Prostate enlargement is common with age, but every urinary symptom in men is not due to prostate enlargement.
Weak flow, straining and incomplete emptying often suggest obstruction. Frequency, urgency and night urination may be due to prostate obstruction, but may also be due to overactive bladder, diabetes, sleep disturbance, infection, excessive fluids or bladder dysfunction.
The aim is to find out whether the prostate is actually blocking urine and whether the bladder or kidneys are affected.
We commonly evaluate
- Weak urine stream
- Delay in starting urine
- Straining
- Dribbling
- Incomplete emptying
- Night urination
- Urgency
- Retention of urine
- Catheter dependence
- Recurrent urinary infection
- Bladder stone
Evaluation may include
- Symptom assessment
- Urine test
- Ultrasound KUB with prostate size and post-void residual urine
- Uroflowmetry
- Kidney function test
- PSA when appropriate
- Cystoscopy or urodynamics in selected cases
Treatment may include
- Observation for mild symptoms
- Fluid timing and lifestyle correction
- Prostate medicines
- Bladder medicines when storage symptoms dominate
- Catheter care
- TURP, laser prostate surgery or other endoscopic prostate procedures when indicated
Surgery may be considered when
- Medicines fail
- Retention recurs
- Catheter cannot be removed safely
- Bladder stones form
- Recurrent infections occur
- Kidney swelling develops
- Bleeding from prostate recurs
- Quality of life is severely affected
