London Urology Online

email us Should benign prostatic disease be screened for? Who should be referred? Bladder outflow obstruction (BOO) is a term covering a constellation of symptoms which range from a slightly slow urinary stream, through urgency and incontinence, to end stage obstructive kidney failure. There is as yet no proof that screening for benign prostatic disease is of value. In a screening project carried out in Stirling, 34% of 1627 screened men aged 40 to 79 years were advised to have urological consultation; of these fifty percent were offered non surgical treatment and ten per cent were advised to have surgery due to the objective severity of their symptoms. In addition 17 cases of prostate cancer were discovered. While this shows the size of the problem, it is by no means clear whether screening is either justified or affordable. A rational approach seems to be to try to identify those men who are at risk of developing serious complications from their prostatic disease. Men with urinary symptoms: Most men with urinary symptoms will fall into one of these groups Bothersome symptoms Dangerous signs or symptoms Possible significant cancer For the vast majority of men with bothersome symptoms, a number of simple screening tests will make sure there is no serious problem. In our practice we recommend a clinical examination, urinalysis with culture if any abnormality is found, and a serum creatinine estimation, with a check on the serum PSA. In the case of elevated creatinine we would recommend a renal and bladder ultrasound, (occasional unsuspected ureteric obstruction due to locally advanced prostate cancer may present in this with hydronephrosis and a high PSA). If any haematuria is present, urgent urological referral is necessary. A urinary flow rate ( most men with peak flow of less than 10ml/s will be obstructed) and bladder ultrasound will complete the baseline investigations. Most general practitioners will now have access to these last two tests, and whereas they are not mandatory of a patient is to be referred or reassured, it would be difficult to recommend drug therapy without some objective measure of any likely obstruction present.Assuming there is no abnormality in the tests mentioned, the patient can be treated symptomatically. In many cases reassurance will be sufficient, since most men remain somewhat reticent about discussing their problems with their peers and may be unaware that they are not the only sixty five year old getting up once a night to pass urine. Similarly, simple advice such as avoiding large amounts of diuretic drinks (tea, coffee, alcohol), may make life tolerable without more complex treatment. Who should be referred? With regard to dangerous signs or symptoms, the urologistís prime concern is to make sure that men with high pressure retention do not go on to develop renal failure, thus the concern with creatinine and renal ultrasound. Other worrying symptoms include the presence of proven urinary tract infections, which might indicate either poor bladder emptying or a bladder stone. Bladder pain is a very unusual feature of benign prostatic disease, and can indicate either infection, stone or possible cancer of the bladder. Visible haematuria (blood in the urine) is never normal. Patients whose main complaint is of incomplete emptying are usually right about their bladder function and if bladder ultrasound shows a residual volume of greater than 150ml referral is appropriate due to the probable risk of acute or chronic retention developing. In many cases it will be the case that a general urological opinion can be given based on a GPís findings and the results of tests: cultivating an informal link with your local urologist will be very helpful in keeping referral rates down for such patients. I am always happy to give advice by letter or telephone in respect of patients who do not fall neatly into one of the above groups. The place of PSA testing and detection of prostate cancer is dealt with elsewhere. [Practice details][Research News][Publications][Information][Links][Referrals] Copyright (c) 1999-2001 GH Muir. All rights reserved. [email protected]

