FAMILY MEDICINE® COLUMN

By John C. Wolf, D.O.
Associate Professor of Family Medicine
Ohio University College of Osteopathic Medicine

READER MAY HAVE TO LIVE WITH DISCOMFORT AFTER PROSTATE SURGERY

Question: I had an operation for an enlarged prostate (no cancer) three years ago. Now, when I urinate I get a burning feeling. My urologist has suggested I take a hot bath to reduce the discomfort. What causes my burning, and is there something more than taking a bath -- which doesn’t seem to make any difference -- that I can do?

Answer: I think I need to start with a brief anatomy lesson. The prostate gland is an important part of the male reproductive system. The prostate -- located next to the urinary bladder -- actually surrounds the urethra, the tube that empties urine from the bladder and, at times, carries semen. The gland’s principle function is to make fluid that is mixed with sperm and other fluids to make semen. An enlarged prostate presses upon the urethra that passes through it. This pressure causes some difficulty in initiating the flow of urine so that the person may need to strain to “get going.” In addition, the rate of urine flow is decreased. Subsequently, there is often incomplete emptying of the bladder so that it is necessary to go again within a brief time after the last visit to the bathroom. Burning or other uncomfortable sensations may occur with voiding, too.

In a 20 year-old man, the prostate gland is about the size of a walnut. Thereafter, it slowly enlarges to the point that 38 percent of men between 40 and 79 complain of difficulty with urination. In men of Japanese ancestry, the rate is substantially higher -- 56 percent.

The symptoms of mild prostate enlargement may be controlled by restricting the use of caffeine, alcohol and carbonated drinks. Cough and cold medications with decongestants should be avoided altogether. The non-prescription herbal preparation saw palmetto has been used extensively for prostate symptoms. Research has shown that it does help some men with mild prostate enlargement. Prescription medicines such as Hytrin, Cardura, Flomax and Proscar can be effective, but they are not sufficient to give relief for every sufferer.

Men in several categories need to have surgery, as you did, to alleviate blockage caused by an enlarged prostate. This includes those who don’t benefit from treatment, have repeated urinary tract infections, form bladder stones, develop kidney damage due to backpressure or are repeatedly unable to urinate.
There are several types of prostate surgery. The “gold standard” is the slicing away of prostate tissue by passing the surgical instruments through the penis. This is called a TransUrethral Resection of Prostate, or TURP for short. Perhaps you had this type of surgery. An enlarged prostate can also be treated with other surgical methods that utilize ultrasound, laser, radio frequency ablation, stenting and a number of other minimally invasive approaches.

All surgical treatments of prostatic enlargement have the potential to cause injury to the urethra. When this occurs a number of urination difficulties may ensue, including burning after urinating as you experience. Another concern with your symptoms is urinary tract infection. The most likely cause of your symptoms, however, is that the nerves controlling urination and the sensations associated with it have been injured. This is an undesirable but known complication from all types of prostate surgery.

Soaking in a warm tub can be soothing for an irritated prostate -- or feet -- or emotions, for that matter. Unfortunately, it doesn’t change the underlying disorder. That is why you have had no significant relief from it. Unfortunately, there are conditions for which we doctors can only offer emotional support and minimally effective treatments. Check again with your urologist to see if there are more effective treatments for you.

"Family Medicine" is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701. Past columns are available online at http://www.FamilyMedicineNews.org.