Edward J Mueller: The prostate is a small gland. This is right below the bladder deep in the pelvis and its main function is to produce about one-third of the semen that you ejaculate.
Barry Stein: People think it has some thing to do with potency and things like that. They come in well my prostate is enlarged, then I’m impotent; they are related. No actually, they’re not at all. It just produces some sugars and other supporting things so that most of men’s ejaculate comes from the prostate or its little want to be the seminal of vesicle. But after the child bearing years, it really doesn’t do anything that you care about.
Edward J Mueller: BPH is benign growth of the prostate. The prostate is a hormonally sensitive organ and it’s stimulated by the male hormone, Testosterone. So starting at puberty when the male gets his testosterone burst and for the rest of his life as long as testosterone is present, the prostate will slowly enlarge and BPH or Benign Prostatic Hyperplasia is the term for the slow enlargement of the prostate gland.
Barry Stein: Caused by male hormones. If we remove men’s testicles before puberty, it would never happen. But nobody ever seems to care when I say that. Nobody is volunteering well, take mine, take mine.
Edward J Mueller: Perhaps the 50% of man at age 50 will have BPH and approximately 80% of men at age 80 have BPH and it’s fairly linear and between. So the older you get the more likely you’re going to have BPH.
Barry Stein: Symptoms might be weakening of the man’s strength. You have to stand a little closer to the urinal to heat it, might go more frequently. When you got to go, it might be get out my way or what some of patients called the key-in-the-door-syndrome. They are okay till they put the key in the door and from that point, they can’t get in fast enough to reach the bathroom.
Edward J Mueller: When I talk to my patients and I try to explain this to them, I try to tell them it’s like trying to put out a fire with one inch garden hose or a 4-inch fire inch. The bigger diameter opening you get more water out quickly and if the prostate when you’re teenager, 20 years old the prostate is quite open and urinate frequently, totally empty the bladder, good stream and you’re done. As you get older, it narrows down and you get the one-inch garden hose and it takes a lot longer for the urine to get out and the bladder will fatigue before all that urine gets out. And you think you’re done but you still have residual urine left in the bladder and those symptoms gradually become more and more common as you get older and the prostate enlarges.
Barry Stein: Maybe they are getting up at night two or three times now which they weren’t doing before. So it’s kind of the basic symptoms. There are others but those are the ones that seems to bother people the most.
Edward J Mueller: The diagnosis depends on several things; one of course, is the history. Talking to the patient, finding out what his symptoms are and there is a good tool we use called the AUA Symptom Score or the International Prostate System Score and that’s a series of questions that patient answers asking about how often he gets up at night, how forceful the stream is. Does you feel like he totally empties his bladder and several others. There are seven questions on it. It gives us a real idea of what the symptoms are. Then on a digital rectal exam, just checking the prostate.
You can feel how big it is although that is not always accurate cause you’re feeling the posterior surface of the three-dimensional object and you may have wide open urethra to the middle of it but it can still feel pretty big. But it’s important to check the prostate. We do urine flows where a patient comes in, he void into a little funnel and it records the stream and we’ll get a printout actually of the force of the stream and how much volume he will urinate in a definite period of time and then we scan the bladder to see how much urine is still left in the bladder, so you can totally empty these.
Another thing we can do is put a little scope down the urethra and actually look at the prostate. It’s probably the most accurate way of seeing how much obstruction there is because it’s a little fiber-optic scope that goes right down the urethra, will go right through the prostate into the bladder. We can look at the prostate; we can look at the bladder, and then actually see how much obstruction there is.
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