The prostate, men and men's health

Abstract

Benign prostatic hyperplasia (BPH) is the most prevalent disease in the ageing male and the incidence of symptomatic disease is likely to increase in the millenium with increased life expectancy. BPH can have a severe impact on quality of life, including sexual function, and yet many men do not seek medical attention for this and many other diseases. Surgery is no longer a mandatory treatment for BPH. Medical management can provide excellent symptom relief and improvement in urinary¯ow rates, as well as quality of life, and men need to be made aware of this in order to make informed treatment decisions. In the broader context, men should be encouraged to become more health conscious and develop a more positive attitude towards their health.Keywords: benign prostatic hyperplasia; men's health Prevalence of BPHBenign prostatic hyperplasia (BPH) is the most prevalent disease among men beyond middle age. Autopsy studies show that histological BPH is present in 50% of men in their 60s, rising to 90% in men b 85 years of age. 1 The proportion of men with palpable prostatic enlargement is rather less, with a prevalence of 21% in men aged 50 ± 60 y and 53% in men in their 80s. More important is the proportion of men actually troubled by the lower urinary tract symptoms (LUTS) associated with BPH. Results show that, again, the incidence of these symptoms increases with age (Table 1). 2 ± 6 Worldwide, there is a pronounced shift towards an increasingly aged society, and as a result, more patients will be diagnosed with BPH and require treatment. By the year 2000, male life expectancy will exceed 80 y in many countries, and the majority of men can therefore be expected to have an 88% chance of developing histological BPH and a 50% chance of developing symptomatic BPH. Effect of BPH on quality of lifeAlthough BPH is a common disease which is rarely lifethreatening, it can result in signi®cant impairment in the patient's quality of life. A study by Garraway and associates 7 indicates that about half of the men with evidence of obstructive BPH (de®ned as a prostate on transrectal ultrasonography b 20 g, and symptoms of urinary dysfunction and/or a peak urine¯ow rate of`15 mL/s) reported interference with one or more activities of daily living, compared with 28% of men without the condition. 7 In addition to this impairment in quality of life, many patients reported worry and embarrassment about their urinary function. 8 A recent study shows that sexual dysfunction is increased in men with LUTS associated with BPH. Sexual expression was affected by 45% of men reporting such symptoms to a urology clinic in one of 12 countries and by 7% of community-dwelling men aged 40 y and over. 9 In this and other ways, BPH can impact not only on the man but also on his partner.A number of speci®c questionnaires have been developed to assess the impact on quality of life of BPH and its treatment. One long-term study by Lukacs and coworkers 10 involving 7093 patients in general practice used a self-administered questionnaire, which measured...

Individual personal relations: effects on service quality

“…Regarding communication patterns, three patient types have been identified:“Denying” patients are those rebuffed if they have problems or existential issues to discuss. In this group there may be some who have intimate friends with whom they can talk, some who are utterly reserved about talking to strangers, and those who are unable to describe feelings and therefore hesitate to seek professional help (Kirby, 1999). “Passive” patients wait until nurses guess their wants.…”