Symptoms associated with BPE
Benign prostatic enlargement (BPE) can affect the way you normally urinate. This happens because the enlarged prostate compresses the urethra at the outlet of the bladder (Fig. 1a and b).
Sometimes the symptoms are mild. For example you may need to urinate more often or find it more difficult to empty your bladder completely. These mild symptoms are a normal part of the aging process – just like decline in mobility, memory, or flexibility. It is possible that your doctor will not recommend treatment for mild symptoms.
Sometimes the symptoms are very bothersome and can have a negative effect on your quality of life. In this case you may benefit from treatment.
The symptoms which are often called lower urinary tract symptoms (LUTS) may be caused by BPE and may be due to other conditions which affect the urinary system.
Types of symptoms
In men with BPE, the symptoms can affect urination in different ways:
- The way you hold the urine in the bladder (storage)
- The way you urinate (voiding)
- How you feel after you urinate (post-micturition)
Storage symptoms include:
- The need to urinate more often than usual
- The need to wake up at night to urinate
- The sudden need to urinate and having trouble postponing it
- Any involuntary loss of urine
Voiding symptoms include:
- A weak stream of urine
- Splitting or spraying of the urine stream
- The flow of urine starts and stops
- Straining when urinating
- It takes a while before the urinary flow starts
- It takes longer to finish urinating
- In rare cases acute or chronic urinary retention
Post-micturition symptoms include:
- The feeling that the bladder is not completely empty
- Involuntary loss or dribbling of urine into your underwear shortly after leaving the toilet
metimes the symptoms are very bothersome and can have a negative effect on your quality of life. In this case you may benefit from treatment.
The symptoms which are often called lower urinary tract symptoms (LUTS) may be caused by BPE and may be due to other conditions which affect the urinary system.
Terms your doctor may use:
- LUTS → Lower urinary tract symptoms
- Micturition → Urination
- Nocturia → The need to wake up at night to urinate
- Post void residual urine (PVR) → The amount of urine left in the bladder after urination
- Urinary incontinence → Involuntary loss of urine
- Urgency → The sudden need to urinate which is difficult to postpone
A type of minimally-invasive procedure to remove abnormal tissue. The doctor destroys the abnormal tissue using heat (radiofrequency ablation) or extreme cold (cryoablation).
The female external genitals.
The large vein that returns blood with low oxygen from the body into the heart.
The muscular tube leading from the external genitals to the cervix of the uterus in women.
Vacuum erection device
An external pump with a band on it that a man with erectile dysfunction can use to get and maintain an erection.
A doctor specialized in health and diseases of the urinary tract and the genitals.
A special funnel that is used during a uroflowmetry test. The funnel is connected to a measuring instrument that calculates the amount of urine, rate of flow in seconds, and length of time until you finish urinating.
The accidental escape of urine from the bladder.
The urination cycle has two phases. One is when the bladder fills up, and it is followed by the urination phase, where the bladder empties.
The organ system which produces and transports urine through and out of the body. It includes two kidneys, two ureters, the bladder and the urethra. The urinary tract is similar in men and women, only men have a longer urethra.
The muscles used to control the exit of urine in the bladder, through the urethra. When either one of the muscles contracts, the urethra is sealed shut.
When you are unable to urinate. This condition can be chronic.
Involuntary loss of urine.
The need to urinate more often than usual, generally more than 8 times a day.
A chemical that is created when the body breaks down substances called purines.
Urgency urinary incontinence
Urgency urinary incontinence (UUI) happens when you get a sudden need to urinate which you cannot postpone. The bladder muscle contracts and you urinate when you do not want to.
The sudden need to urinate which is difficult to postpone.
The tube which carries urine from the bladder and out of the body.
Treatment option to remove kidney or ureteral stones. A ureteroscope is inserted into the urinary tract via the urethra to pull out the stone.
