A Discussion with Mr Ivor Cullen, Consultant Urologist and Andrologist at Aut Even Hospital, about……

What problems can a man encounter with his waterworks as he gets older?

Quite commonly as a gentleman starts to age they will often begin to develop obstructive lower urinary tract symptoms. This is generally a result of a benign enlargement of the prostate gland which essentially causes an obstruction to the bladder and an outflow obstruction to the flow of urine.

So a gentleman will often start to experience a reduced power to their flow rate and a sensation that their bladder is not emptying fully when they urinate.  As a result of this, they end up in a cycle where they are peeing more frequently and have to visit the bathroom on a more regular basis.  This can spill over into the night time where they can develop something called “nocturia” or having to pee multiple times during the night.  Ultimately, this can progress to developing urinary tract infections, bladder stones, damage to the kidneys etc. so a very common problem that can cause a lot of discomfort and suffering for men as they get a bit older.

There is a stereotype that men can sometimes ignore their symptoms, often until it is too late. So what advice would you offer to men to encourage them to seek help in relation to urination issues?

I think it is important that men attend their GP if they are beginning to experience these symptoms because often there are medications and lifestyle modifications that can greatly enhance and improve someone’s quality of life. Certainly surgery is not always the first line of treatment and we do have a number of less invasive therapies that can dramatically improve someone’s quality of life.

What are the investigations that are undertaken if a patient is displaying urinary tract symptoms?

So generally, when I see a gentleman with lower urinary tract symptoms, the first thing to do is assess them and ensure that there is no degree of urinary tract infection, which will often make these symptoms worse. One simple non-invasive test that we often undertake is called “the flow rate” test where we assess how strong the flow of urination is and equally how well the bladder empties after a gentleman finishes peeing.  These tests have a strong predictive ability in determining who is going to require surgical or medical therapy or just simple lifestyle advice.

What are the treatment options available?

The first line of treatment for somebody with lower urinary tract symptoms is often general advice about reducing evening fluids, not consuming too many fluids, maybe avoiding caffeinated beverages and so on.

When we go on to the next line of treatment there are a couple of different medications that we can use which work to shrink and relax the prostate gland and open up the channel for a better flow or urine and better emptying of the bladder.  A lot of men will respond to these medications and will remain on these long term, with good improvement.

For some men this is not adequate and they are beginning, even despite medication, their symptoms will progress.  For these men we do have a number of different operative interventions.  All the operations revolve around trying to open up the channel through the prostate.  We can use a laser to vaporise the prostate tissue and open the gland out into a funnel shape.  We can use staples to clip the prostate across and make the gland narrower, allowing a better flow of urine.  Or we can reset the tissue, or essentially chip away the tissue from the prostate gland, again opening out this pathway for a better flow of urination and better bladder emptying.