The prostate is a small, almond-shaped gland that sits at the base of the bladder. Its main function is to produce the majority of fluid that a man ejaculates, but it is not essential for life.
It enlarges throughout a man’s life, and can commonly cause problems with a man’s “waterworks”. As can be seen from the diagram the urethra passes through the middle of the prostate, and as it grows it compresses this tubular structure.
This compression in turns leads to the difficulty men often experience in passing urine as they get older.
Symptoms caused by problems with the prostate are often known collectively as “lower urinary tract symptoms” or LUTS.
Symptoms and signs of prostate problems include:
LUTS are rarely caused by cancer, though when you are investigated the Urologist will often seek to exclude this possibility (more later). The most common prostate problem that causes these symptoms is BPH (Benign Prostatic Hyperplasia).
BPH occurs in all men – prostates enlarge throughout adult life. The size of the prostate does not correlate well with the occurrence of symptoms. Many men with large prostate have few symptoms, whilst conversely some men with small prostates may experience quite severe LUTS.
The prostate can block the bladder (BOO = Bladder Outlet Obstruction) as it enlarges. Treating the prostate for enlargement does not result in incontinence, as the prostate sits above the urinary sphincter and is separate from that structure.
You will find that some or all of the following may be required to make an accurate diagnosis of LUTS caused by your prostate:
The DRE should not cause you any anxiety. It is not painful (though perhaps a little embarrassing) and is performed with you laying on your left side or standing whilst bending over. This examination allows the doctor to obtain an indication of the size of your prostate as well as the presence of any lumps or nodules, etc.
You may be required to have one or all of the following tests as well:
The main risk men face when suffering from LUTS due to prostatic enlargement is acute urinary retention. This is the medical term for when a person cannot urinate – they usually suffer severe pain and need to go to hospital to have a catheter inserted in the bladder.
The other risks faced are urinary tract infections and more rarely kidney failure and bladder stones.
There are many treatment options for BPH that do not involve surgery. Once “dangerous” conditions such as prostate cancer, bladder cancer, kidney disease, bladder stones etc have been excluded, the need for any treatment depends on how bothered you are by your LUTS.
You will have noticed the so-called bother score you provided if you completed an IPSS -International Prostate Symptom Score – a simple questionnaire about your symptoms. Some of the treatment options are listed below.
You may decide you do not wish any specific medical treatment at this point in time. Some of the following tips may help make some of your symptoms more bearable.
You should have an annual prostate check as back-up to ensure you are not developing any hidden problems.
These drugs block the nerves to the muscles of the prostate. This relaxes the prostate and allows easier passing of the urine. Symptoms improve 2-4 weeks after commencing the drugs.
Prazosin (Minipress or Pressin) is relatively nonspecific and in larger doses is used as a blood pressure tablet. Its big advantage is that it a PBS listed drug.
Tamsulosin (Flomaxtra) and Alfuzosin (Xatral) are prostate-specific alpha-blocker that works more rapidly and often with more effect, but at this time is only on the Repatriation PBS scheme – therefore for most people it costs about $50 per script.
These drugs – the one available in Australia is Finasteride = Proscar – reduce some of the hormonal activities of testosterone in the prostate causing it to shrink. It is not commonly used in Australia as it is very expensive and less than 30% of men who try it find it provides them any relief of their symptoms.
Dr Cozzi has the largest single surgeon experience to date of implantation of the UroLift device for men with mild to moderate symptoms who wish to avoid the side effects of drugs or traditional prostate surgery. Dr Cozzi has implanted more men than any other surgeon in the world with almost 500 cases performed between 2013 through 2017.
The aim of this novel device is to:
The procedure is performed as day surgery without a catheter and with no reports of loss of ejaculation, impotence or incontinence.
FIND OUT MOREThe Water Vapour Therapy System
Water Vapour Therapy is a transurethral RF thermal therapy to treat benign prostatic hyperplasia (BPH) that can be performed in a clinic or out-patient setting. Using a hand-held device, Water Vapour Therapy delivers radio frequency generated thermal therapy, in the form of water vapour, directly to the extra prostate tissue that is causing symptoms such as frequency, urgency, irregular flow, weak stream, straining and getting up at night to urinate. There are minimal side effects with preservation of ejaculation in more than 94% of patients undergoing this new minimally invasive treatment.
Dr Cozzi was the first surgeon in Australia to be fully credentialed (in March 2018) to perform Water Vapour Therapy independently and currently offers the procedure to suitable patients each week with timely availability.
Dr Cozzi and his colleagues were integral to the deployment of the technology in Australia including arranging a local distributor, organising re-imbursement from health funds and obtaining TGA approval.
The three year follow up data from US studies has recently been released which demonstrates durable, reproducible and highly effective improvement is symptom scores, urinary flow rates and quality of life with no major side effects on urinary and sexual function.
Interested in how WVT could help you but would like more information? We have recently completed a Complete Guide to Water Vapour Therapy.
For more information on Water Vapour Therapy please visit www.rezum.com
Channel Nine News interviews Dr Cozzi about Rezum, the breakthrough new treatment for enlarged prostate