Bladder outflow obstruction (BOO) is a term covering a constellation of symptoms which range from a slightly slow urinary stream, through urgency and incontinence, to end stage obstructive kidney failure. There is as yet no proof that screening for benign prostatic disease is of value. In a screening project carried out in Stirling, 34% of 1627 screened men aged 40 to 79 years were advised to have urological consultation; of these fifty percent were offered non surgical treatment and ten per cent were advised to have surgery due to the objective severity of their symptoms. In addition 17 cases of prostate cancer were discovered. While this shows the size of the problem, it is by no means clear whether screening is either justified or affordable. A rational approach seems to be to try to identify those men who are at risk of developing serious complications from their prostatic disease. Men with urinary symptoms: Most men with urinary symptoms will fall into one of these groups Bothersome symptoms Dangerous signs or symptoms Possible significant cancer For the vast majority of men with bothersome symptoms, a number of simple screening tests will make sure there is no serious problem. In our practice we recommend a clinical examination, urinalysis with culture if any abnormality is found, and a serum creatinine estimation, with a check on the serum PSA. In the case of elevated creatinine we would recommend a renal and bladder ultrasound, (occasional unsuspected ureteric obstruction due to locally advanced prostate cancer may present in this with hydronephrosis and a high PSA). If any haematuria is present, urgent urological referral is necessary. A urinary flow rate ( most men with peak flow of less than 10ml/s will be obstructed) and bladder ultrasound will complete the baseline investigations. Most general practitioners will now have access to these last two tests, and whereas they are not mandatory of a patient is to be referred or reassured, it would be difficult to recommend drug therapy without some objective measure of any likely obstruction present.Assuming there is no abnormality in the tests mentioned, the patient can be treated symptomatically. In many cases reassurance will be sufficient, since most men remain somewhat reticent about discussing their problems with their peers and may be unaware that they are not the only sixty five year old getting up once a night to pass urine. Similarly, simple advice such as avoiding large amounts of diuretic drinks (tea, coffee, alcohol), may make life tolerable without more complex treatment. Who should be referred? With regard to dangerous signs or symptoms, the urologistís prime concern is to make sure that men with high pressure retention do not go on to develop renal failure, thus the concern with creatinine and renal ultrasound. Other worrying symptoms include the presence of proven urinary tract infections, which might indicate either poor bladder emptying or a bladder stone. Bladder pain is a very unusual feature of benign prostatic disease, and can indicate either infection, stone or possible cancer of the bladder. Visible haematuria (blood in the urine) is never normal. Patients whose main complaint is of incomplete emptying are usually right about their bladder function and if bladder ultrasound shows a residual volume of greater than 150ml referral is appropriate due to the probable risk of acute or chronic retention developing. In many cases it will be the case that a general urological opinion can be given based on a GPís findings and the results of tests: cultivating an informal link with your local urologist will be very helpful in keeping referral rates down for such patients. I am always happy to give advice by letter or telephone in respect of patients who do not fall neatly into one of the above groups. The place of PSA testing and detection of prostate cancer is dealt with elsewhere.

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Should benign prostatic disease be screened for?

Who should be referred?

Bladder outflow obstruction (BOO) is a term covering a constellation of symptoms which range from a slightly slow urinary stream, through urgency and incontinence, to end stage obstructive kidney failure. There is as yet no proof that screening for benign prostatic disease is of value. In a screening project carried out in Stirling, 34% of 1627 screened men aged 40 to 79 years were advised to have urological consultation; of these fifty percent were offered non surgical treatment and ten per cent were advised to have surgery due to the objective severity of their symptoms. In addition 17 cases of prostate cancer were discovered. While this shows the size of the problem, it is by no means clear whether screening is either justified or affordable. A rational approach seems to be to try to identify those men who are at risk of developing serious complications from their prostatic disease. Men with urinary symptoms: Most men with urinary symptoms will fall into one of these groups Bothersome symptoms Dangerous signs or symptoms Possible significant cancer For the vast majority of men with bothersome symptoms, a number of simple screening tests will make sure there is no serious problem. In our practice we recommend a clinical examination, urinalysis with culture if any abnormality is found, and a serum creatinine estimation, with a check on the serum PSA. In the case of elevated creatinine we would recommend a renal and bladder ultrasound, (occasional unsuspected ureteric obstruction due to locally advanced prostate cancer may present in this with hydronephrosis and a high PSA). If any haematuria is present, urgent urological referral is necessary. A urinary flow rate ( most men with peak flow of less than 10ml/s will be obstructed) and bladder ultrasound will complete the baseline investigations. Most general practitioners will now have access to these last two tests, and whereas they are not mandatory of a patient is to be referred or reassured, it would be difficult to recommend drug therapy without some objective measure of any likely obstruction present.Assuming there is no abnormality in the tests mentioned, the patient can be treated symptomatically. In many cases reassurance will be sufficient, since most men remain somewhat reticent about discussing their problems with their peers and may be unaware that they are not the only sixty five year old getting up once a night to pass urine. Similarly, simple advice such as avoiding large amounts of diuretic drinks (tea, coffee, alcohol), may make life tolerable without more complex treatment. Who should be referred? With regard to dangerous signs or symptoms, the urologistís prime concern is to make sure that men with high pressure retention do not go on to develop renal failure, thus the concern with creatinine and renal ultrasound. Other worrying symptoms include the presence of proven urinary tract infections, which might indicate either poor bladder emptying or a bladder stone. Bladder pain is a very unusual feature of benign prostatic disease, and can indicate either infection, stone or possible cancer of the bladder. Visible haematuria (blood in the urine) is never normal. Patients whose main complaint is of incomplete emptying are usually right about their bladder function and if bladder ultrasound shows a residual volume of greater than 150ml referral is appropriate due to the probable risk of acute or chronic retention developing. In many cases it will be the case that a general urological opinion can be given based on a GPís findings and the results of tests: cultivating an informal link with your local urologist will be very helpful in keeping referral rates down for such patients. I am always happy to give advice by letter or telephone in respect of patients who do not fall neatly into one of the above groups. The place of PSA testing and detection of prostate cancer is dealt with elsewhere.

