Prostate and Other Urologic Diseases Sourcebook, 1st Ed.

By Omnigraphics

Provides consumer health information about prostate and urologic diseases, including urinary tract infections, kidney stones, etc.; sexual, reproductive, and bladder problems in men; and facts about prevention, diagnosis, and treatment of prostate and urologic diseases.

• Language: English
• Publisher: Omnigraphics
• Release date: Apr 1, 2021
• ISBN: 9780780818477

Book preview

Preface

About This Book

Urologic diseases that affect men, and children of all ages include a wide variety of conditions, such as urinary tract infections (UTIs), kidney stones, bladder control problems, and prostate problems, etc., which are all related to filtering and carrying urine out of the body. Some common prostate problems include prostatitis, benign prostatic hyperplasia (BPH), and prostate cancer. According to the Centers for Disease Control and Prevention (CDC), in the United States, among men, aside from nonmelanoma skin cancer, prostate cancer is the most common and leading cause of cancer deaths. In the United States, during 2017, the latest year for which incidence data are available, there were 207,430 new cases of prostate cancer reported, and 30,486 deaths. For every 100,000 men, 107 new prostate cancer cases were reported and there were 19 deaths.

Prostate and Other Urologic Diseases Sourcebook, First Edition begins with information for men to understand male growth and development, their reproductive system, the urinary tract and how it works, and prostate and bladder problems. It also has information regarding urological issues among different age groups. It goes on to explain the common urinary tract and prostate conditions in newborns and children, kidney stones in adults, urinary tract and bladder infection in adults, urinary incontinence in older adults, urethritis, urethral stricture, prostatitis, prostate enlargement, and epididymitis and orchitis. There is information about bladder control problems, interstitial cystitis (IC), urinary retention, overactive bladder, hematuria, perineal injury in males, and bladder health for older adults. It sheds light on sexual and reproductive concerns facing men such as sexually transmitted diseases (STDs), the effects of workplace hazards on male reproductive health, testosterone deficiency, diabetes and sexual problems, infertility management, erectile dysfunction (ED), Peyronie disease, enlarged prostate and sex life, undescended testicle, varicocele, and male sterilization, along with cancers of the genitourinary system including prostate cancer, kidney and renal pelvis cancer, testicular cancer, penile cancer, urethral cancer, and bladder cancer. The later part then goes on to explain the diagnosis and treatment and prevention of various prostate and urologic diseases. The book concludes with a glossary of related terms and a directory of resources for more information.

How to Use This Book

This book is divided into parts and chapters. Parts focus on broad areas of interest. Chapters are devoted to single topics within a part.

Part 1: Understanding the Genitourinary System gives information about growth and development in males along with details on the male reproductive system. The part also provides information about the urinary tract and how it works, and also about prostate and bladder problems. It also covers urology issues in different age groups.

Part 2: Urinary Tract and Prostate Conditions starts with explaining hydronephrosis in newborns, and then goes on to explain conditions in children such as kidney stones, urinary tract and bladder infections, and vesicoureteral reflux. It provides information about hydrocele. It covers information related to adults such as kidney stones, urinary tract and bladder infections, urinary incontinence (UI), prostatitis and its types, and prostate enlargement. Information regarding urethritis, urethral stricture, epididymitis, and orchitis is also covered in this part.

Part 3: Bladder Problems in Men begins with bladder control problems. It also covers information with respect to interstitial cystitis (IC), urinary retention, overactive bladder, hematuria, perineal injury in males, and bladder health for older adults.

Part 4: Sexual and Reproductive Concerns in Men is dedicated to providing information on male reproductive issues, including sexually transmitted diseases and what gay, bisexual, and other men who have sex with men need to know about sexually transmitted diseases, the effects of workplace hazards on male reproductive health, and testosterone deficiency. The part also covers information about diabetes and sexual problems, infertility management, erectile dysfunction (ED), enlarged prostate and sex life, undescended testicle, varicocele, and Peyronie disease. The part also focuses on male sterilization including vasectomy and its reversal.

Part 5: Cancers of the Genitourinary System begins with a detailed elaboration of prostate cancer, its genetics, biopsy, and hormone therapy. It also provides information with respect to prevention, treatment, and coping with prostate cancer, and also about the use of complementary and alternative medicine (CAM) in prostate cancer. The part also provides information about various types of cancers that occur in the genitourinary system such as kidney and renal pelvis cancer, testicular cancer, penile cancer, urethral cancer, and bladder cancer, etc. It also highlights sexual health issues in men with cancer, and the impact of COVID-19 on genitourinary malignancies.

