The way the health of the woman’s breasts is a much-discussed topic among women so should the health of the prostate be a topic of constant discussion among men. Why? As breast cancer is the commonest cancer in women in Nigeria and all over the world so is prostate cancer the commonest cancer in men in Nigeria and all over the world.

The prostate gland is a mass of tissue located at the neck of the bladder from where it extends to surround the beginning part of the urethra (the pipe-like structure that extends from the bladder neck to the tip of the penis and through which urine and sperm are passed to the outside). The structure that carries sperm from the testes joins the urethra within this prostate gland. The prostate gland produces secretions containing various chemicals that help maintain the health of sperm cells produced by the testes, and these secretions provide the fluid that carries the sperm cells as they are ejaculated outside during sexual intercourse.

The prostate gland has a normal size range which ensures that it does not block the neck of the bladder and part of the urethra within it, allowing the passage of urine or semen under the control of the man. However as a man advances in age, the size of his prostate gland starts increasing. By the age of 40 and above, some men may start having problems as regards urinating unlike before, and these problems may worsen in some as they approach 60 and 70 years of age. These problems may be one or more of the following:

1. Pushing or straining their lower abdomen to start urinating or taking too long before urine starts coming out even when in a very relaxed position and environment.

2. Dribbling of the urine instead of the normal full urine stream that shoots out

3. Stopping and starting several times whenever they are urinating unlike before when they urinate at one full stretch and flow

4. Having a sensation of not completely passing out every urine in your bladder whenever you finish urinating

5. Difficulty with holding urine whenever they feel like urinating such that if the man does not use a toilet immediately, he may urinate on himself without controlling it.

6. Always going to urinate again after less than one hour of a previous urination

7. Frequently waking up throughout the night to urinate.

The above problems are known as lower urinary symptoms which may also present in other health conditions such as urinary tract infection and diabetes mellitus. But for a man in his late 40s, 50s, 60s or 70s and above, the presence of some or all of these symptoms, no matter the level of severity, is an indicator that this man likely has a medical condition of the prostate gland which doctors call benign prostatic hyperplasia (BPH).

BPH is a harmless tumour (not cancerous) of the prostate gland. This means enlargement of the prostate gland to a size way above the normal range. When this happens, the now enlarged prostate gland starts compressing the bladder neck and the beginning part of the urethra which it surrounds, altering the normal flow of urine from the bladder and the urethra to the outside: this is why the affected man starts experiencing the lower urinary symptoms stated above.

Once a man above 40 years starts experiencing some of these lower urinary symptoms, it is advisable to go to a hospital at once to see a specialist doctor (a surgeon) called a urologist. In this case, a teaching hospital, some private specialist hospitals or a federal medical centre is where one can find a urologist. A urologist is a medical doctor who is a specialist surgeon and treats both urinary and reproductive medical conditions of men using drugs and surgical operation as the case may be. It is the urologist who will take the man’s medical history, perform the necessary physical examinations and investigations on him to determine the current size of the prostate gland. After this, the urologist can prescribe the appropriate drugs or counsel him on the need for surgical operation on the prostate gland depending on its size and the severity of the lower urinary symptoms.

It is important to see a urologist very early because a delay or not seeing one at all will allow the prostate gland to keep increasing in size, further obstructing the outflow of urine from the bladder. With time, the urine stored in the bladder starts pushing back up the ureters (the two structures connecting the two kidneys with the bladder). This can cause formation stones in the bladder, recurrent urinary tract infection which can damage the kidneys over time, possibly leading to a chronic kidney disease and eventually kidney failure. At this point, regular dialysis and finally a kidney transplant will become the only option to save the man’s life. In very rare cases, an untreated enlarging prostate gland (BPH) may transform to prostate cancer.

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Written by Dr. Okechukwu Amako, MB;BS (Ibadan)

Tags: benign prostatic hyperplasia, chronic kidney disease, diabetes mellitus, dialysis, kidney failure, kidney transplant, prostate cancer, prostate gland, urinary tract infection, urologist

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