dies and is siowiy passed through your urethra for several months Signiricant irritation usually also occurs lt is quite likely that you will need a catheter for up to 7 days after some of these procedures Some of these treatments may be less likely to cause bleeding or other complications and some can be done without anaesthetic Appendix Working Party on Voiding Dysfunction in M en Terms of Reference and M embership Terms of Reference Undertake the development and implementation of clinical practice guidelines which will facilitate the identificaticn and care of men with voiding dysfunction In fulfilling this task review kev literature and follow the procedures recommended by the Quality of Care arid H
31. urinary problems you miaht have aside from those listed above If you have any of these you are likely to require medical treatment of a type not covered by this book These complicated urinary problems include haematuria blood in your urine pain on urinating other types of genital pain urinary retention an inability to empty the bladder urinary incontinence uncontrolled and involuntary loss of urine which is severe continuous O ther medical conditions Some men with urinary symptoms also have coexisting medical conditions which complicate matters and require other medical assistance These conditions include brain disorders and brain damage as a result of accidents or disease Alzheimer s disease and dementia diseases of the nervous system Parkinson s disease nerve damage muitiple sclerosis alcoholism diabetes perhaps undiagnosed Factors which increase the severity of urinarysymptoms Some men raay have other factors which aggravate the severity of their urinary symptoms These may include confusion impairment in mobility impaired manual dexterity for example difficulty in undoing your pants constipation acute illness which accentuates the urinary symptoms environmental factors which make it difficult to reach a toilet quickly such as the need to use stairs or getting to the toilet in the dark polyuria the passing of an exc
32. us disease you can turn your attention to whether you wish to have any treatment for your urinary symptoms As already mentioned your decision whether you even wish to learn more about such possible treatments should largely be determined by just how bothered you are by the symptoms Simple urinary symptoms can be treated in various ways There is no preferred option and only you can decide which treatment offers you the greatest benefit for the least personal and financial cost After reading this guide and clarifying any remaining unanswered questions with your doctor you should have enough information to make the decision about atreatment that best suits your condition The four approaches to managing your urinary symptoms are advice and lifestyle change medication surgery emerging treatment options Before deciding to proceed with medication surgery or other therapies you should be aware of the benefits costs side effects and disadvantages of each form of treatment and of thetime it may take to achieve any results ae Changes im wrimary fonction Syrnplornz moderately Io become bothersome serene bolhersome eposgh for yor o wa n in oesi fam iy doco GP f Discuss your sird ons wilh your dad or Problem diagnosed ample urinary amiptors a Problem diagnosed a Surnplorn z orly mildly compared vinar bulhersorne Spmaphoris rol covered by this book Ty simple
33. ymptoms may include any or all of the following the need to wake frequently from sleep to urinate urinating too freauently during the daytime a feeling of urgency to urinate urge incontinence asudden strong desire to urinate that you are unable to control for sufficient time to reach atoilet hesitancy a feeling that you want to pass urine but it takes awhile before it starts after dribble the loss of urine after re dressing This may happen just as you finish passing uring but often occursa little later after you have left the toilet feeling of incomplete emptying of the bladder poor stream of urine flow difficulty in projecting the urinary stream outwards feeling the need to pass urine within a few minutes of having done so Itisnatural forthestreain to becomepoorerasyou age Whidhlinemostreoresents yournormal urinary seam Urinary retention Some men may be unable to urinate at ali This is known as acute urinary retention and requires urgent medical treatrnent A catheter a thin soft flexible tube is inserted through the urethra and into the bladder This allows the urine to drain and brinas immediate relief Although it is known that certain factors can cause urinary retention there is no way to predict whether or not it will happen to you Factors which may be associated with urinary retention include excessive alcohol consumption prolonged travel constipation and surgery particularly for
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