Ureteroscope (rigid or flexible)
An endoscope used for the urinary tract. It is inserted into the urethra and can move through the bladder, up the ureter, and even into the kidney.
One of the two tubes through which urine flows from the kidneys to the bladder.
Imaging technique that uses high-frequency sounds to make an image of the inside of the body.
Imaging technique that uses high-frequency sounds to make an image of the inside of the body (ultrasound).
This refers to how extended a cancer is in the body. It is usually based on the size of the tumour and whether the tumour has spread to the lymph nodes or other organs.
When tumour cells reach the blood or another organ during surgery. These cells may grow in a different location and develop into tumours.
One of the main management tools for doctors. The different tasks or interventions are defined, optimized and set in a specific order. With this the medical team can work on the health of a patient together.
Transurethral resection of the prostate (TURP)
TURP is a standard surgery to treat benign prostatic enlargement (BPE). A part of the prostate is removed to improve the symptoms without making an incision in your lower abdomen. This type of surgery is known as minimally invasive treatment.
Through the natural space in the hip bone.
The Tumour Node Metastasis (TNM) classification is an international classification used to classify tumours according to the size and invasiveness of the tumour (T), whether any lymph nodes are affected (N) and if the cancer has spread to any other parts of your body (M).
The non-metallic part of an Artificial Urinary Sphincter (AUS) that serves to adjust the pressure of the device.
A gland found in the neck which controls how quickly the body uses energy, makes proteins and how sensitive it is to other hormones.
A steroid androgen hormone that is produced mainly in the testicles and is responsible for the development of male sexual characteristics.
The testicles are the male organs that produce sperm and the male hormone testosterone.
Erectile dysfunction that is not chronic or permanent.
These are drugs that target the mechanisms that cancer cells use to grow.
Closely monitoring a patient’s condition but postponing therapy until symptoms appear or change.
Surgical robot system
An instrument to help doctors perform laparoscopic surgery. The surgeon controls the robotic instrument with remote control sensors.
Stress urinary incontinence (SUI)
When your urethra or urinary sphincter cannot resist the pressure of a full bladder. As a result, you lose urine when the pressure on your lower urinary tract suddenly increases. This can happen during activities like coughing, sneezing, or laughing, exercise like running or jumping, or carrying heavy things like groceries.
A drug that tries to reproduce the effect of a hormone in the body. Some steroids are used to treat infections. Other steroid drugs have effects similar to testosterone.
Spinal cord compression
An emergency condition where a tumour or bone fragment puts pressure on the nerves in the spinal cord.
Muscle tissue that is responsible for the contraction of hollow organs, like blood vessels
Shock-wave lithotripsy (SWL)
Treatment option to break stones into smaller pieces using high energy sound waves. Stone fragments pass with urine after the procedure.
A state of physical, emotional, mental and social well-being in relation to sexuality.
A pair of glands located below the bladder. They produce semen.
Treatment that is given when initial treatment does not work, or stops working.
A pouch of skin containing the testicles.
A treatment for cancer given together with or after the main treatment. It can be a treatment to prevent recurrence or part of a palliative care approach.
A tool to determine a treatment pathway. It is based on disease characteristics combined with personal characteristics like medical and family history or general state of health.
Behind the pelvic bone.
A condition when semen can no longer go through the urethra during orgasm but goes into the bladder instead. The semen later leaves the body during urination.
A type of endoscope used for minimally invasive treatment of BPE.
This is the vein that carries the blood filtered by the kidney back into the body.
Also called Gerota’s fascia, it is a layer of connective tissue that surrounds the kidneys.
Fluid-filled sacs located on the kidney. Cysts can be malignant.
Severe pain in flank, loin, groin, or thigh caused by a stone blocking the normal flow of urine.
Renal cell carcinoma
Medical name of kidney cancer.
Renal artery clamp
An instrument used during surgery. The blood flow through the renal artery is blocked with a device called a clamp that compresses the artery.
