As men grow older, urinary difficulties commonly develop related to an enlarged prostate. This condition, called benign prostatic hyperplasia or BPH, affects nearly half of men over the age of 50 years to some degree.
Initially the size of a walnut, the prostate gland begins to grow during middle age and over time can obstruct urinary flow. BPH is not cancer but can still have an aggravating or bothersome effect on daily living. As the condition progresses, a variety of symptoms arise:
• Frequent, urgent urination
• Problems starting or maintaining the urine stream
• Slow or weak stream
• Frequent nighttime visits to the bathroom
• Dribbling at the end of urination
• Sensation of incomplete emptying of the bladder
In recent years, technological advances have introduced many new, less invasive options for patients that can open the blocking prostate with safer, simpler approaches.
Several options use “controlled heat” in the form of lasers, microwave energy, or steam to treat the enlarged prostate.
Other new innovations can open the urinary pathway with sutures to tent open the blocking prostate tissue without even having to destroy tissue at all.
While all patients with BPH are potential candidates for any of these types of therapy, minimally invasive therapies are most commonly used in patients who progress despite medications orprefer not to remain on medications as long-term therapy.
In some instances, medical management is working but may cause undesirable side effects. In other cases, medication is working, but patients either do not like to take it or it costs too much. In any event, minimally invasive technology is very appealing to many BPH patients.
On the cutting edge of today’s BPH therapy are Rezum prostate therapy and Urolift.
Rezum offers the benefit of being able to be performed in the office with local anesthesia. After numbing the prostate and urethra in the office, Rezum uses a scope inserted through the penis that delivers a steam injection to the overgrown prostate.
The steam permeates the prostate tissue in that area and remains confined in the prostate, limited by the gland’s capsule. The heat from the steam causes the prostate tissue to wither away, thereby relieving blockage.
Patients often experience improved flow within just a few weeks, but the prostate continues to shrink for several months after the procedure so that the maximum benefit is apparent after three to four months.
The side effects include mild blood in the urine and some irritative voiding for 1-2 weeks. Insurances have specific approval criteria related to prostate size for Rezum that your urologist can assess.
The Urolift procedure “tacks” the prostate lobes open to relieve blockage, a concept similar to pulling back the drapes of a window to open the view.
During the procedure, the Urolift instrument is inserted through the penis and positioned at the level of the blocking prostate tissue.
A suture is then accurately fired into the prostate tissue. Tension tightening of the suture retracts the lobe of the prostate and opens the water channel. Multiple sutures can be used as needed depending on the size of the prostate gland. In many cases, no catheter is needed at all following the procedure.
Because this procedure does not actually destroy prostate tissue (the sutures just “tent” it open) it has very few side effects, in particular no changes in ejaculatory function.
Patients may see mild blood in the urine for several days following the procedure. Uroliftis usually performed in an outpatient surgery center under general anesthesia.
Each of these procedures is considered low risk and has an excellent track record for medium to large sized prostate glands. Safe and simple, they represent state-of-the-art minimally invasive prostate therapies.
These therapies are not designed for prostate cancer treatment, and huge prostate glands may need a more robust option. It is very simple for your urologist to determine if you are a good candidate.
If not, many other technologies are available, including LASER (Evolve laser, Green Light Laser), Vaporization (“Button” TURP), and TUMT (transurethral microwave thermotherapy).
These newer, minimally invasive procedures represent true advancements in the treatment of BPH, but clearly they are not for everyone.
Dr. Robert S. Hollabaugh Jr. is with the Conrad Pearson Clinic, which specializes in the diagnosis and treatment of a variety of urological issues. For more information call (901) 252-3400 or visit conradpearson.com