Part 6: Diagnosis and Treatment of Prostate and Urologic Diseases elaborates on prostate-specific antigen (PSA) test, kidney stone analysis, urodynamic testing, urinalysis, urinary tract imaging, cystoscopy and ureteroscopy, urinary diversion, chronic urinary retention (CUR) treatment, and bladder control medicines. Additional details about the various urological procedures including the types of prostate surgery, lithotripsy, orchiopexy, penile plication, prosthesis, and implantation, and male circumcision are also focused.

Part 7: Preventing Prostate and Other Urologic Problems starts with information about bladder infection prevention in children and tips to keep the bladder healthy. It also covers information about natural ways to lower risks related to prostate and other urologic problems and about Kegel exercises for men. It also discusses information about how to reduce the risk of getting a sexually transmitted disease.

Part 8: Additional Help and Information contains a glossary of terms related to prostate and other urologic diseases and a list of resources providing information about prostate and other urologic diseases.

Bibliographic Note

This volume contains documents and excerpts from publications issued by the following U.S. government agencies: Agency for Healthcare Research and Quality (AHRQ); Centers for Disease Control and Prevention (CDC); Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD); National Cancer Institute (NCI); National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); National Institute of Environmental Health Sciences (NIEHS); National Institute on Aging (NIA); National Institutes of Health (NIH); and U.S. Food and Drug Administration (FDA).

It also contains original material produced by Omnigraphics and reviewed by medical consultants.

About the Health Reference Series

The Health Reference Series is designed to provide basic medical information for patients, families, caregivers, and the general public. Each volume provides comprehensive coverage on a particular topic. This is especially important for people who may be dealing with a newly diagnosed disease or a chronic disorder in themselves or in a family member. People looking for preventive guidance, information about disease warning signs, medical statistics, and risk factors for health problems will also find answers to their questions in the Health Reference Series. The Series, however, is not intended to serve as a tool for diagnosing illness, in prescribing treatments, or as a substitute for the physician–patient relationship. All people concerned about medical symptoms or the possibility of disease are encouraged to seek professional care from an appropriate healthcare provider.

A Note about Spelling and Style

Health Reference Series editors use Stedman’s Medical Dictionary as an authority for questions related to the spelling of medical terms and The Chicago Manual of Style for questions related to grammatical structures, punctuation, and other editorial concerns. Consistent adherence is not always possible, however, because the individual volumes within the Series include many documents from a wide variety of different producers, and the editor’s primary goal is to present material from each source as accurately as is possible. This sometimes means that information in different chapters or sections may follow other guidelines and alternate spelling authorities. For example, occasionally a copyright holder may require that eponymous terms be shown in possessive forms (Crohn’s disease vs. Crohn disease) or that British spelling norms be retained (leukaemia vs. leukemia).

Medical Review

Omnigraphics contracts with a team of qualified, senior medical professionals who serve as medical consultants for the Health Reference Series. As necessary, medical consultants review reprinted and originally written material for currency and accuracy. Citations including the phrase Reviewed (month, year) indicate material reviewed by this team. Medical consultation services are provided to the Health Reference Series editors by:

Dr. Vijayalakshmi, MBBS, DGO, MD

Dr. Senthil Selvan, MBBS, DCH, MD

Dr. K. Sivanandham, MBBS, DCH, MS (Research), PhD

Health Reference Series Update Policy

The inaugural book in the Health Reference Series was the first edition of Cancer Sourcebook published in 1989. Since then, the Series has been enthusiastically received by librarians and in the medical community. In order to maintain the standard of providing high-quality health information for the layperson the editorial staff at Omnigraphics felt it was necessary to implement a policy of updating volumes when warranted.

