Unemployed labourer Billy (52) reluctantly went to see his family doctor after a few months of prompting by his wife, who was concerned about his health.
A father of five from west Dublin, Billy is overweight and smokes. When asked by his GP what his own health concerns were, Billy mentioned that he had been having some trouble "with the waterworks".
He had been getting up a couple of times every night to pass urine. The force of his stream had reduced and he found that his water had begun to dribble out.
Although not keen for an internal examination, he eventually agreed to have a digital examination of his back passage.
This revealed a smooth, enlarged prostate gland, consistent with a diagnosis of benign prostatic hypertrophy (BPH).
Billy's GP explained where the prostate gland is, with the aid of a desktop model, and also outlined how an enlargement could cause symptoms.
Billy's only previous experience with the prostate was a bad memory of his late father being taken as an emergency case to hospital when he developed acute urinary retention.
He had a tube passed into his bladder to relieve the blockage of urine and underwent urgent surgery to remove an enlarged prostate gland.
The outcome was not good, and his father was left with a permanent catheter.
Billy's doctor made a follow-up appointment with Billy to discuss treatment options. Billy did not turn up but responded to a second reminder.
Wishing that he had some written information to suit Billy's level of literacy, the GP explained the treatment options: adopt a wait-and-see approach; start medical treatment with tablets aimed at increasing the flow of urine; or referral to a consultant urologist for another opinion.
Billy opted to wait and see. He never came back for follow-up.
After three years his symptoms suddenly worsened and he developed acute retention of urine.
He had a tube placed in his bladder in the accident and emergency department of the local hospital and is currently waiting for an appointment for urgent prostate surgery.
Billy's story illustrates a number of problems typical of BPH and men's health:
• He did not make contact with the health service himself.
• He failed to attend a follow-up as part of a wait-and-see approach.
• As a result, he missed out on a surgical treatment option.
• Some men are still relatively ignorant about their health and an appropriate level of information is often not available for them.