Bladder outflow obstruction (BOO) is a term covering a constellation of symptoms which range from a slightly slow urinary stream, through urgency and incontinence, to end stage obstructive kidney failure. There is as yet no proof that screening for benign prostatic disease is of value. In a screening project carried out in Stirling, 34% of 1627 screened men aged 40 to 79 years were advised to have urological consultation; of these fifty percent were offered non surgical treatment and ten per cent were advised to have surgery due to the objective severity of their symptoms. In addition 17 cases of prostate cancer were discovered. While this shows the size of the problem, it is by no means clear whether screening is either justified or affordable.

A rational approach seems to be to try to identify those men who are at risk of developing serious complications from their prostatic disease.

Men with urinary symptoms: Most men with urinary symptoms will fall into one of these groups

Bothersome symptoms

Dangerous signs or symptoms

Possible significant cancer

For the vast majority of men with bothersome symptoms, a number of simple screening tests will make sure there is no serious problem. In our practice we recommend a clinical examination, urinalysis with culture if any abnormality is found, and a serum creatinine estimation, with a check on the serum PSA. In the case of elevated creatinine we would recommend a renal and bladder ultrasound, (occasional unsuspected ureteric obstruction due to locally advanced prostate cancer may present in this with hydronephrosis and a high PSA). If any haematuria is present, urgent urological referral is necessary. A urinary flow rate ( most men with peak flow of less than 10ml/s will be obstructed) and bladder ultrasound will complete the baseline investigations. Most general practitioners will now have access to these last two tests, and whereas they are not mandatory of a patient is to be referred or reassured, it would be difficult to recommend drug therapy without some objective measure of any likely obstruction present.

Assuming there is no abnormality in the tests mentioned, the patient can be treated symptomatically.

In many cases reassurance will be sufficient, since most men remain somewhat reticent about discussing their problems with their peers and may be unaware that they are not the only sixty five year old getting up once a night to pass urine.

Similarly, simple advice such as avoiding large amounts of diuretic drinks (tea, coffee, alcohol), may make life tolerable without more complex treatment.

Who should be referred?

With regard to dangerous signs or symptoms, the urologistís prime concern is to make sure that men with high pressure retention do not go on to develop renal failure, thus the concern with creatinine and renal ultrasound.

Other worrying symptoms include the presence of proven urinary tract infections, which might indicate either poor bladder emptying or a bladder stone. Bladder pain is a very unusual feature of benign prostatic disease, and can indicate either infection, stone or possible cancer of the bladder. Visible haematuria (blood in the urine) is never normal.

Patients whose main complaint is of incomplete emptying are usually right about their bladder function and if bladder ultrasound shows a residual volume of greater than 150ml referral is appropriate due to the probable risk of acute or chronic retention developing.

In many cases it will be the case that a general urological opinion can be given based on a GPís findings and the results of tests: cultivating an informal link with your local urologist will be very helpful in keeping referral rates down for such patients. I am always happy to give advice by letter or telephone in respect of patients who do not fall neatly into one of the above groups.

The place of PSA testing and detection of prostate cancer is dealt with elsewhere.

Copyright (c) 1999-2001 GH Muir. All rights reserved.
[email protected]