Medical researchers have been making tremendous strides, and it is the purpose of the Health Reference Series to stay current with the most recent advances. Each decision to update a volume is made on an individual basis. Some of the considerations include how much new information is available and the feedback we receive from people who use the books. If there is a topic you would like to see added to the update list, or an area of medical concern you feel has not been adequately addressed, please write to:

Managing Editor

Health Reference Series

Omnigraphics

615 Griswold St., Ste. 520

Detroit, MI 48226

Part 1 | Understanding the Genitourinary System

Chapter 1 | Growth and Development of Male Body

Puberty is a period of changes that occur in young girls and boys during the ages of 10–16. It is also termed as sexual development. As their bodies develop, hormonal changes transform teens into physically mature adolescents. The growth spurt of boys usually occurs one to two years later than girls. Though the skeletal growth stops by the age of 16, their muscles still continue to develop and grow. Puberty changes can cause teens to worry about what others might think of them and causes peer pressure in them. Healthy eating habits, physical activities, and well-balanced diets are important to ensure proper growth and development during these years.

Transition of a Boy into Adulthood

Hormonal changes are the reason for sexual and other physical development that happens during puberty. It is a period of mental, physical, emotional, and social changes. As sexual development happens gradually over a period of time, it is difficult to know when exactly puberty occurs. A few stages of sexual development – usually five stages of puberty – that boys go through are as follows:

The initial stage of puberty involves the enlargement of the scrotum and testes; however, the penis does not grow in size.

Gradually over time, the penis starts to grow along with the scrotum and testes around the age of 10.

Around the age of 11, soft pubic hair starts to grow in a small area around the genitals.

Over time, this hair then becomes thicker, darker, and coarser as it continues to spread over to the thighs and up to the stomach.

The additional changes that may happen to boys during puberty:

As a result of the hormonal changes, there is the formation of breast tissue in some teenage boys, which usually goes away in a few years. This is normal and is typically a transient condition among teenage boys.

At the age of 13, voice changes occur and become deeper.

At the age of 14, acne may appear and hair will appear in the armpits.

Boys will experience hair growth on their face, chest, under their arms, and on their legs usually around the age of 14–15.

Boys start to experience erection of the penis. These erections are normal signs that the body is maturing, and they gradually decrease over time.

The body starts to produce sperm, which is usually released during an erection. Sometimes ejaculation of sperm occurs during sleep and is known as wet dreams, which is a normal part of puberty.

Other Changes during Puberty

Acne

Acne is a common condition faced by both girls and boys and it occurs as the oil secreted from the body settles on the skin and clogs the sweat pores. Acnes can be seen on the face, back, or even chest.

Body Odor

Sweat glands develop during puberty and lead to more perspiration. This can cause sweat stains and even bad odor.

Emotional Imbalance

At this stage of puberty, boys will experience a range of emotions such as being sad, irritated, angry, conflict of opinions with peers, and misunderstandings among family members. However, these situations will start to normalize by the end of puberty.

Duration of Puberty

The onset and duration of puberty vary greatly among boys and can last between two to five years from onset. Some boys may experience maturity sooner than others. Development charts indicate that the growth of the body reduces after the age of 18. Certain individuals may experience puberty growth in their late teens or early twenties. It is important to note that these bodily shifts happen to everyone at different times. As every child encounters puberty at different times, it is common for boys to look smaller or larger than other boys, which need not be a thought to worry about.

References

Goldman, Rena. Stages of Puberty: Development in Girls and Boys, Healthline, August 23, 2018.

Puberty: Adolescent Male, Nationwide Children’s Hospital, October 1, 2016.

Young Teens (12–14 Years of Age), Centers for Disease Control and Prevention (CDC), December 2, 2020.

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Growth and Development of Male Body, © 2021 Omnigraphics. Reviewed February 2021.

Chapter 2 | Male Reproductive System

The male reproductive system, like that of the female, consists of those organs whose function is to produce a new individual, that is, to accomplish reproduction. This system consists of a pair of testes and a network of excretory ducts, such as epididymis, ductus deferens (vas deferens), and ejaculatory ducts, seminal vesicles, the prostate, the bulbourethral glands, and the penis.

Testes

The male gonads, testes or testicles, begin their development high in the abdominal cavity, near the kidneys. During the last two months before birth, or shortly after birth, they descend through the inguinal canal into the scrotum, a pouch that extends below the abdomen, posterior to the penis. Although this location of the testes, outside the abdominal cavity, may seem to make them vulnerable to injury, it provides a temperature about 3 °C below normal body temperature. This lower temperature is necessary for the production of viable sperm.