The artery that carries a large portion of the blood flow that needs to be filtered to the kidneys.
Related to the kidneys.
The return of cancer after treatment and after a period of time in which the cancer could not be detected. This can happen either in the place where the cancer first was detected, or somewhere else in the body. There is no standard period of time, but most doctors would consider it a recurrence if the cancer had not been detected again for at least one year.
The final section of the large intestine, ending at the anus.
A medical professional who specialises in imaging techniques. In cancer, the radiologist analyses x-ray, ultrasound, CT, MRI, or other scans to diagnose or monitor the tumour.
A medical procedure which uses the heat generated from high-frequency currents to treat kidney tumours.
A surgical procedure in which the entire kidney is removed.
A type of cancer treatment that uses radiation to control or kill malignant cells.
A specialist who uses radiation therapy to treat cancer.
Having to do with or affecting the mind.
A medical doctor specializing in the diagnosis and treatment of mental illness.
Testing men for the level of prostate-specific antigen (PSA) in their blood. A high level of PSA in the blood suggests that the cells in the prostate are behaving unusually.
A surgical procedure in which part of or the entire prostate is removed.
Prostate-specific antigen (PSA)
A protein produced by the prostate which may increase in men with a benign prostatic enlargement, prostatic inflammation, or prostate cancer.
The gland which produces the fluid which carries semen. It is located in the male lower urinary tract, under the bladder and around the urethra.
The medical term for predicting the likely outcome of health after treatment.
The malignant cell growth located where the tumour first began to develop.
The sensation that your mouth is dry which leads you to drink too much.
A persistent and painful erection of the penis.
Post void residual urine (PVR)
The amount of urine left in the bladder after urination.
Having to do with or affecting the body.
A measure between 0.0 and 14.0 to describe if a fluid is acidic or alkaline. pH values close to 7.0 are neutral, anything above is alkaline, anything below is acidic.
Lots of tiny red spots or bruises on your arms and legs, caused by a minor haemorrhage in the blood vessels of the skin.
A positron emission tomography (PET) scan is an imaging test that uses a radioactive substance called a tracer to look for disease in the body. A PET scan shows how organs and tissues are working.
A small soluble block that is inserted into the vagina to treat infection or as a contraceptive. It can also be an elastic or rigid device that is inserted into the vagina to support the uterus.
The fat that surrounds the kidney.
Oedema means swelling. Peripheral oedema refers specifically to swelling of the ankles and legs.
The area between the anus and the scrotum or vulva.
A collection of blood next to or around the kidney.
Percutaneous nephrolithotomy (PNL)
Treatment option to remove stones directly from the kidney by placing a tube through the skin.
Through the skin.
A reproductive organ in men which also carries urine out of the body.
Pelvic floor muscles
Muscles that support the pelvic organs, including the bladder and rectum.
A medical professional who studies tissue, blood, or urine to understand the specific characteristics of diseases. In cancer treatment, the pathologist helps with the diagnosis and classification of tumours.
A surgical procedure in which a part of the kidney is removed.
Reactions that the body can have to any type of cancer and may include high blood pressure, weight loss, fever, anaemia, muscle mass loss, and loss of appetite.
A prickling (“pins and needles”) or tingling (“falling asleep”) sensation of the skin.
A concept of care with the goal to optimize your quality of life if you cannot recover from your illness. It involves physical, psychological, social, and spiritual issues.
During the pad test your doctor asks you to wear an absorbent pad. Usually the test lasts between 1 and 24 hours. You have to weigh the amount of urine absorbed by the pad.
A component found in many kinds of food which may be related to forming kidney or ureteral stones.
Overactive Bladder Symptoms
A collection of urinary storage symptoms, including urgency, incontinence, frequency and nocturia.
A bone disease characterized by a reduction of bone mass.
A method of surgical castration in which one or both testicles are removed. If only one testicle is removed, this is known as unilateral orchiectomy. If both testicles are removed this is referred to as bilateral orchiectomy.
