Editor’s note: This is the first of a two-part series on medical issues that men face. Next week, we will further focus on erectile dysfunction, prostate cancer and kidney stones.

By Kristine Porter

kporter@tnonline.com

The main reasons male patients come to see Dr. Shawn Mendonca, a urologist at Lehigh Valley Health Network, is voiding dysfunction, erectile dysfunction, prostate cancer and kidney stones.

The most common of these is voiding dysfunction, which is the result of an enlarged prostate.

“As men age, inevitably the prostate gets larger,” Mendonca said.

By age 70, most men have voiding problems, but it can also occur in men in their 50s, especially if they have family history of enlarged prostate. On the rare occasion, it can develop in men in their 20s and 30s.

As the prostate gets larger, it narrows the channel, making it difficult to empty the bladder completely. This causes a stop and starting in urination. Many men also find they have to go to the bathroom several times during the night.

Another issue with voiding dysfunction is a symptom called urgency. This symptom is a sudden sensation of the need to urinate. It often sends a man racing for the bathroom in order to prevent an accident.

Mendonca said it’s not known what causes the prostate to enlarge and there’s nothing a man can do to prevent it. But there are a range of treatments for it.

“The most important question is ‘Is it bothering you,’?” he said. “These issues aren’t life or death, but there are ways to improve the quality of life.”

Treating dysfunction

Mendonca said he suggest behavioral modifications before jumping to medication. For instance, he recommends waiting a minute or two after urinating, then urinating a second time. This is called double voiding.

“That usually solves the issue with emptying the bladder,” he said.

Another modification is called time voiding. This is when a man goes to the bathroom every three or four hours throughout the day in order to keep the bladder empty.

If waking at night is a problem, Mendonca suggest restricting the intake of liquids two hours before bedtime. If they are on diuretics, such as a water pill for blood pressure or congestive heart failure, then wait until morning to take the pill instead of at bedtime.

Medication options

If these lifestyle changes don’t work, then medications are an option.

There are medications to help relax the prostate and those to shrink the it. Both help patients improve the flow and empty the bladder. For patients whose main symptom is urgency, there is a medication to help relax the bladder

“There’s an art to how to manage patients and help them get through it,” he said.

Of course, medications can have side effects.

Medications to relax the prostate are called alpha blockers. These effect the blood vessels and for some men, especially those who are older or more fragile, it can cause them to feel light headed or dizziness when moving from a sitting to standing position, for example. It can also occur in men who are taking a higher dosage of blood pressure medication or HIV medication.

Side effects often occur after a few dose, but lessens over time.

Another side effect is called retrograde ejaculation. Instead of the ejaculate exiting the body, it goes the other direction into the bladder. It’s not harmful and feels the same, Mendonca said. The only problem is that it interferes with a man’s fertility. As for the ejaculate, the patient will just urinate it out later.

Medications can also cause some issues for men with cataracts, so they should tell their eye doctor that they are taking a medication.

As far as natural supplements such as saw palmetto, there is no scientific evidence that it helps more than a placebo.

“I have patients that swear by saw palmetto and they are like, ‘This stuff works, doc,’?” he said.

If a patient is taking their medication and he thinks the supplement is helping, then Mendonca said he is fine with him taking the supplement. Just make sure to tell the primary care physician everything that is being taken, because some supplements can interfere with other medications.

Another option: surgery

The next step is surgery if medications are not working.

Surgery involves opening up the prostate channel by cutting the prostate to widen the channel. Mendonca said he assesses a patient’s co-morbidities, prostate size, and the shape of the prostate before choosing a surgical option.

When surgery is chosen, it is usually an outpatient procedure with a very low risk of complications.

It is minimally invasive with no incisions, and takes about 15 minutes, but can take an hour or so.

Mendonca recommends a week or two for recovery, but some patients choose to go back to work the next day.

Whichever treatment is chosen, Mendonca recommends seeking treatment sooner than later.

Don’t wait more than 5 to 10 years to seek treatment. Eventually the bladder will stop squeezing as hard, because it’s been fighting against this enlarged prostate for too many years.