Prostate Health

The prostate is a male reproductive gland about the size of a walnut, located in front of the rectum and just below the bladder. It is wrapped around the upper portion of the urethra, the tube that carries urine from the bladder out through the penis. The function of the prostate is to secrete a fluid that makes up part of semen.

Arkansas Urology treats all conditions of the prostate, including enlarged prostate, prostate cancer and prostate infection. All men are at risk for prostate problems, although conditions vary by age and other factors. It is important to be aware of the risks and educated about treatment options.

Furthermore, it is critical that all men receive annual prostate screenings over the age of 50. Screening should begin earlier, at age 40, for those who have a higher risk of prostate cancer, such as African-American men or those with a family history of prostate cancer.

Prostatitis

Prostatitis is an inflammation of the prostate that often causes swelling or pain. There are three levels of prostatitis: nonbacterial prostatitis, acute bacterial prostatitis and chronic prostatitis.

  • Nonbacterial prostatitis, or chronic pelvic pain syndrome, is the most common type of prostatitis. It may be caused by stress or irregular sexual activity. Symptoms include frequent urination and pain in the lower abdomen or back.
  • Acute bacterial prostatitis is a sudden bacterial infection marked by inflammation of the prostate. This is the least common form of prostatitis, but the symptoms are usually severe. Patients with this condition have an acute urinary tract infection with increased urinary frequency and urgency, need to urinate often at night, and pain in the low back, pelvis and genital area. They often have fever, chills, nausea, vomiting and burning when urinating. This condition commonly occurs in older and middle-aged men.
  • Chronic prostatitis is characterized by recurrent urinary tract infections in men. When symptoms do appear, they are generally less severe than acute bacterial prostatitis and are rarely accompanied by fever. This condition can affect any age group, but is most common in young and middle-aged men.

An accurate diagnosis is crucial because the treatment is different for the different types of prostatitis. In addition, it is extremely important to make sure that the symptoms are not being caused by other conditions such as urethritis, cystitis, an enlarged prostate or cancer. To help the physician make an accurate diagnosis, several types of examinations are useful.

  • Your doctor will take a urine sample to determine whether the problem is in the urethra, bladder or prostate.
  • Your doctor will perform a digital rectal exam to make sure your prostate feels normal in shape and size.
  • Your doctor may also collect a sample of prostatic fluid by pressing on your prostate to force fluid out into the urethra.
  • A prostate-specific antigen (PSA) test may be performed to test for infection and cancer, and to rule out other problems.
  • If more serious problems are detected, your doctor may perform a transrectal ultrasound to view your prostate more clearly. Cytoscopy may also be used to rule out other conditions when no infection is present. This test uses a slender device inserted into the urethra to examine the bladder and prostate.

Nonbacterial prostatitis is most often treated with anti-inflammatories or muscle relaxants. Other options may include hot baths, relaxing when urinating, drinking more fluids or dietary changes. Some people may benefit from avoiding spicy foods and caffeinated or acidic drinks. Activities that aggravate the condition, such as bicycling, may need to be eliminated as well.

If acute bacterial prostatitis is diagnosed, the patient will need to take antibiotics for a minimum of 14 days. Sometimes, this means being admitted to the hospital and being given intravenous antibiotics. A catheter is sometimes required if the patient has difficulty urinating. Almost all acute infections can be cured with this treatment. Frequently, the antibiotics will be continued for as long as four weeks. Acute bacterial prostatitis requires prompt treatment, as the condition can lead to bladder infections, abscesses in the prostate or, in extreme cases, completely blocked urine flow. Bed rest, stool softeners and increased fluid intake may also be recommended.

Chronic prostatitis is typically treated with antibiotics for four to 12 weeks. About 75 percent of all cases of chronic bacterial prostatitis clear up with this treatment. For cases that do not respond to this treatment, long-term, low-dose antibiotic therapy may be recommended to relieve the symptoms. In some rare cases, surgery on either the urethra or prostate may be recommended if there is an identified problem that needs attention, such as scar tissue in the urethra.