A surgical procedure in which the surgeon cuts skin and tissues to have direct access to the structures or organs.
A medical professional who is dedicated to the diagnosis, therapy, follow-up and general care of a person with any type of cancer.
The main female sex hormones which control female characteristics of the body and are important to the reproductive and menstrual cycle.
Obstructive sleep apnoea
Repetitive pauses in breathing during sleep, despite the effort to breathe, commonly paired with snoring.
A group of medicines used to relieve pain. It is often used to relieve renal colic.
Type of CT scan with low radiation exposure.
When the kidneys overproduce urine at night.
Waking up one or more times during the night because of the need to urinate.
New hormonal agents
A group of drugs for castration-resistant prostate cancer when standard hormonal treatment is no longer effective.
A medical doctor who has trained in the diagnosis and treatment of nervous system disorders, including diseases of the brain, spinal cord, nerves, and muscles.
Related to the nervous system.
Neurogenic lower urinary tract dysfunction
A complication in the lower urinary tract caused by problems in the nervous system that influences its activity.
A type of surgery that attempts to save the nerves near the tissues being removed.
A tube placed directly into the kidney through the skin. This allows the urine to leave the body.
Another name for partial nephrectomy, the surgical removal of a kidney tumour together with some of the normal kidney tissue. This surgery aims at preserving as much of the kidney tissue as possible.
The process through which new blood vessels form from pre-existing vessels. In cancer this process allows tumours to grow.
A combination of different branches of expertise. In medicine, it means that for instance urologists, oncologists, psychologists or other medical specialists work together.
Magnetic Resonance Imaging is a technique in which strong magnetic fields and radio waves are used to make images of the body.
Mixed urinary incontinence
Having symptoms of both stress urinary incontinence and urgency urinary incontinence.
A surgical procedure where there is no need to cut through skin and tissue. Small incisions are made in the abdomen to insert the surgical instruments.
A surgical procedure where there is no need to make an incision in the body. An endoscope is used to reach the part of the body that needs to be treated through the urethra (see also Endoscope).
When a tumour has spread to other organs or lymph nodes.
The surgical procedure to remove metastases. These are tumours that have spread to other organs of the body.
Series of blood and urine tests for patients who have a high risk of forming stones.
A doctor who specializes in all types of cancer and mostly uses drugs to treat them.
A brief summary of previous operations, previous and current diseases, known allergies, and drugs you currently take.
Medical Expulsive Therapy (MET)
Medication that makes the natural passing of stones easier and less painful.
Glands located in the breasts. In women, the mammary glands can produce milk.
A cancerous growth which either grows continuously or in spurts. Malignant tumours can metastasize, which means they spread throughout the body.
Leakage of lymph fluid onto the skin. The fluid leads to skin damage, and may cause an infection.
The surgical procedure in which the lymph nodes are removed because they are enlarged due to the presence of a tumour.
Small oval-shaped organs that play a role in regulating how the immune system responds.
Lower urinary tract symptoms. A term used for the symptoms caused by BPE which can also point to other diseases affecting the urinary tract (see also Urinary tract).
Locally-advanced prostate cancer
A prostate cancer where the tumour has spread outside of the prostate and into surrounding tissue.
Locally-advanced kidney cancer
A cancer where the tumour has grown out of the kidneys into surrounding tissue and invaded veins, the adrenal gland, or lymph nodes.
Localized prostate cancer
A prostate cancer where the tumour is limited to the prostate and has not spread.
Localized kidney cancer
A kidney cancer where the tumour is limited to the kidney and has not spread.
A lobe is any division or extension of an organ that is clearly visible without using a microscope.
A short band of tough, flexible fibrous tissue which connects two bones or cartilages or holds together a joint.
Drugs used in prostate cancer treatment to stop the production of testosterone, by inhibiting the production of androgens.
Drugs used in prostate cancer treatment to stop the production of testosterone in the testicles.