The scrotum consists of the skin and subcutaneous tissue. A vertical septum, or partition, of subcutaneous tissue in the center, divides it into two parts, each containing one testis. Smooth muscle fibers, called the dartos muscle, in the subcutaneous tissue contract to give the scrotum its wrinkled appearance. When these fibers are relaxed, the scrotum is smooth. Another muscle, the cremaster muscle, consists of skeletal muscle fibers and controls

Figure 2.1. The Male Reproductive System

Figure 2.2. Sagittal Section of a Testis and Epididymis

the position of the scrotum and testes. When it is cold or a man is sexually aroused, this muscle contracts to pull the testes closer to the body for warmth.

Structure

Each testis is an oval structure about 5 cm long and 3 cm in diameter. A tough, white fibrous connective tissue capsule, the tunica albuginea, surrounds each testis and extends inward to form septa that partition the organ into lobules. There are about 250 lobules in each testis. Each lobule contains 1 to 4 highly coiled seminiferous tubules that converge to form a single straight tubule, which leads into the rete testis. Short efferent ducts exit the testes. Interstitial cells (cells of Leydig), which produce male sex hormones, are located between the seminiferous tubules within a lobule.

Spermatogenesis

Sperm are produced by spermatogenesis within the seminiferous tubules. A transverse section of a seminiferous tubule shows that it is packed with cells in various stages of development. Interspersed with these cells, there are large cells that extend from the periphery of the tubule to the lumen. These large cells are the supporting, or sustentacular cells (Sertoli’s cells), which support and nourish the other cells.

Early in embryonic development, primordial germ cells enter the testes and differentiate into spermatogonia, immature cells that remain dormant until puberty. Spermatogonia are diploid cells, each with 46 chromosomes (23 pairs) located around the periphery of the seminiferous tubules. At puberty, hormones stimulate these cells to begin dividing by mitosis. Some of the daughter cells produced by mitosis remain at the periphery as spermatogonia. Others are pushed toward the lumen, undergo some changes, and become primary spermatocytes. Because they are produced by mitosis, primary spermatocytes, like spermatogonia, are diploid and have 46 chromosomes.

Each primary spermatocytes goes through the first meiotic division, meiosis I, to produce two secondary spermatocytes, each with 23 chromosomes (haploid). Just prior to this division, the genetic material is replicated so that each chromosome consists of two strands, called chromatids, that are joined by a centromere. During meiosis I, one chromosome, consisting of two chromatids, goes to each secondary spermatocyte. In the second meiotic division, meiosis II, each secondary spermatocyte divides to produce two spermatids. There is no replication of genetic material in this division, but the centromere divides so that a single-stranded chromatid goes to each cell. As a result of the two meiotic divisions, each primary spermatocyte produces four spermatids. During spermatogenesis there are two cellular divisions, but only one replication of deoxyribonucleic (DNA) so that each spermatid has 23 chromosomes (haploid), one from each pair in the original primary spermatocyte. Each successive stage in spermatogenesis is pushed toward the center of the tubule so that the more immature cells are at the periphery and the more differentiated cells are nearer the center.

Spermatogenesis (and oogenesis in the female) differs from mitosis because the resulting cells have only half the number of chromosomes as the original cell. When the sperm cell nucleus unites with an egg cell nucleus, the full number of chromosomes is restored. If sperm and egg cells were produced by mitosis, then each successive generation would have twice the number of chromosomes as the preceding one.

The final step in the development of sperm is called spermiogenesis. In this process, the spermatids formed from spermatogenesis become mature spermatozoa, or sperm. The mature sperm cell has a head, midpiece, and tail. The head, also called the nuclear region, contains the 23 chromosomes surrounded by a nuclear membrane. The tip of the head is covered by an acrosome, which contains enzymes that help the sperm penetrate the female gamete. The midpiece, the metabolic region, contains mitochondria that provide adenosine triphosphate (ATP). The tail or locomotor region, uses a typical flagellum for locomotion. The sperm are released into the lumen of the seminiferous tubule and leave the testes. They then enter the epididymis where they undergo their final maturation and become capable of fertilizing a female gamete.

Sperm production begins at puberty and continues throughout the life of a male. The entire process, beginning with a primary spermatocyte, takes about 74 days. After ejaculation, the sperm can live for about 48 hours in the female reproductive tract.