Enlarged Prostate

Enlarged prostate, also known as benign prostatic hyperplasia (BPH), is a common urological condition caused by the enlargement of the prostate gland in aging men. Enlarged prostate symptoms occur in more than half of all men between age 51 and 60, and in more than 80 percent of men over age 80. As the prostate enlarges, it can squeeze down on the urethra. Enlarged prostate is not cancer and has not been shown to lead to cancer. But, this condition does cause painful and uncomfortable symptoms and may lead to more serious health problems. Symptoms may include difficult or painful urination, frequent need to urinate, weak urine flow, urinary incontinence and interference with sexual activity.

If you are suffering from an abnormal urinary flow, you may have an enlarged prostate. Call Arkansas Urology for an appointment and evaluation. The evaluation may include a questionnaire developed by the American Urological Association that addresses your symptoms, a urine test called a urinalysis, a thorough medical history, a physical examination and a blood test.

Arkansas Urology is the one practice in the state with a UroCuff Test, a noninvasive diagnostic and management device that measures isovolumetric bladder pressure as well as reflex activity and “unvoided residual” (leftover urine in the bladder). The results help physicians empirically evaluate bladder functioning over time, and indicate a clinical pathway for treatment and diagnose whether the issues are BPH-related.

Depending on the severity of your situation, other tests may be offered:

  • A prostate-specific antigen (PSA) test helps check for prostate cancer, which can cause the same symptoms as enlarged prostate.
  • A digital rectal exam (DRE) checks the size and firmness of the prostate. The size of the prostate does not always determine the severity of the symptoms. A man with only a small degree of prostate enlargement may have more severe symptoms than a man with more enlargement.
  • A urinalysis and urine culture checks for a urinary tract infection that might be the cause of the symptoms.
  • A blood creatinine test checks how well your kidneys are working.
  • Urinary cytology is a urine test to screen for bladder cancer.
  • A measurement of post-void residual volume (PVR) determines the amount of urine left in the bladder after urinating.
  • Uroflowmetry, or urine flow study, measures how fast urine flows when you urinate.
  • Cystoscopy is a direct look in the urethra and/or bladder using a small flexible scope.
  • A urodynamic pressure-flow study tests the pressure inside the bladder during urination.
  • An ultrasound may be used to check the kidneys or the prostate

Enlarged prostate can be treated with medication, nonsurgical microwave procedures, an innovative new laser procedure or surgery:

  • Two types of medication are often used for treatment of enlarged prostate. One type helps relax the muscles of the prostate, while the other aims to shrink the prostate.
  • Microwave therapy is a nonsurgical and minimally invasive treatment for enlarged prostate. This procedure uses microwave technology to heat and destroy enlarged prostate tissue. A catheter is used to direct heat deep into the prostate.
  • Several different microwave devices can be used in this procedure. The Targis™ System has a cooling mechanism to protect surrounding tissue during the procedure. Though it cannot cure enlarged prostate, microwave therapy reduces the symptoms of the condition. This procedure is performed in the Little Rock Office procedure area, allowing you to return home within hours of the procedure.
  • The GreenLight PVP Laser Procedure uses laser energy to vaporize and precisely remove enlarged prostate tissue. This new technology dramatically restores urine flow and immediately relieves symptoms. During the procedure, a thin fiber is inserted into the urethra through a cystoscope. The fiber delivers green laser energy that removes the enlarged prostate tissue. The physician is able to safely view and control the treatment area, tailoring it to each patient’s anatomy and needs. This new treatment is more effective and less complicated than traditional enlarged prostate treatments. It requires a shorter hospital stay and recovery period than invasive surgery.
  • The UroLift® System treatment is a revolutionary, minimally invasive approach to treating an enlarged prostate, or BPH, that lifts or holds the enlarged prostate tissue out of the way so it no longer blocks the urethra. There is no cutting, heating or removal of prostate tissue.
  • Rezūm™ Water Vapor Therapy is a treatment for BPH (benign prostatic hyperplasia) that uses natural water vapor to reduce the size of the prostate.

Surgical treatment is typically a last resort if your symptoms are severe and other treatments have not worked.

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