A minimally-invasive surgical technique in which the surgeon does not need to cut through skin and tissue. Instead, the surgeon inserts the surgical instruments through small incisions in your abdomen.
Two bean-shaped organs in the back of the abdomen that filter the blood and produce urine.
A tube that is temporarily placed in the ureter to make sure urine can flow from the kidney to the bladder.
Any procedure in which the doctor inserts instruments into the body, or parts of the body.
An imaging technique where x-ray contrast agent is injected into the vein, usually in the arm.
An injection into the base of the penis.
A tube placed in the urethra and bladder to help you urinate. An intermittent catheter is manually placed and removed several times a day, to empty the bladder fully.
A tube placed in the urethra and bladder to help you urinate.
A type of cancer treatment which boosts the immune system to fight tumour cells.
Taking images of the body with ultrasound, x-ray or other scanning techniques.
A medical condition characterized by redness of the skin, sweating and a sudden feeling of inner heat.
Molecules that are produced in glands and circulate in the blood system to reach their target organs. They affect body functions and behaviour.
Any treatment option in which hormones are used.
The examination of tissue under a microscope, to study the presence and characteristics of diseases such as cancer.
High-Intensity Focussed Ultrasound. A minimally-invasive procedure that applies ultrasound energy to heat up and destroy cancer cells.
A side effect of some types of drug therapy for cancer. It causes redness, swelling and pain on the palms of the hands and/or the soles of the feet, and in some cases blisters.
A hormonal disorder in which men have benign enlargement of breast tissue.
Having to do with the health of the female reproductive system, including the vagina, uterus and ovaries, and the breasts.
The Gleason score determines the aggressiveness of a tumour in the prostate. It is based on the pattern of the cancer cells. Each pattern gets a value between 1 and 5. The pathologist adds the scores of the two patterns that appear in most of the tissue samples after a biopsy. Tumours with a higher score are more aggressive and more difficult to cure.
The rounded part forming the end of the penis.
A gland is an organ that synthesizes hormones for release into the bloodstream or other parts of the body.
Fuhrman nuclear grade
Analysing the aggressiveness of a tumour based on the structure of its cells.
Pieces of the stone broken during a procedure.
In radiology, the act of dividing the dose of radiation into smaller doses with one or more rest periods in between.
A general term for a variety of minimally-invasive techniques for destroying small tumours. The main purpose of focal therapy is to limit damage to surrounding tissue.
When testosterone levels increase before decreasing as a result of hormonal drug therapy with LHRH agonist drugs.
The first treatment given for a disease. It is often part of a standard set of treatment options.
A type of connective tissue made of cells which store fat. Also called adipose tissue.
This means you feel more tired than usual, you are out of energy, and it doesn’t get better after you sleep. You may also experience pain in your joints, muscles, and chest.
Extracorporeal shockwave therapy (ESWT)
A treatment option that uses high energy sound waves to break down tissue.
The erectile tissue forming the bulk of the penis.
The inability to get or keep an erection.
Large biological molecules that are responsible for the processes of the metabolism.
A tube-like instrument to examine the inside of the body. Can be flexible or rigid.
A medical doctor who deals with the diagnosis and treatment of diseases related to hormones.
A non-surgical, minimally-invasive procedure in which a blood vessel is blocked to prevent the blood flow from reaching a tumour.
Digital rectal examination
A test in which the doctor uses a finger to feel the size, shape, and consistency of the prostate to diagnose conditions like an enlarged prostate or prostate cancer.
The doctor and nurses do a series of tests to understand what causes your symptoms.
A smooth muscle found in the bladder wall. The detrusor muscle remains relaxed to allow the bladder to store the urine, and contracts during urination to release the urine.
An injection of a drug, usually into the muscle or right under the skin. The drug is either solid or oil-based and the active compound is released over a long period of time, without having to take any extra steps.
