Untitled - Quarter Century Wireless Association

Ham's Health
By: Dr. Dub George, WA5BFT, 4100 Big Bend, Port Arthur, TX 77641, Phone numbers: Work: 409-983-5145, Home: 409-
982-4442, Fax: 409-983 {5 I 9.
In any discussion of the prostate gland the first issue is the
proper pronunciation of the word. This is one of the most
mispronounced words in the English language. Remember that
the word has only one "R'0. It is pros-777E not pros-TMTE.
The prostate is a crab-apple sized gland sitting beneath the
bladder. A passage-way called the urethra leads from the
bladder, through the prostate and penis to the outside world.
The secretions of the prostate, along with those from
the seminal vesicles, give volume to the semen and are thought
to protect and enhance the functions of the sperm. The gland
furnishes approximately 0.5 ml of the 2.5 to 3.0 ml of semen.
I want to discuss three problems that affect the prostate:
infection, benign enlargement and malignancy.
PROSTATITIS: Acute prostatitis is a common disease of men
between the ages of 20 and 40. It usually starts with chills, fever,
painful urination and pain in the lower back, lower aMomen
and rectal area, The picture is similar to that of any lower
urinary tract infection except that on rectal examination the
prostate is found to be extremely tender. The bacteria
responsible for the infection are those usually found in other
urinary tract infections and should respond to antibiotic therapy.
BENIGN PROSTATIC HYPERTROPHY (BPE): Before
puhrty the prostate gland is quite small. Under the inlluence of
the male sex hormone testosterone the gland reaches a size of
approximately 20 grams (213 of an ounce) by age twenty.
It remains about this size for the next 25 years and then
for unknown reasons begins to grow again. If its enlargement is
limited to the outer layers of the gland it causes no problems, but
if the growth involves the central part of the gland that
surrounds the urinary passage that passes thorough the gland, it
may narow the passage and obstruct the flow of urine from the
bladder.
This obstruction to flow gives rise to the classical
symptoms of "prostatism." Initially the individual may notice
only that he is having to urinate more frequently; later, he has
trouble suppressing and delaying the urge to urinate. He may
notice that he is getting up to the bathroom several times each
night. He may dwelop diffrculty in starting urination.
There may also be hesitancy, intermittency, weak
stream, straining and dribbling. Other qymptoms include
urgenqy, sensation of incomplete voiding and later even
incontinence. The first sign of obstruction to urinary flow may
be the development of an acute urinary tract infection. While
this is a common occurence in women, a urinary tract infection
in an older man is almost always due to incomplete emptying of
the bladder due to prostatic obstruction.
If these Symptoms of BPH are ignored the individual
will continue to get up more and more frequently at night and
will notice that he can only ride short distances between "pit
stops". This may happen so gradually that the individual does
not realize that anything is n'rong.
The problem may come to medical attention with the
sudden onset of complete urinary obsruction. This can be
triggered by minor over-indulgence in alcohol or the use of
over-therounter "cold preparations" containing antihistamines.
This acute obstruction requires medical attention with the
insertion ofa catheter into the bladder to establish drainage.
BPH is best diagnosed from this history of gradrully
increasing frequency of urination, getting up more times at night
to urinate and difficulty in zuppressing or postponing the urge to
urinate. While a digital rectal examination @RE) by a physician
may detect an enlargement of the prostate, if the enlargement
has been limited to the central portion of the gland there may be
urinary obstruction with what feels like a relatively small gland.
Digital-rectal examination is also important in that it may detect
an early prostate cancer.
A urinary flow test in which the patient urinates into a
fancy machine that calculates specific urinary flow rates can be
used. X-rays ofthe urinary tract using x-ray opaque dyes that are
excreted in the urine (IVP) may be helpful to demonstrate
secondary signs ofobstruction in the bladder and kidneys.
If the symptoms of obstruction are mild and there is no
evidence of deterioration of kidney function, the condition may
be managed by "watchful waiting." Recently it has become
possible to manage some of the symptoms with medications. The
family of drugs knows as Alpha-Adrenergic Blocking agents
(Hytrin) that are frequently used to control hypertension may be
used to relax the smooth muscle in the prostatic urethra and
bladder neck.
It is well known that removal of the testicles prevents
enlargement of the prostate; however, this has never been
considered a practical treatment. Recently a new medication"
Proscar, has been shown to reduce the size of the prostate when
given for long periods of time. Proscar blocks some of the effects
of the male hormone testosterone on the prostate with minimal
side effects. It is ho@ that this medication will redue the
number ofsurgical procedures that need to be done.
In the past the treatment of this condition has been
primarily surgical. In the United States there are approximately
400,000 surgtcal procedures done each year for this condition.
The most popular procedure has been the transurethral
resection of the prostate (IIJR). This proedure consists of
passing an instrument called an operating cystoscop€ though the
penis into the area of the prostate. There, under indircct vision
through the optical system ofthe cystoscope, the central portion
of the prostate gland is removed using a heated wire loop to
shell it out. In the hands of an experienced operator this
procedure is well tolerated with few complications. A catheter is
left in the urethm for a few days and the patient usually goes
home from the hospital in 2-3 days.
If the prostate is quite large it may require a more
traditional surglcal procedure in which the gland is removed
through an incision in the lower abdominal wall.
There are also several new procedures being developed.
One that shows promise uses a special catheter equipped with an
inflatable balloon that is similar to those us€d by the cardiologist
35 Spring 1994