Diagnostic Evaluation of Urinary Symptoms in Men
- BPH is the term used to describe the nonmalignant growth of the prostate gland responsible for blocking the flow of urine out of the urinary bladder.
- LUTS is the term used for 'lower urinary tract symptoms', which include urinary frequency, urgency, decreased force of stream, difficulty starting urination, intermittency (stopping and starting of stream), and awakening at night to urinate.
- BOO stands for bladder outlet obstruction. The bladder outlet is at the junction of the bladder and prostate.
Historically urinary tract symptoms (LUTS) in men over the age of 50 were almost always attributed to enlargement the prostate gland or benign prostatic hyperplasia (BPH), thereby causing bladder outlet obstruction (BOO). We now know quite clearly that many patients with LUTS have no BOO. We now know clearly that many patients with LUTS caused by BOO do not have BPH. These terms are complicated but our expanding research into the physiology of patients with urinary symptoms has clearly shown us that many men have other diagnoses for their symptoms and that treating the prostate for symptoms not caused by prostate enlargement has only a small chance of being successful.
In some men, the growth of prostate is outward giving the gland increased overall size. This growth causes blockage by sheer increase in prostate size with impingement on the urinary channel or urethra. In others, the outward growth is minimal but the blockage is caused by increased muscle tone around the urinary channel or urethra. Many men develop both types of obstruction, gland growth, and increased muscle tone.
The following are the steps that we often use to help diagnose LUTS in men.
Not every man needs treatment for early BPH. It is normal for a man's urinary flow to reduce as he ages. Mandatory reasons to proceed with some form of treatment include recurring infections, repeated bleeding episodes, bladder or kidney damage, and the presence of cancer. When any of the above problems occur, or one's lifestyle is changed by the presence of prostate obstruction, consideration to treat the prostate enlargement should be given.
As time goes on, additional medications and surgical procedures will be developed to treat prostatic enlargement. Today, however, each patient must be analyzed individually as to what therapy gives him the best chance for successful treatment.
Reprinted with permission from Dialog Medical, dialogmedical.com.
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