Duct System

Sperm cells pass through a series of ducts to reach the outside of the body. After they leave the testes, the sperm passes through the epididymis, ductus deferens, ejaculatory duct, and urethra.

Epididymis

Sperm leave the testes through a series of efferent ducts that enter the epididymis. Each epididymis is a long (about 6 meters) tube that is tightly coiled to form a comma-shaped organ located along the superior and posterior margins of the testes. When the sperm leave the testes, they are immature and incapable of fertilizing ova. They complete their maturation process and become fertile as they move through the epididymis. Mature sperm are stored in the lower portion, or tail, of the epididymis.

Ductus Deferens

The ductus deferens, also called vas deferens, is a fibromuscular tube that is continuous (or contiguous) with the epididymis. It begins at the bottom (tail) of the epididymis then turns sharply upward along the posterior margin of the testes. The ductus deferens enters the abdominopelvic cavity through the inguinal canal and passes along the lateral pelvic wall. It crosses over the ureter and posterior portion of the urinary bladder, and then descends along the posterior wall of the bladder toward the prostate gland. Just before it reaches the prostate gland, each ductus deferens enlarges to form an ampulla. Sperm are stored in the proximal portion of the ductus deferens, near the epididymis, and peristaltic movements propel the sperm through the tube.

The proximal portion of the ductus deferens is a component of the spermatic cord, which contains vascular and neural structures that supply the testes. The spermatic cord contains the ductus deferens, testicular artery and veins, lymph vessels, testicular nerve, cremaster muscle that elevates the testes for warmth and at times of sexual stimulation, and a connective tissue covering.

Ejaculatory Duct

Each ductus deferens, at the ampulla, joins the duct from the adjacent seminal vesicle (one of the accessory glands) to form a short ejaculatory duct. Each ejaculatory duct passes through the prostate gland and empties into the urethra.

Urethra

The urethra extends from the urinary bladder to the external urethral orifice at the tip of the penis. It is a passageway for sperm and fluids from the reproductive system and urine from the urinary system. While reproductive fluids are passing through the urethra, sphincters contract tightly to keep urine from entering the urethra.

The male urethra is divided into three regions. The prostatic urethra is the proximal portion that passes through the prostate gland. It receives the ejaculatory duct, which contains sperm and secretions from the seminal vesicles, and numerous ducts from the prostate glands. The next portion, the membranous urethra, is a short region that passes through the pelvic floor. The longest portion is the penile urethra (also called spongy urethra or cavernous urethra), which extends the length of the penis and opens to the outside at the external urethral orifice. The ducts from the bulbourethral glands open into the penile urethra.

Accessory Glands

The accessory glands of the male reproductive system are the seminal vesicles, prostate gland, and bulbourethral glands. These glands secrete fluids that enter the urethra.

Seminal Vesicles

The paired seminal vesicles are saccular glands posterior to the urinary bladder. Each gland has a short duct that joins with the ductus deferens at the ampulla to form an ejaculatory duct, which then empties into the urethra. The fluid from the seminal vesicles is viscous and contains fructose, which provides an energy source for the sperm; prostaglandins, which contribute to the mobility and viability of the sperm; and proteins that cause slight coagulation reactions in the semen after ejaculation.

Prostate

The prostate gland is a firm, dense structure that is located just inferior to the urinary bladder. It is about the size of a walnut and encircles the urethra as it leaves the urinary bladder. Numerous short ducts from the substance of the prostate gland empty into the prostatic urethra. The secretions of the prostate are thin, milky colored, and alkaline. They function to enhance the motility of the sperm.

Bulbourethral Glands

The paired bulbourethral (Cowper’s) glands are small, about the size of a pea, and located near the base of the penis. A short duct from each gland enters the proximal end of the penile urethra. In response to sexual stimulation, the bulbourethral glands secrete an alkaline mucus-like fluid. This fluid neutralizes the acidity of the urine residue in the urethra, helps to neutralize the acidity of the vagina, and provides some lubrication for the tip of the penis during intercourse.

Seminal Fluid

Seminal fluid, or semen, is a slightly alkaline mixture of sperm cells and secretions from the accessory glands. Secretions from the seminal vesicles make up about 60 percent of the volume of the semen, with most of the remainder coming from the prostate gland. The sperm and secretions from the bulbourethral gland contribute only a small volume.

