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Prostate problems can make life awkward for men over 50.

There's a joke about a urologist's favorite keyboard shortcut: Control-P.

Dr. Carmela Lapitan, a urologist, observes that the number of her middle-aged male patients with urination problems has increased over time. Many of them have been confronting an awkward problem called benign prostatic hyperplasia (BPH) for years. They have catheters inserted in their urethra to drain the bladder.

BPH is the gradual enlargement of the prostate, the male reproductive gland that sustains and secretes semen, which can make urination challenging.

'Its position surrounds the urethra, the tube for the outflow of urine,' Lapitan says. 'When it grows, it tightens around the urethra. Patients with an enlarged prostate will have problems passing urine. They will either strain or wait for a long time.

'On the other hand, they will have frequent urination day and night. When there is the urge to urinate, they have to rush.'

Although troublesome, BPH is neither life-threatening nor leading to cancer. Still, when left untreated, it can result in serious health problems or can hamper daily activities.

'Many patients come to my clinic in the later stages of BPH. By then, there have been complications-bladder stones, recurrent infections, and hernia due to the constant strain in passing their urine' Lapitan says.

Quality of life

Quality of life is compromised. Some men refuse to travel long distances because they are unable to hold their urine. Physical intimacy with their partners is decreased due to men's lack of self-confidence. Likewise, partners lose quality of sleep when men keep waking up at night to rush to the bathroom.

BPH commonly occurs in men over 50. Unlike 20 years ago when surgery was the option, BPH can now be controlled through medication or minimally invasive procedures.

Lapitan cites three types of drugs that can manage specific conditions: alpha blockers relax the muscle fibers in the prostate and bladder; and alpha reductive inhibitors shrink enlarged prostates over nine to 18 months. The combination of these two are said to provide greater results.

'Then there is a group of drugs that act on the bladder to reduce the frequency of urination and urgency.'

The dosage depends on the patient's stage. Once the medication is stopped, however, symptoms typically recur.

'It's like taking maintenance medicines for long-term conditions. As long as your testes are working, the prostates tend to enlarge,' she says.

Minimally invasive

Another option is minimally invasive BPH procedures. These utilize ultrasound, microwaves, heat, radiofrequency waves or lasers to scrape out the prostate's core and ease the stress on the urethra that decreased the urine flow in the first place. These outpatient procedures have a longer effect, but will require a repeat after a few years.

The medical treatment is complemented by lifestyle changes. Lapitan advises men to limit the intake of fluids at night, cut down on coffee and alcohol, and avoid straining to urinate.

GlaxoSmithKline (GSK) Philippines is urging men to take charge earlier to avert problems in the future. Last June 25, it launched World BPH Day as an awareness campaign.

Dr. Joselito Javier, GSK's medical affairs manager, cites studies from Europe and Asia about the communication gap between the doctor and the patient.

Filipino men, in particular, don't consult their doctors despite the warning signs on their health.

'Thinking it is a part of aging, they will not do anything about it until the symptoms become unbearable,' Javier says. 'They are also afraid of the high cost of medicine or on being operated on. We want men to be aware that BPH is not cancerous, but it can greatly affect their daily life.'

Javier adds that men can consult a primary care doctor, physician or internist who can prescribe medications that can relax the muscles of the bladder and prostate or diminish the size of the prostate to prevent the obstruction of the urethra.

'When the condition becomes serious, they should consult a urologist,' he says.
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Publication:Philippines Daily Inquirer (Makati City, Philippines)
Date:Jul 3, 2018
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