Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
No. Treatment of BPH is usually reserved for men with significant
symptoms. Watchful waiting with medical monitoring once a year is
appropriate for most men with BPH.
How is BPH treated?
There are several different ways to treat BPH:
Watchful waiting is often chosen by men who are not
bothered by symptoms of BPH. They have no treatment but get regular checkups and wait to see
whether or not the condition gets worse.
Medical treatment of BPH is usually reserved for men who
have significant symptoms. The available drugs include
alpha blockers relax the smooth muscles of the prostate, and the bladder neck, which helps to relieve urinary obstruction caused by an enlarged prostate in BPH. Side effects can include headaches, fatigue, or lightheadedness. Commonly used alpha blockers in BPH include tamsulosin (Flomax), alfuzosin (Uroxatral), and older medications such as terazosin (Hytrin) or doxazosin (Cardura).
These drugs generally will lead to improvement in symptoms within several weeks
and have no effect on prostate size; and
5-alpha reductase inhibitors block the conversion of the male hormone testosterone into its active form in the prostate (DHT). The prostate enlargement in BPH is directly dependent on DHT, so these drugs lead to an approximate 25% reduction in prostate size over
six to 12 months. For this reason, improvement in urinary symptoms most commonly takes this long to occur. Examples of 5-alpha reductase inhibitors include Finasteride (Proscar) and dutasteride (Avodart). Side effects of finasteride may include declining interest in sex, problems getting an erection, and problems with ejaculation.
Surgery or office procedures may also be used to treat BPH, most commonly in men who have not responded satisfactorily to medication or those who have more severe problems, such as a complete inability to urinate.
Transurethral resection of the prostate (TURP) has been used for the longest period of time. After the patient is given anesthesia, the doctor inserts a special instrument into the urethra through the penis. With the instrument, the doctor then shaves away part of the inner prostate to relieve the outflow of urine from the bladder.
Laser procedures: A number of laser procedures are available, some of which can be performed in the doctor's office with minimal anesthesia. These procedures also involve the removal of obstructing prostate tissue. They are generally associated with less bleeding and quicker recovery than TURP but may not be as effective over the long term in some men.
Microwave therapy: This procedure is generally performed in the office and involves the use of microwave energy delivered to the prostate to kill some of the cells leading eventually to shrinkage of the prostate.
Men should carefully weigh the risks and benefits of each of these
options. Prostate surgery has traditionally been seen as offering the
most benefits for BPH but unfortunately carries the most risks.
Urinary tract infection (UTI) is an infection of the kidney, ureter, bladder, and/or urethra. Not
everyone with a UTI has symptoms. Common symptoms include a frequent urge to
urinate and a painful, burning when urinating.
Prostatitis is a painful condition of the prostate gland. There are four types of prostatitis, acute bacterial, chronic bacterial, chronic pelvic pain syndrome, and asymptomatic inflammatory prostatitis. Diagnosis is made with a digital rectal exam, urinalysis, ultrasound, MRI, biopsy, or blood test. Treatment depends upon the type of prostatitis.
Although a fever technically is any body temperature above the normal of 98.6 degrees F. (37 degrees C.), in practice a person is usually not considered to have a significant fever until the temperature is above 100.4 degrees F (38 degrees C.). Fever is part of the body's own disease-fighting arsenal: rising body temperatures apparently are capable of killing off many disease- producing organisms.
E. coli is the most common cause of bladder infections. Bladder infection symptoms and signs include frequent urination, burning urination, and foul smelling urine. Mild bladder infections may go away by increasing one's intake of fluid. More severe infections may be treated with a few days of antibiotics.
Prostate cancer is an uncontrolled (malignant) growth of cells in the prostate gland. Prostate cancer is the second
leading cause of death of males in the U.S. Prostate cancer is often initially
suspected because of an abnormal PSA blood test or a hard nodule (lump) felt on
the prostate gland during a routine rectal examination.
Overactive bladder is a sudden involuntary contraction of the muscle wall of the bladder causing urinary urgency (an immediate unstoppable need to urinate). Overactive bladder is is a form of urinary incontinence. Treatment options may include Kegel exercises, biofeedback, vaginal weight training, pelvic floor electrical stimulation, behavioral therapy, and medications.
Hydronephrosis is a condition in which the kidney swells, due to a backup of urine. Hydronephrosis generally occurs with another disease.Symptoms of hydronephrosis include nausea, vomiting, urinary tract infection, fever, painful urination, increased urinary frequency and urgency, flank pain, and swelling of the abdomen. Treatment of hydronephrosis depends on the cause.
There are many types of urinary incontinence (UI), which is the accidental leakage of urine. These types include stress incontinence, urge incontinence, and overflow incontinence. Urinary incontinence in men may be caused by prostate or nerve problems. Treatment depends upon the type and severity of the UI and the patient's lifestyle.
Urinary retention (inability to urinate) may be caused by nerve disease, spinal cord injury, prostate enlargement, infection, surgery, medication, bladder stone, constipation, cystocele, rectocele, or urethral stricture. Symptoms include discomfort and pain. Treatment depends upon the cause of urinary retention.
Enjoying a satisfying sex life as we age is important to both physical and mental health. As we age, diseases and conditions may pose challenges in our sexual health, and sexual experiences. Learn how to manage your conditions and still have a gratifying sex life as you age.
A urethral stricture, or narrowing of the urethra, may cause decreased urine output. Symptoms include painful urination, urinary retention, and pelvic pain. Surgery is the only treatment for people with uncontrolled symptoms of urethral narrowing.
Men's health is an important component to a happy lifestyle and healthy relationships. Eating healthy, exercise, managing stress, and knowing when to have medical tests for a particular age is key to disease prevention in men.
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