The volume of semen in a single ejaculation may vary from 1.5 to 6.0 ml. There are usually between 50 to 150 million sperm per milliliter of semen. Sperm counts below 10 to 20 million per milliliter usually present fertility problems. Although only one sperm actually penetrates and fertilizes the ovum, it takes several million sperm in ejaculation to ensure that fertilization will take place.

Figure 2.3. Structure of the Penis

Penis

The penis, the male copulatory organ, is a cylindrical pendant organ located anterior to the scrotum and functions to transfer sperm to the vagina. The penis consists of three columns of erectile tissue that are wrapped in connective tissue and covered with skin. The two dorsal columns are the corpora cavernosa. The single, midline ventral column surrounds the urethra and is called the corpus spongiosum.

The penis has a root, body (shaft), and glans penis. The root of the penis attaches it to the pubic arch, and the body is the visible, pendant portion. The corpus spongiosum expands at the distal end to form the glans penis. The urethra, which extends throughout the length of the corpus spongiosum, opens through the external urethral orifice at the tip of the glans penis. A loose fold of skin, called the prepuce, or foreskin, covers the glans penis.

Male Sexual Response and Hormonal Control

The male sexual response includes erection and orgasm accompanied by ejaculation of semen. Orgasm is followed by a variable time period during which it is not possible to achieve another erection.

Three hormones are the principle regulators of the male reproductive system: follicle-stimulating hormone (FSH) stimulates spermatogenesis; luteinizing hormone (LH) stimulates the production of testosterone; and testosterone stimulates the development of male secondary sex characteristics and spermatogenesis.

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This chapter includes text excerpted from Male Reproductive System, Surveillance, Epidemiology, and End Results Program (SEER), National Cancer Institute (NCI), April 28, 2009. Reviewed February 2021.

Chapter 3 | The Urinary Tract and How It Works

What Is the Urinary Tract?

The urinary tract is the body’s drainage system for removing urine, which is made up of wastes and extra fluid. For normal urination to occur, all body parts in the urinary tract need to work together, and in the correct order.

The urinary tract includes two kidneys, two ureters, a bladder, and a urethra.

Kidneys. Two bean-shaped organs, each about the size of a fist. They are located just below your rib cage, one on each side of your spine. Every day, your kidneys filter about 120 to 150 quarts of blood to remove wastes and balance fluids. This process produces about 1 to 2 quarts of urine per day.

Ureters. Thin tubes of muscle that connect your kidneys to your bladder and carry urine to the bladder.

Bladder. A hollow, muscular, balloon-shaped organ that expands as it fills with urine. The bladder sits in your pelvis between your hip bones. A normal bladder acts like a reservoir. It can hold 1.5 to 2 cups of urine. Although you do not control how your kidneys function, you can control when to empty your bladder. Bladder emptying is known as urination.

Urethra. A tube located at the bottom of the bladder allows urine to exit the body during urination.

All parts of the urinary tract – the kidneys, ureters, bladder, and urethra – must work together to urinate normally.

The urinary tract includes two sets of muscles that work together as a sphincter, closing off the urethra to keep urine in the bladder between your trips to the bathroom.

The internal sphincter muscles of the bladder neck and urethra stay closed until your brain sends signals to urinate.

The external sphincter muscles surround the internal sphincter and provide extra pressure to keep the urethra closed. You can consciously squeeze the external sphincter and the pelvic floor muscles to keep urine from leaking out.

How Does Urination Occur?

To urinate, your brain signals the sphincters to relax. Then it signals the muscular bladder wall to tighten, squeezing urine through the urethra and out of your bladder.

How often you need to urinate depends on how quickly your kidneys produce the urine that fills the bladder and how much urine your bladder can comfortably hold. The muscles of your bladder wall remain relaxed while the bladder fills with urine, and the sphincter muscles remain contracted to keep urine in the bladder. As your bladder fills up, signals sent to your brain tell you to find a toilet soon.

Why Is the Urinary Tract Important?

The urinary tract is important because it filters wastes and extra fluid from the bloodstream and removes them from the body.

What Affects the Amount of Urine You Produce

The amount of urine you produce depends on many factors, such as the amount of liquid and food you consume and the amount of fluid you lose through sweating and breathing. Certain medicines, medical conditions, and types of food can also affect the amount of urine you produce. Children produce less urine than adults.