Relieving pressure in the kidneys. A nephrostomy tube is placed directly in the kidney through the skin so that urine can leave the body.
Cytoreductive means reducing the number of tumour cells. This surgery is specific for metastatic kidney cancer. In this surgical procedure a tumour in the kidney is removed, while leaving distant metastases. The aim of the surgery is to reduce the total tumour cells in the body.
It is a procedure in which the doctor looks inside your body with a cystoscope inserted through the urethra
A type of endoscope which is used in the urethra (see also Endoscope, Urethra).
CT stands for Computed Tomography. It is an imaging technique that makes a series of x-ray images of the body.
Cryosurgical ablation of the prostate. In this minimally-invasive technique, freezing temperatures are applied directly to the tumour cells to kill them.
Is the use of low temperatures in medical therapy, to treat either benign or malignant cell growth.
A substance that increases the contrast of structures or fluids in the body. It is used in medical imaging (See also Imaging).
Any symptoms or conditions that make a certain treatment option undesirable.
Monitoring the progress of the stone disease or treatment with medication to ease the natural passing of stones.
A type of treatment in which the doctor monitors your health and can recommend treatment if necessary.
These are experimental research studies designed to answer specific questions about treatments or drugs. They generally test how well a treatment works among patients with specific characteristics.
Clear cell renal cell carcinoma
A type of kidney tumour with a high content of fat.
Is a treatment of cancer with drugs that are toxic to cells. Some are specifically toxic to cells that grow faster than normal, like cancer cells.
A type of treatment in which drugs are used to stop the production of androgens, or block their effect.
A hollow flexible tube to insert or drain fluids from the body. In urology, catheters are generally used to drain urine from the bladder.
Castration-resistant prostate cancer
A type of prostate cancer that needs lower levels of androgens to continue to grow.
A chemical or surgical treatment in which the production of androgens is stopped, or the effect of the hormones is blocked.
A disease involving the heart and the blood vessels.
A doctor who specializes in cardiovascular diseases.
Sometimes called seed implantation. Radioactive “seeds” are carefully placed inside of the cancerous tissue and positioned to attack the cancer most efficiently.
A scan of the entire body that can be used to find bone metastases.
The different layers of tissue that shape the bladder.
The group of muscles that connect the bladder to the urethra. These muscles contract to keep the urine in the bladder, and relax to let the urine pass to the urethra.
Organ which collects urine from the kidneys.
A medical procedure in which a small piece of tissue is removed from the body to examine it. This is done to get information for diagnosing, monitoring, and treatment.
A non-cancerous growth which will not spread to other organs.
Benign Prostatic Enlargement (BPE)
An enlargement of the prostate related to hormonal changes with age.
Cell growth in the body which is not cancerous.
Stones that do not cause any symptoms. They are usually found during imaging tests done for another condition.
Any condition which does not cause symptoms and is discovered incidentally.
Therapy with drugs which prevent the formation of new blood vessels that feed a tumour and allow it to grow.
Any drug that blocks the action of androgens.
The medical specialist that deals with male health, particularly relating to the problems of the male reproductive system and urological problems that are unique to men.
Male sex hormones that control and provide male characteristics like facial hair and lower voice.
Anaesthesia (general, spinal, or local)
Before a procedure you will get medication to make sure that you don’t feel pain. Under general anaesthesia you are unconscious and unaware of what is happening to you. Under spinal or local anaesthesia you will not feel pain in the part of your body where the procedure is done. Anaesthesia wears off gradually after the procedure.
A lowered level of red blood cells. It is the most common disorder of the blood. It causes fatigue, weakness and poor concentration, among others.
A group of drugs that reduces or stops the production of the hormone adrenaline.
The surgical procedure in which the adrenal gland is removed.
The adrenal glands are organs that sit at the top of the kidneys. They are responsible for releasing hormones.
The enlarged part of the prostate.
Procedures to remove a kidney or ureteral stone.