How Can You Keep Your Urinary Tract Healthy?

You can help keep your urinary tract healthy by following some basic tips.

Drink enough fluids, especially water. If you are healthy, try to drink six to eight glasses (8-ounce) of fluid each day. You may need to drink more if you have kidney stones or bladder stones. At least half of your fluid intake should be water. You might need to drink less water if you have certain conditions, such as kidney failure or heart disease. Ask your healthcare professional how much fluid is healthy for you.

Keep your bowels regular. Regular bowel movements are important to your bladder health. You can promote both bowel health and bladder health by:

Making healthy food choices. You can keep your urinary tract healthy by sticking to an eating plan that includes lean proteins, whole grains, fiber-rich breads, nuts, colorful berries, fruits, and vegetables to promote regular bowel movements.

Living a healthy lifestyle. Get regular physical activity, limit your alcohol intake, cut down on caffeinated food and drinks, and do not smoke.

Go whenever you need to. Often, people will hold their urine because it is not a good time to go to the bathroom. However, holding in your urine for too long can weaken your bladder muscles and make it harder for your bladder to empty completely. Urine left in your bladder can allow bacteria to grow and makes you more likely to develop a urinary tract infection (UTI).

Develop healthy bathroom habits. Take enough time to fully empty your bladder when urinating – do not rush it. Urinate after sex to flush away bacteria that may have entered the urethra during sex. Clean the genital area before and after sex.

Stay in tune with your body. Pay attention to how often you feel the urge to urinate. Take note if you need to urinate more often than usual, if you leak urine, if it becomes more difficult for you to begin urinating, or if you feel you are not able to completely empty your bladder. These changes may be early signs of different urinary tract problems. Talk with your healthcare professional if you notice any of these signs. You may be able to prevent a condition from becoming more severe if you get help early on.

Do pelvic floor muscle exercises. Pelvic floor exercises, also called Kegel exercises, can keep your pelvic floor muscles strong and maintain healthy bladder and bowel function.

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This chapter includes text excerpted from The Urinary Tract & How It Works, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), June 2020.

Chapter 4 | The Prostate and Bladder Problems: An Overview

What Are Common Prostate Problems?

Common prostate problems include:

Prostatitis. Inflammation, or swelling, of the prostate

Benign prostatic hyperplasia (BPH). An enlarged prostate due to something other than cancer

Prostate cancer

What Is the Prostate?

The prostate is a walnut-shaped gland that is part of a man’s sex organs, which also include the penis, scrotum, and testicles. The prostate makes fluid that goes into semen, which is a mix of sperm and prostate fluid. The prostate fluid is important for a man’s ability to father children.

The prostate is in front of the rectum and just below the bladder. The gland surrounds the urethra at the neck of the bladder. The bladder neck is the area where the urethra joins the bladder. The urethra is the tube that carries urine from the bladder to the outside of the body. In men, the urethra also carries semen out through the penis during sexual climax or ejaculation. The bladder and urethra are parts of the lower urinary tract.

Figure 4.1. Lower Urinary Tract

The prostate is a walnut-shaped gland that is part of a man’s sex organs, which also include the penis, scrotum, and testicles. The bladder and urethra are parts of the lower urinary tract.

Urine and semen flowing through the urethra pass through the prostate.

How the Prostate Changes as You Age

Because the prostate gland tends to grow larger with age, it may squeeze the urethra and cause problems in passing urine. Sometimes men in their 30s and 40s may begin to have these urinary symptoms and need medical attention. For others, symptoms are not noticed until much later in life. An infection or a tumor can also make the prostate larger. Be sure to tell your doctor if you have any of the urinary symptoms listed below.

Are passing urine more during the day

Have an urgent need to pass urine

Have less urine flow

Feel burning when you pass urine

Need to get up many times during the night to pass urine

Growing older raises your risk of prostate problems. The three most common prostate problems are inflammation (prostatitis), enlarged prostate (BPH, or benign prostatic hyperplasia), and prostate cancer.

One change does not lead to another. For example, having prostatitis or an enlarged prostate does not increase your risk of prostate cancer. It is also possible for you to have more than one condition at the same time.

Prostate Changes That Are Not Cancer

Prostatitis

Prostatitis is an inflammation of the prostate gland that may result from a bacterial infection. It affects at least half of all men at some time during their lives. Having this condition does not increase your risk of any other prostate disease.

Symptoms of prostatitis

Trouble passing urine

A burning or stinging feeling or pain when passing urine

Strong, frequent urge to pass urine, even when there is only a small amount of urine

Chills and high fever

Low – back pain or body aches

Pain low in the belly, groin, or behind the scrotum

Rectal pressure or pain

Urethral discharge with bowel movements

Genital and rectal throbbing

Sexual problems and loss of sex drive

Painful ejaculation (sexual climax)

Several tests, such as a digital rectal exam (DRE) and a urine test, can be done to see if you have prostatitis. Correct diagnosis of your exact type of prostatitis is key to getting the best treatment. Even if you have no symptoms you should follow your doctor’s advice to complete treatment.

Types of Prostatitis and Treatments

Acute bacterial prostatitis. This type is caused by a bacterial infection and comes on suddenly (acute). Symptoms include severe chills and fever. There is often blood in the urine. Your PSA level may be higher than normal. You must go to the doctor’s office or emergency room (ER) for treatment. It is the least common of the four types, yet it is the easiest to diagnose and treat.

Most cases can be cured with a high dose of antibiotics, taken for 7 to 14 days, and then lower doses for several weeks. You may also need drugs to help with pain or discomfort. If your PSA level was high, it will likely return to normal once the infection is cleared up.

Chronic bacterial prostatitis. Also caused by bacteria, this type of prostatitis does not come on suddenly, but it can be bothersome. The only symptom you may have is bladder infections that keep coming back. The cause may be a defect in the prostate that lets bacteria collect in the urinary tract.

Antibiotic treatment over a longer period of time is best for this type. The treatment lasts from 4 to 12 weeks. This type of treatment clears up about 60 percent of cases. Long-term, low-dose antibiotics may help relieve symptoms in cases that would not clear up.

Chronic prostatitis or chronic pelvic pain syndrome. This disorder is the most common, but least understood type of prostatitis. Found in men of any age from late teens to the elderly, its symptoms can come and go without warning. There can be pain or discomfort in the groin or bladder area. Infection-fighting cells are often present, even though no bacteria can be found.

There are several different treatments for this problem, based on your symptoms. These include anti-inflammatory medications and other pain control treatments, such as warm baths. Other medicines, such as alpha-blockers, may also be given. Alpha-blockers relax the muscle tissue in the prostate to make passing urine easier. Some men are treated with antibiotics in case the symptoms are caused by an undetected infection.

Asymptomatic inflammatory prostatitis. You do not have symptoms of this condition. It is often found when you are undergoing tests for other conditions, such as to determine the cause of infertility or to look for prostate cancer. If you have this form of prostatitis, your PSA test may show a higher number than normal.

Men with this condition are usually not treated, but a repeat PSA test will usually be done if the PSA number is high.

Who Develops Prostate Problems and How Common Are They

Any man can develop a prostate problem. Prostatitis can affect men of all ages. However, it is the most common prostate problem in men younger than age 50. BPH is the most common prostate problem in men older than age 50.

What Are the Symptoms of Prostate Problems?

The symptoms of a prostate problem may include problems with urinating and bladder control. Bladder control is how well you can delay, start, or stop urination. These problems can cause you to:

Go to the bathroom frequently

Feel as if you need to rush to the bathroom, only to find you cannot urinate or you urinate only a little

Leak or dribble urine

Have a weak urine stream

Depending on the cause of your prostate problems, you may have other symptoms.

See Your Doctor If You Have Symptoms

If you cannot urinate at all, you should get medical help right away. Sometimes this problem happens suddenly to men after they take certain cold or allergy medicines.

Do Prostate Problems Cause Other Problems?

Yes, a prostate problem may cause other problems, such as:

Problems having sex

A UTI

Feeling stressed due to chronic pain

Inflammation in areas near your prostate

Bladder stones

Kidney failure

Which problem you may get depends on the type of prostate problem you have. Other problems may vary from man-to-man for each type of prostate problem.

How Does Your Doctor Know If You Have a Prostate Problem?

Your doctor will know if you have a prostate problem based on the following:

Your medical and family history

A physical examination, including a digital rectal examination of your prostate

Tests on your urine, blood, and lower urinary tract

Ultrasound

Prostate biopsy

What Are Bladder Control Problems?

Bladder control problems are